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Year 1 Medicine > Week 141 - Diabetes Mellitus > Flashcards

Week 141 - Diabetes Mellitus Flashcards

1
Q

What is the BP target for a patient with uncomplicated T2DM?

A

140/80

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2
Q

What is the first line antihypertensive for a patient with T2DM?

A

ACE I

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3
Q

What is the target LDL Choleterol for a patient with T2DM?

A

2mmol/L - LDL

4mmol/L - Total Cholesterol

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4
Q

What is the most important thing to reduce to reduce the risk of cardiovascular events?

A

Cholesterol

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5
Q

What drugs may precipitate/exacerbate hyperglycaemia?

A

Thiazides

Diuretics

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6
Q

What are the two types of ulcers in T2DM?

A

Neuropathic

Ischaemic

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7
Q

What symptoms can intermittent claudication present with?

A

Calf pain
Allodynia (interfering with sleep)
This is due to atherosclerotic blockages resulting in peripheral arterial disease

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8
Q

What did the the HOPE trial investigate?

A

The efficacy of ACE Inhibitors

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9
Q

What did the UK Prospective Diabetes Study show?

A

Tight glycaemic control is good, but takes time to become significant

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10
Q

What did the ACCORD trial show?

A

Tight glycaemic control increases mortality

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11
Q

What is Acanthosis nigricans?

A

Brown to black hyperpigmentation of the skin

Associated with insulin-like activity

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12
Q

What is Necrobiosis lipoidica diabeticorum?

A

Necrotising skin condition that usually occurs in diabetes (ulcers)

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13
Q

Which finding is suggestive of cardiac autonomic neuropathy?

A

Absent beat to beat variation in pulse rate with deep resipiration

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14
Q

At what level of eGFR should one stop Metformin?

A

30ml/min/1,31m2

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15
Q

What drug is contraindicated with PD5 inhibitor (Viagra)?

A

Isosorbide mononitrate (nitrate used for angina pectoris)

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16
Q

Which agent is most effective in attenuating the risk of progression to macroalbuminuria?

A

Irbesartan (angiotensin II receptor antagonist)

17
Q

Which electrolyte disturbance is a potential concern when dosing ACE inhibitors?

A

Hyperkalaemia

18
Q

At what time of day are basal levels of insulin at their highest?

A

4am-10am (Dawn phenomenon)

19
Q

What are the features of Type I Diabetes?

A

Skinny
Blood ketones
GAD antibodies

20
Q

What can an Oral Glucose Tolerance Test?

A

After 2 hrs:
>7.8 = impaired glucose tolerance
>11.1 = Diabetes mellitus

21
Q

What is the life-span of a RBC?

A

120 days

22
Q

What factors affect HbA1c levels?

A 
Haemolysis
Iron deficiency anaemia
Renal Impairment (erythropoiesis affected)
Pregnancy (high cell turn over)
Blood transfusion
23
Q

What are the actions of Insulin?

A 
↑ Peripheral Glucose Uptake
↑Glycogen storage
↑Protein Synthesis
↑Triglyceride storage
↓Breakdown of glycogen
24
Q

What counter-regulatory hormones give the features of aggressiveness, sweating during a hypo?

A

Adrenaline
Noradrenaline
Cortisol

25
Q

How is insulin secretion triggered?

A

Glucose enters via GLUT2
ATP is synthesised, closing the ATP-sensitive K+ channel
Depolarisation leads to Ca channel opening
Insulin is exocytosed

26
Q

What is the mechanism of action of Sulphonylureas drugs?

A

Binding to its receptor subsequently blocks the ATP sensitive potassium channels

27
Q

What happens to the GLUT4 transporter in diabetes

A

It is downregulated
Glucose needs to be transported into cells
GLUT4 is regulated by insulin

28
Q

Where are SGLT2 found and what is their function?

A

Reabsorb glucose in the proximal convoluted tubule

SGLT2 inhibitors can block this process

29
Q

How does T2DM develop?

A

1) Hyperinsulinaemia (body compensates for insulin resistance)
2) Hyperglycaemia (failure to compensate)
3) Diabetes Mellitus

30
Q

Name a biguanide drug, its mechanism of action and side-effects

A

Metformin
↑Insulin Action
S/E - GI disturbance

31
Q

Name a sulphonylureas drug, its mechanism of action and side-effects

A

Gliclazide, Glimepiride
↑Insulin Production
S/E - Hypoglycaemia, weight gain

32
Q

Name a Metaglinide drug, its mechanism of action and side-effects

A

Rapaglinide, Nateglinide
Similar to sulphonylureas action
S/E - Hypoglycaemia, GI-disturbance

33
Q

Name a alpha-glucosidase inhibitor, its mechanism of action and side-effects

A

Acarbose
Delays glucose absorption
S/E - GI-disturbance

34
Q

Name a Thiazolidinedione drug, its mechanism of action and side-effects

A

Glitazones (Pioglitazone)
↑Peripheral Sensitivity to insulin
S/E - Peripheral oedema, anaemia, fractures

35
Q

Name a DPP-4 Inhibitor and its effects

A

Silagliptin, Vildagliptin, Saxagliptin, Linagliptin

Protect native GLP-1 from inactivation by DPP-4

36
Q

Name a GLP-1 Agonist and its effect

A

Exenatide, Liraglutide, Lixisenatide

↓Weight Loss, ↓HbA1c

37
Q

Name an SGLT2 inhibitor and its mechanism of action

A

Canagliflozin, Dapagliflozin, Empagliflozin
Stops SGLT2 reabsorbing glucose in the prox con tubule
Contraindicated in genital and urinary infections

Year 1 Medicine (12 decks)

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