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TMS exam > 1 - diabetes and its treatment > Flashcards

1 - diabetes and its treatment Flashcards

(56 cards)

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1
Q

negative consequences of diabetes

A

decreases life expectancy

contributes to kidney failure and CV diseases (MI and stroke)

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2
Q

diabetes mellitus type 1

A

hyperglycemia due to insufficient insulin secretion by the pancreas

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3
Q

relative percentages of people with T1 or T2 diabetes

A

10% of people with diabetes are Type 1

90% are T2

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4
Q

monogenic causes of diabetes

A

single gene defects of beta cells

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5
Q

MODY

A

maturity onset diabetes of the young

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6
Q

types of monogenic causes of diabetes

A 
MODY (autosomal dominant gene mutation)
neonatal diabetes (e.g. mutation in K+ATP channel)
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7
Q

properties of people with T2 diabetes

A

often older, overweight, commonly genetic cause
thirsty
polyuria
tiredness

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8
Q

lifestyle treatment for T2 diabetes

A

better diet

more exercise

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9
Q

pharmaceutical treatment for T2 diabetes

A

drugs to improve insulin sensitivity
e.g. metformin

drugs to stimulate insulin secretion
e.g. GLP-1 agonist

drugs to promote glucose excretion via kidneys

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10
Q

type 2 diabetes

A

long-term metabolic disorder characterized by high blood sugar, insulin resistance, and relative lack of insulin

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11
Q

type 1 diabetes

A

autoimmune destruction of insulin-producing pancreatic beta cells

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12
Q

signs of T1 diabetes

A

presence of autoantibodies and autoreactive T cells

total loss of beta cells within an islet
alpha cells remain intact

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13
Q

targets of autoreactive T cells in T1 diabetes

A

islet cells or their antigenic constituents

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14
Q

properties of people suffering from type 1 diabetes

A

young
rapid onset
thin/underweight at diagnosis

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15
Q

treatment of T1 diabetes

A

insulin replacement therapy
- injections or pump

monitoring of blood glucose

carbohydrate counting

transplantation of pancreas/islets

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16
Q

biomarkers for diabetes

A

HbA1c
anti-GAD
serum c-peptide

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17
Q

HbA1c testing

A

long-term –> tests average blood glucose over last 2-3 months

high HbA1c –> too much blood glucose

normal range for diabetes = 48 mmol/mol

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18
Q

who gets their HbA1c tested

A

patients that know they have diabetes already

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19
Q

what is HbA1c

A

Haemaglobin A1c
(glycated haemaglobin)

secreted when glucose builds up and sticks to blood vessels

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20
Q

anti-GAD as a diagnostic test

A

presence of anti-GAD identifies someone with T1 diabetes
–> suggestive of autoimmunity

blood test (from the arm) measuring whether the body is producing antibodies targeted to destroy its own GAD cells

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21
Q

what is GAD

A

glutamic acid decarboxylase enzyme

acts as an autoantigen –> stimulates antibodies to be released

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22
Q

which test determines which type of diabetes someone has

A

anti-GAD blood test

serum c-peptide test

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23
Q

what does serum c-peptide test for

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A

shows how well the body is making insulin

24
Q

how is serum c-peptide tested

Study These Flashcards
A

blood or urine sample taken

25
what is c-peptide
released by beta cells when they make insulin proinsulin + c-peptide = insulin
26
why is c-peptide a good biomarker for insulin production
C-peptide and insulin are present in pancreatic beta cells in equal amounts C-peptide remains in your blood for approximately 5 times as long as insulin, and is therefore present in your blood at approximately 5 times the concentration
27
normal serum c-peptide range
0.5-2.0 ng/ml
28
what c-peptide results would indicate T1 diabetes
low serum c-peptide levels and high blood glucose
29
what c-peptide results would indicate T2 diabetes
high serum c-peptide levels and low blood glucose levels
30
most common mutation causing MODY
glucokinase mutation | MODY 2
31
alternative mutation causing MODY
HNFa mutation (hepatocyte nuclear factor) (MODY 1 and 3)
32
which type of diabetes is associated with insulin resistance
type 2
33
method and advantages of most common method of insulin delivery
insulin pen insulin injected into subcutaneous tissue little pain, easy, accurate therefore good for kids
34
disadvantages of insulin pen
exPENsive | not all insulin types available
35
alternative methods of insulin delivery
implantable insulin pump external insulin pump 'smart insulin' insulin inhaler
36
methods of blood glucose monitoring
finger pricks (most common) non-invasive monitoring (measures interstitial fluid) flash glucose monitor (scan small white disk) continuous glucose monitor
37
what is an artificial pancreas
system that measures blood sugar levels using a continuous glucose monitor (CGM) transmits information to an insulin pump that calculates and releases the required amount of insulin into the body
38
benefits and disadvantages of artificial pancreas
no immunosuppressants required little risk of infection hard to connect glucose monitor to insulin pump
39
2 methods of beta cell replacement therapy
regeneration of remaining beta cells islet transplants
40
process of regeneration of beta cells
some T1 diabetes patients still have detectable levels of c-peptide chemicals can be used to enhance proliferation of beta cells (transdifferentiation)
41
advantages and disadvantages of islet transplants
+ effective treatment -->reduces hypoglycaemic events - potential immune rejection injecting islets into the liver can cause clots insulin dependence may not last that long --> requires repeats
42
what is iPS cell treatment
induced pluripotent stem cell treatment reverts cells back to stem cells so specialised cells can then be derived from them
43
advantages and disadvantages of iPS cell treatments
+ don't need an embryo fewer ethical issues - expensive
44
what is ES cell-based generation
embryonic stem cell-based generation hijacking normally occurring differentiation pathways and replicating them in culture to produce specific specialised cells
45
how does ES cell-based generation work
replicate differentiation pathways of embryo from endoderm stage into mature pancreatic tissue transcription factors change at every stage of differentiation therefore can be used as markers of specific stage
46
disadvantages of embryonic stem cell-based generation
difficult to generate fully functional cells in vivo | ethical issues from source of cells
47
transdifferentiation in mice
inject specific transcription factors to convert liver cells to beta cells or alpha cells to beta cells
48
importance of changing properties of insulin
changes the rate of absorption
49
properties of naturally occurring insulin
stored in the pancreas in tetramer crystals tetramers broken up into monomers
50
rapid acting insulin
usually taken straight before a meal peaks after 1 hour often used with long-acting insulin
51
short-acting insulin
taken 30 mins before a meal peaks after 2-3 hours often used with long-acting insulin
52
intermediate acting insulin
covers glucose elevations when rapid-acting stops working | peaks after 4-12 hours
53
long-acting insulin
sustained basal insulin rate throughout day can lower glucose levels for 24 hours taken before bed
54
artificial pancreas is an example of ...
a closed loop insulin delivery system
55
where does the artificial pancreas get its name?
it monitors and adjusts insulin levels just as the pancreas does in people without diabetes.
56
evidence that the artificial pancreas is effective
People using the system spent 14% more time with their glucose levels in the ideal range, compared to people using standard insulin therapy They also had lower average overnight blood glucose levels without increasing hypos.

TMS exam (22 decks)

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