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Aint nobody go time for that, Iv got diabetes!!! > 1 > Flashcards

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1
Q

insulin chromosome

A

11

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2
Q

insulin creation to excretion pathway

A

beta cells in pancrease > portal blood > liver 50% degraded) > remainder excreted by kidneys

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3
Q

what does C-peptide indicate

A

rate of insulin secretion

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4
Q

what are normal glucose levels

A

3.5-8.0 mmol/L

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5
Q

liver stores glucose as _____

A

glycogen

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6
Q

what is gluconeogenisis

A

liver makes 6 carbon glucose from combining 3 carbon molecules from fat (glycerol), muscle glycogen (lactate), protein (alanine)

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7
Q

90% of daily glucose comes from?

A

liver glycogen & gluconeogenisis

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8
Q

insulin progression pathway

A

preproinsulin > proinsulin (disulphide bond & stored in vesicles) > insulin ( C-peptide cleaved as secreted)

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9
Q

what role does insulin have in fasting state

A

controls glucose release from liver

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10
Q

what role does insulin have in post feeding state

A

promotes glucose uptake into muscle and adipose

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11
Q

GLUT 1 receptor does what

A

basal non-insulin-stimulated glucose uptake

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12
Q

GLUT 2 receptor does what

A

transports glucose into beta cells

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13
Q

GLUT 3 receptor does what

A

non-insulin mediated glucose uptake into brain

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14
Q

GLUT 4 receptor does what

A

peripheral action of insulin, channel glucose taken up into muscle and adipose following stimulation of insulin receptors

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15
Q

sequence in beta cell for insulin release

A

glucose taken up into beta cell by GLUT2 > glucokinase phospohorylates glucose into gluco-6-phosphate > ATP > inc ATP closes potassium channels > = depolarisation (calcium ion influx) > release of insulin

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16
Q

glucose production in liver ___ as insulin levels fall

A

rises

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17
Q

insulin receptors are made up of what sub units

A

alpha (outer) and beta (inner)

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18
Q

insulin binds which part of insulin receptor

A

alpha

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19
Q

what happens when insulin binds insulin receptor

A

GLUT 4 receptor which are in intracellular vesicles translocate to membrane and start taking up glucose

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20
Q

type 1 diabetes due to

A

auto immune pathogenesis = insulin deficiency (peaks around puberty)

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21
Q

type 2 diabete due to

A

insulin resistance and less severe insulin deficiency

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22
Q

LADA stands for

A

latent autoimmune diabetes in adults (slow progression)

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23
Q

HLA associated with type 1

A

HLA-DR3/DR4

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24
Q

C-peptide presence will vary between type 1 compared to type 2 how

A

type 1 it will vanish (cos insulin not being produced)

type 2 it persists

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25
type 1 is associated with which conditions
autoimmune thyroid disease, coeliacs, addisons, pernicious anaemia
26
what will histology in type 1 show
infiltrates of mononuclear cells called insulits
27
type 2 associated with
family history central obesity hyper secretion of insulin by depleted beta cells
28
what is MODY
maturity onset diabetes of young (also called monogenic diabetes)
29
age of MODY onset
before 6 months of age * acute onset 2-6 wks * chronic months-yrs
30
WHO diagnostic criteria for diabetes
fasting glucose >7 random plasma glucose >11.1 HbAC1 >6.5 * 1 value is diagnostic in symptomatic person * 2 values in non symptomatic person
31
type 2 treatment (6)
metformin sulfonylureas thiazolidinedione (glitazones) other: dideptidyl peptidase-4 (DPP4) inhibitors GLP-1 agonist meglitinides
32
how does metformin work (3)
activates AMP-kinase (involved in GLUT4 metabolism & fatty acid oxidation), reduces rate of gluconeogensis, inc insulin sensitivity
33
how does sulfonylureas work
acts on beta cells and promotes insulin secretion
34
side effects of sulfonylureas
weight gain | hypos
35
who dont you give sulfonylureas to
pregnant woman
36
thialidinedione (TZDs)/glitazone work how
reduce insulin resistance, regulates transcription, activate PPARs (nuclear receptors that acts as transcription factors)
37
who dont you give metformin to
renal and hepatic failure
38
hypo is blood glucose of ___
<3
39
features of hypo
sweating tremor pounding heart
40
when does injected insulin hit peak
60-90 mins post injection
41
examples of rapid acting insulin
USPRO/ASPART/GLUSIN
42
Examples of long acting insulin
NPH (isophane), glargin, determin
43
what do you give person who is hypo and unconscious
1mg glucagon IM OR IV glucose 25-50ml of 50% glucose solution + 0.9% saline to preserve vein
44
fatty lumps at over used injection site is called
lipohypertrophy
45
how does glucagon work
mobilises hepatic glycogen, works as rapidly as glucose
46
how does islet transplantation work
from cadaver, injected into portal vein, seeds in liver ** requires immuno suppresion **
47
2 steps lead to glcosylation of Hb (giving HbA1C), what changes occur
covalent bonds forms between glucose and terminal valine of B-chain of Hb
48
normal range of HbA1c
4-6.1% (20-44 mmol/l)
49
average Hb life span is
6 weeks
50
target HbA1c in type 1
7% (53)
51
target BP in type 1
130/80
52
target LDL, HDL and triglicerides in type 1
LDL: < 2 HDL: >1.1 triglicerides: <1.7
53
features of DKA
no insulin, uncontrolled catabolism, hormone excess, fluid depletion
54
what does lack of insulin (in DKA) lead to
accelerated hepatic glucose production & reduced glucose uptake
55
increased blood glucose leads to what
osmotic diuresis = loss of fluids and electrolytes (dehydration) increased osmolarity and reduced renal perfusion
56
what is osmotic diuresis
glucose in urine = inc osmotic pressure within kidney tubules causing water retention in lumen and reduced reabsorption of water, so, inc urination
57
fasting glucose: 2h after glucose in normal person
fasting glucose: <7.8
58
fasting glucose: 2h after glucose: in impaired glucose tolerance
fasting glucose: <7 | 2h after glucose: 7.8-11.0
59
fasting glucose: 2h after glucose: in diabetic
fasting glucose: >7 | 2h after glucose: 11.1 or more
60
other than blood glucose, what tests do you want to do in a diabetic (5)
- urinalysis for protein - FBC - U & E - liver biochemistry - random lipids (rule out hyperlipidaemia)
61
sequence of how ketones are produced
in DKA rapid lipolysis occurs > inc circulating free fatty acids > broken down to acyl-CoA in liver > ketone bodies in mitochondria = accumulation causes metabolic acidosis
62
symptoms of DKA
``` collapse hyperventilation nausea vomiting abdominal pain ```
63
kidney hypo perfusion occurs in DKA what does this lead to
reduces excretion of ketones & hydrogen ions
64
how do you diagnose DKA
demonstrate hyperglycaemia + ketonaemia OR heavy ketonuria and acidosis
65
in DKA what will the levels be for: ketones: bicarb: PH:
ketones: >6 bicarb: <7
66
how do you manage DKA
- fluids 0.9% saline - electolytes (potassium) - insulin - rarely give bicarb if PH <7
67
why must you give electrolytes in DKA
because insulin leads to potassium uptake by cells
68
what must you be careful of when giving fluids to someone with DKA
can cause cerebral oedema (especially in kids)
69
what is condition that type 2 diabetics can get if poor glucose control
hyperosmolar hyperglycaemia state
70
what is hyperosmolar hyperglycaemia state
severe hyperglycaemia WITHOUT ketone formation (there is enough circulation insulin to prevent ketones)
71
who tends to get hyperosmolar hyperglycaemia state
mid/late life people with undiagnosed type 2
72
what leads to hyperosmolar hyperglycaemia state
dehydration/hyperosmolarity + insulin deficiency = hepatic glucose production
73
investigations for hyperosmolar hyperglycaemia state
plasma osmolarity (2(Na+ K+)+glucose + urea) in mmol/L
74
what is a normal anion gap
40
75
who gets lactic acidosis
those on metformin (low risk)
76
what is absent in lactic acidosis
hyperglycaemia and ketones
77
lactic acidosis treatment
rehydration and infusion with isotonic 1.26% bicarbonate
78
list complications of diabetes (4)
retinopathy nephropathy neuropathy cataracts
79
nephropathy aslo called what
kimmelstein-wilson syndrome
80
pathophysiology of nephropathy
afferent arteriole leading to glomerulous vasodilates more then efferent arteriole, this incr intre-glomerular pressure. this causes sheering force which causes mesangial cell hypertrophy and incr secretion of extracellular mesangial matrix material = glomerular sclerosis. loss of protein cross linkage so leakage of large molecules into urine.
81
what precedes proteinuria
microalbuminoria > intermittent albuminuria > proteinuria
82
what indicates late stage kidney disease
incr plasma creatinine (fall in glomerular filtration)
83
normal albumin creatine ratio (ACR)
< 2.5 in men | < 3.5 in woman
84
what 3 things rise in nephropathy
plasma creatinine proteinuria mean BP
85
what drops in nephropathy
glomerular filtration rate
86
things that autonomic neuropathy can lead to (6)
- gustratory sweating - cardiac denervation - postural hypotension - gastrophoresis - diarrhoea - atonic bladder/erectile dysfundtion
87
things that somatic neuropathy can lead to (6)
- occular palsies - carpal tunnel - small muscle wasting - painful neuropathy - neuropathic foot
88
which nerves usually affected in occular palsies
3rd and 6th

Aint nobody go time for that, Iv got diabetes!!! (1 decks)

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