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Clinical 3rd Yr > Chapter 5-diabetes > Flashcards

Chapter 5-diabetes Flashcards

1
Q

Does glycemic control worsen over time?

A

YES

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2
Q

Name a biguanide

A

Metformin

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3
Q

How does metformin work

A

Decreases gluconeogensis

Increases peripheral utilisation of glucose

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4
Q

Does metformin work in the presence of insulin?

A

Yes acts only in the presence of insulin

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5
Q

What’s the rate but potentially fatal side effect of metformin

A

Lactic acidosis

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6
Q

Why can lactic acidosis occur with metformin

A

Because metformin reduces hepatic uptake of lactate

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7
Q

What are the symptoms of lactic acidosis

A 
Insidious onset with vague and non specific symptoms: 
Anorexia 
Lethargy 
Nausea 
Respiratory distress
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8
Q

How do sulfonylureas work

A

Stimulate insulin release by the beta cells of the pancreas

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9
Q

What do sulfonylureas need in order to work

A

Require functioning beta cells

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10
Q

Why do you need to take sulfonylureas with food?

A

To prevent hypoglycaemia

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11
Q

How do meglitinides work?

A

Stimulate insulin secretion but only in the presence of food

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12
Q

Do meglitinides work quickly and how long for?

A

Rapid onset and short duration of action

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13
Q

Which has a lower risk of hypoglycaemia:
Sulfonylureas
Meglitinides

A

Meglitinides

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14
Q

What class of drugs prevent intestinal absorption of starch and sucrose

A

Alpha-glucosidase inhibitors

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15
Q

When a patient is on alpha-glucosidase inhibitors should they use sucrose to treat hypos?

A

NO USE GLUCOSE

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16
Q

How do thiazolidinediones work?

A

Enhance tissue sensitivity to insulin

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17
Q

What does GLP-1 stand for?

A

Glucagon-like peptide

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18
Q

What is GLP-1 glucagon like peptide?

A

It’s a neuropeptide it increases insulin excretion from the pancreas in a glucose dependant manner

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19
Q

define incretin

A

Incretins are a group of metabolic hormones that stimulate a decrease in blood glucose levels

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20
Q

Name two incretin based therapies

A

DPP-4 inhibitors

GLP-1 receptor agonists

21
Q

When is GLP-1 secreted

A

Upon the ingestion of food

22
Q

Two benefits of DPP-4 inhibitors

A

Weight neutral

Low risk for causing hypos

23
Q

How do you administer GLP-inhibitors?

A

Subcutaneous injection

24
Q

Key benefit of GLP-1?

A

Weight loss woo

25
Q

what does SGLT2 stand for?

A

Sodium-glucose co-transporter-2

26
Q

How do SGLT-2 inhibitors work?

A

Work by helping the kidneys to lower blood glucose levels- they inhibit reabsorption at the proximal tubule

27
Q

List 4 ways in which insulin works

A

Removes glucose from circulation
Helps tissues (muscles) to uptake glucose
Promotes glucose to be stored as glycogen
Helps body make fat and protein

28
Q

How do WHO diagnose diabetes?

A

Random venous glucose >11.1mmol/l or

Fasting venous >7mmol/l or

2hour venous conc>11.1mmol/l 2hrs after 75g anhydrous glucose in an oral glucose tolerance test

29
Q

Name the types of insulin

A

Short/rapid acting
Intermediate
Long acting
Biphasic

30
Q

First line insulin should be what?

A

OD or BD human insulin e.g humulin insulatard

31
Q

What is phentermine

A

The first anti obesity drug acts my stimulating catecholamine release thus fight or flight reducing appetite, now a controlled drug

32
Q

What is fenfluramine

A

Weight loss drug withdrawn from market after reports of hypertension, it acted by increasing serotonin levels and caused a sensation of fullness

33
Q

What is rimonabant?

A

Is a cannabinoid CB1 receptor antagonist that after centrally on the brain, decreasing appetite

34
Q

Why was rimonabant withdrawn?

A

Links to serious psychiatric disease and suicidal behaviour

35
Q

What’s sibutramine

A

Centrally acting serotonin-NA reuptake inhibitor structurally related to amphetamines

36
Q

Why was sibutramine withdrawn?

A

Cardiovascular events and strokes

37
Q

How does orlistat work?

A

Acts peripherally where it inhibits an enzyme involved in the breakdown of fat causing it to be excreted rather than digested

38
Q

List 5 obesity drugs

A 
Phentermine 
Fenfluramine
Rimonabant
Sibutramine
Orlistat
39
Q

What’s leptin

A

A signalling molecule secreted from the adipocyte cell found from the ob gene

40
Q

Mouse with the Db/db gene had what?

A

Obesity and diabetic

41
Q

What BMI is a healthy weight

A

18.5-24.9

42
Q

What BMI is overweight

A

25-29.9

43
Q

What BMI is obese class 1

A

30-34.9

44
Q

What BMI is obese class 3

A

40+

45
Q

What BMI is obese class 4

A

50+

46
Q

What waist circumference in women is associated with an increased risk of for type 2 diabetes?

A

> 35inches

47
Q

Above what waist circumference is associated with an increased risk of diabetes in men?

A

> 40

48
Q

Name the 9 types of drug in T2DM

A 
Biguanides
Sulfonylureas 
Meglitinides 
Alpha-glucosidase inhibitors
Thiazolidinediones 
DPP4 inhibitors 
GLP-1 agonists 
SGLT2 inhibitors 
Insulin

Clinical 3rd Yr (11 decks)

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