Week 141 - Diabetes Mellitus Flashcards
What is the BP target for a patient with uncomplicated T2DM?
140/80
What is the first line antihypertensive for a patient with T2DM?
ACE I
What is the target LDL Choleterol for a patient with T2DM?
2mmol/L - LDL
4mmol/L - Total Cholesterol
What is the most important thing to reduce to reduce the risk of cardiovascular events?
Cholesterol
What drugs may precipitate/exacerbate hyperglycaemia?
Thiazides
Diuretics
What are the two types of ulcers in T2DM?
Neuropathic
Ischaemic
What symptoms can intermittent claudication present with?
Calf pain
Allodynia (interfering with sleep)
This is due to atherosclerotic blockages resulting in peripheral arterial disease
What did the the HOPE trial investigate?
The efficacy of ACE Inhibitors
What did the UK Prospective Diabetes Study show?
Tight glycaemic control is good, but takes time to become significant
What did the ACCORD trial show?
Tight glycaemic control increases mortality
What is Acanthosis nigricans?
Brown to black hyperpigmentation of the skin
Associated with insulin-like activity
What is Necrobiosis lipoidica diabeticorum?
Necrotising skin condition that usually occurs in diabetes (ulcers)
Which finding is suggestive of cardiac autonomic neuropathy?
Absent beat to beat variation in pulse rate with deep resipiration
At what level of eGFR should one stop Metformin?
30ml/min/1,31m2
What drug is contraindicated with PD5 inhibitor (Viagra)?
Isosorbide mononitrate (nitrate used for angina pectoris)
Which agent is most effective in attenuating the risk of progression to macroalbuminuria?
Irbesartan (angiotensin II receptor antagonist)
Which electrolyte disturbance is a potential concern when dosing ACE inhibitors?
Hyperkalaemia
At what time of day are basal levels of insulin at their highest?
4am-10am (Dawn phenomenon)
What are the features of Type I Diabetes?
Skinny
Blood ketones
GAD antibodies
What can an Oral Glucose Tolerance Test?
After 2 hrs:
>7.8 = impaired glucose tolerance
>11.1 = Diabetes mellitus
What is the life-span of a RBC?
120 days
What factors affect HbA1c levels?
Haemolysis Iron deficiency anaemia Renal Impairment (erythropoiesis affected) Pregnancy (high cell turn over) Blood transfusion
What are the actions of Insulin?
↑ Peripheral Glucose Uptake ↑Glycogen storage ↑Protein Synthesis ↑Triglyceride storage ↓Breakdown of glycogen
What counter-regulatory hormones give the features of aggressiveness, sweating during a hypo?
Adrenaline
Noradrenaline
Cortisol
How is insulin secretion triggered?
Glucose enters via GLUT2
ATP is synthesised, closing the ATP-sensitive K+ channel
Depolarisation leads to Ca channel opening
Insulin is exocytosed
What is the mechanism of action of Sulphonylureas drugs?
Binding to its receptor subsequently blocks the ATP sensitive potassium channels
What happens to the GLUT4 transporter in diabetes
It is downregulated
Glucose needs to be transported into cells
GLUT4 is regulated by insulin
Where are SGLT2 found and what is their function?
Reabsorb glucose in the proximal convoluted tubule
SGLT2 inhibitors can block this process
How does T2DM develop?
1) Hyperinsulinaemia (body compensates for insulin resistance)
2) Hyperglycaemia (failure to compensate)
3) Diabetes Mellitus
Name a biguanide drug, its mechanism of action and side-effects
Metformin
↑Insulin Action
S/E - GI disturbance
Name a sulphonylureas drug, its mechanism of action and side-effects
Gliclazide, Glimepiride
↑Insulin Production
S/E - Hypoglycaemia, weight gain
Name a Metaglinide drug, its mechanism of action and side-effects
Rapaglinide, Nateglinide
Similar to sulphonylureas action
S/E - Hypoglycaemia, GI-disturbance
Name a alpha-glucosidase inhibitor, its mechanism of action and side-effects
Acarbose
Delays glucose absorption
S/E - GI-disturbance
Name a Thiazolidinedione drug, its mechanism of action and side-effects
Glitazones (Pioglitazone)
↑Peripheral Sensitivity to insulin
S/E - Peripheral oedema, anaemia, fractures
Name a DPP-4 Inhibitor and its effects
Silagliptin, Vildagliptin, Saxagliptin, Linagliptin
Protect native GLP-1 from inactivation by DPP-4
Name a GLP-1 Agonist and its effect
Exenatide, Liraglutide, Lixisenatide
↓Weight Loss, ↓HbA1c
Name an SGLT2 inhibitor and its mechanism of action
Canagliflozin, Dapagliflozin, Empagliflozin
Stops SGLT2 reabsorbing glucose in the prox con tubule
Contraindicated in genital and urinary infections
