Week 10 Flashcards
Define Diabetes mellitus
How do we diagnose diabetes?
What are the classifications of DM?
Describe the pathophysiology of Type 1 DM
Autoimmune
Beta cell destruction
- Symptoms when 80% beta cell mass loss
85-90% will get Autoantibodies
- Islet cell
- Insulin
- GAD65
- tyrosine phosphatases
Strong HLA associations
- link to DQA and DQB genes
- influenced by DRB genes
What is Osmotic lens change in DM type 1?
Hyperglycemia causes glucose to move into the eye’s lense, causing it to puff up and not accomodate as well
What is important for individuals newly diagnosed DM to know about?
What is the main way that individuals with DM will give themselves insulin?
Basal Bolus regime
What are some genetic factors of Type 2 DM?
Defect of Beta cell
Insulin resistance
What are some environmental factors of Type 2 DM?
Obesity
Stress
Reduced physical activity
What is the clinical presentation of Type 2 DM?
Roughly describe the progression of Type 2 DM
What are some of the Acute and Chronic complications of DM?
What are some clinical symptoms of Hyperglycaemia & Acidosis?
What electrolyte imbalance causes most deaths in DKA?
Potassium
(Arrythmias))
In DKA, what are the treatments for:
- Hyperglycaemia
- Dehydration
- Potassium losses
What are the two sets of symptoms of Hypoglycaemia
AND
What are some examples of each?
What are the 3 most common causes of Hypoglycaemia?
- Too much insulin
- Too little food
- Unusual exercise
What is the bodies natural response to Hypoglycaemia?
What is used to treat Hypoglycaemia?
IV 50% Dextrose
Name and roughly describe 2 other DM related conditions
What are the stages of Nephropathy?
Describe the management of Neuropathy
What is a vascular complication of DM?
Microangiopathy
What are the stages of Diabetic Retinopathy?
What are some examples of Diabetes drugs?
Roughly define a Stressor and Stress
What are the 2 key components of the stress system?
What structures produce Cortisol and Epinephrine respectively?
Adrenal Cortex
Adrenal Medulla
In the context of Cortisol, roughly describe the HPA (hypothalamic-pituitary axis)
What are some conditions related to Increased activity of HPA?
- Chronic stress
- Panic disorder
- DM
- Hyperthyroidism
- OCD
What are some conditions related to decreased activity of HPA?
- Atypical/seasonal depression
- Postpartum period
- PTSD
- Hypothyroidism
- Rheumatoid arthritis
What are the immediate effects of the Stress Response?
What health problems are related with Chronic Stress?
What is the relationship between Cortisol and Depression?
What are the “goals” of cortisol?
Provide adequate nutrients for ATP synthesis during stress
What effects does cortisol have on the bodys organs?
Adipose tissue
- Increased lipolysis
Liver
- Increased Gluconeogenesis
- Increased Glycogenolysis
- Therefore increased Blood Glucose
Brain
- Increased glucose availability
- Increased glucose metabolism
Extrahepatic tissue
- Increased fat oxidation
- Decreased glucose metabolism
- Decreased protein synthesis
- Increased blood aa’s
What should be done when suspecting hypo/hyperfunction of an endocrine gland?
Hormone suppression test
Describe the effects of a Dexamethasone suppression test on Cortisol
Describe the relationship between Cortisol and Mood
How does the stress response effect the immune system?
How does Cortisol impact the immune system?
Describe Transrepression as a model for glucocorticoids
Glucocorticoids have the ability to supress transcription factors that would otherwise produce Inflammatory proteins
Leads to weakend inflammatory response, more prone to infection
What are some examples of Synthetic Glucocorticoids?
Prednisolone
Dexamethosone
Describe the immunosuppressive action of Glucocorticoids
What are some side-effects of Glucocorticoids?
What is done in order to avoid the withdrawal symptoms of coming off of Glucocorticoids?
State the %’s of people with the different types of diabetes mellitus
How high can our insulin get before being detected in urine?
>10 mM
Name some rapid-acting soluble insulins
LAG
- Insulin Lispro
- Insulin Aspart
- Insulin Glulisine
Name some longer-acting insulins
Describe the difference between Fixed and Flexible dose insulin regimens
What are the 3 types of Insulin Therapy?
- 1, 2, 3 injections/day
- Basal-bolus
- Insulin pump
What are some lifestyle modifications to prevent prediabetes?
Name and describe the oral tablet used as first line anti-diabetic medication
Describe Metformin’s MOA
Name and describe Sulphonylureas Insulin Secretagogues
Name and describe Meglitinides Insulin Secretagogues
Describe Sulphonylureas MOA
Describe Incretins
What are some Incretin Mimetics?
Name some DPP-4 Inhibitors (Gliptins)
Name some Selective Sodium Glucose Cotransporter 2 inhibitors
(SGLT2)
Name and describe some alpha-Glucosidase inhibitors
Describe the body’s control of Blood Glucose
Rougly describe the onset / origins of T1DM
Describe how we get Diabetic Ketoacidosis
Describe T2DM
Describe how a person progresses from Prediabetes to T2DM
What test is used to measure diabetes and prediabetes?
Oral Glucose Tolerance Test
Describe glucose regulation during pregnancy
Describe the prevelance and risks of GDM (gestational)
Describe glucose monitoring in the context of T1DM
What is an HbA1c measurement
AND
What may it indicate?
What 3 criteria may be met to diagnose Diabetes
What are 3 of the long term pathologies of Diabetes Mellitus?
- Angina
- Cardiac Arrhthymias
- Renal Disease
Describe the two tissues in the adrenal glands
Name and describe the 4 layers of the Adrenal Gland
What arteries supply the adrenal glands?
sup. mid. inf. Adrenal art.
What steroid hormones are produced within the adrenal gland?
What types of hormones bind to intracelluclar receptors?
Describe some chacracteristics of Cortisol
What is the main effect of Cortisol?
Promote Gluconeogenesis
What is the action of Aldosterone on Mineralcorticoids?
Describe the MOA of suppression of Glucocoricoid activity in renal tubular cells
What are some long-term stress responses due to Mineralcorticoids and Glucocorticoids?
What are some short-term stress responses due to Catecholamines?
Roughly describe the characteristics of Catecholamines
Outline Catecholamine synthesis within a chromaffin cell
What are the fluid compartments percentages in the body
Describe the exchange of fluid across the capillary membrane
Arterial end
- Hydrostatic pressure > Osmotic pressure
Venous end
- Osmotic pressure > Hydrostatic pressure
What are the rough compositions of the fluid compartments in relation to Ions
Describe the difference between sweat and Insensible water loss
How do we control water balance?
How do we control plasma Na+?
Roughly describe the physiological response to a drop in BP
Roughly describe the physiological response to a rise in BP
Describe some of the ways we gain & lose Na+
Describe the 3 causes of HYPOnatraemia
Describe 3 reasons for HYPERnatraemia
How do we control K+ levels?
What are 3 causes of HYPERkalaemia?
What are 3 causes of HYPOkalaemia?
What are some vital signs indicative of Hypovolaemia?
What are some clinical signs of a Fluid Overload?
- Raised JVP
- Peripheral Oedema
- HT
- Inspiratory crackles (base of lung)
What are some tests that may be done to assess fluids?
What are the 4 IV Crystalloid fluids?
What are the 3 IV Colloid fluids?
When should we be cautious when using IV fluids?
