CSI - Diabetes Flashcards

Question

RULING HIVE: G

Answer 1

Increased Glucagon secretion -insulin inhibits glucagon secretion from alpha cells -over time after lots of insulin is being produced, alpha cells become insulin resistant  glucagon secretion increases  blood glucose increases

Answer 2

Increased Hepatic glucose production -increased glucagon levels and enhanced hepatic sensitivity to glucagon contribute to the excessive glucose production by the liver

Answer 3

Decreased Insulin secretion Beta-cell failure due to:  GLP1 resistance  Insulin resistant adipose, muscle, and liver tissue

Answer 4

9. Vascular insulin resistance -prolonged exposure to high levels of insulin causes increased vasculature resistance

Answer 5

Decreased incretin Effect -the incretin ‘glucagon-like peptide 1’ (GLP1) stimulates β-cells to secrete insulin

Answer 6

Diabetes symptoms, the 3 P’s: Polydipsia: an increase in thirst; when blood glucose levels get high, your kidneys produce more urine in an effort to remove the extra glucose from your body, leaving you feeling dehydrated. Polyuria: frequent urination; when blood glucose levels are too high, your body will try to remove some of the excess glucose via urination. This also leads to your kidneys filtering out more water, which leads to an increased need to urinate. Polyphagia: a rise in appetite; in people with diabetes, glucose can’t enter cells to be used for energy. This can be due to either low insulin levels or insulin resistance. Because your body can’t convert this glucose to energy, you’ll begin to feel very hungry

Answer 7

Type 2 diabetes diagnosis:  Symptoms + 1 red glucose range test  No symptoms + multiple red glucose range tests

Answer 8

Renal threshold for glucose (RTG): The proximal tubule can only reabsorb a limited amount of glucose (~375 mg/min), known as the transport maximum. When the blood glucose level exceeds about 160–180 mg/dL, the proximal tubule becomes overwhelmed and begins to excrete glucose in the urine. This point is called the renal threshold for glucose (RTG).

Answer 9

HbA1c Haemoglobin A1C (or HbA1C) is haemoglobin that has become glycosylated, i.e. chemically linked to a sugar  this process occurs non-enzymatically and can occur with the monosaccharides glucose, fructose, and galactose (although glucose least easily)  formation of HbA1C occurs proportionately to plasma glucose levels  therefore, HbA1C levels can be used to diagnose and monitor diabetes

Answer 10

- Cheap - takes into account blood glucose levels for 2- 3months - easy to measure (fasting is not needed for A1C assessment and no acute perturbations (e.g., stress, diet, exercise) affect A1C)

Answer 11

- only an approximate measure - not reliable in certain conditions e.g. Pregnancy (amount of haemoglobin changes/rapid changes in glucose management), renal failure, Sickle Cell

Answer 12

liver: increased glucose uptake increased glycogenesis decreased glycogenolysis decreased gluconeogenesis decreased lipolysis

Answer 13

muscle: increased glucose uptake increased glycogenesis increased protein synthesis decreased protein catabolism

Answer 14

increased glucose uptake increased lipogenesis decreased lipolysis

Answer 15

SGLT1 and SGLT2  active transport  glucose transported into luminal epithelial cells in the kidney and small intestine

Answer 16

4 GLUT-1, GLUT-2, GLUT-3, GLUT-4

Answer 17

GLUT -1 primary distribution: endothelium, erythrocytes function: basal transport (insulin independent)

Answer 18

Primary distribution: kidney, small intestine, liver, pancreatic beta cells function: low affinity transport (insulin independent)

Answer 19

primary distribution: neurones, placenta function: high affinity transport (insulin independent)

Answer 20

primary distribution: skeletal muscle, adipose function: insulin-regulated glucose transport

Answer 21

if your blood glucose is high but you are insulin resistant:  glucose is not taken into skeletal muscle and adipose cells  glut 1, 2, 3 cells (i.e. endothelium, erythrocytes, kidney, small intestine, liver, pancreatic beta cells, neurones, placenta) will take in lots of glucose **Insulin mediates glucose uptake via Glut-4. **

Answer 22

Type 1: very little/no insulin produced at all Type 2: little insulin produced + insulin resistant cells

Answer 23

Impaired fasting glucose VS Impaired glucose tolerance:  Impaired fasting glucose: predominantly hepatic insulin resistance leads to continuous glucose output from the liver  Impaired glucose tolerance: predominantly muscle insulin resistance plus impaired postprandial insulin release results in poor cellular glucose uptake  Impaired fasting glucose and impaired glucose tolerance can occur together or separately, one could occur first

Answer 24

uptake: default referrals  simplify invitation letters  offer taster session retention: sessions at convenient times  identify barriers to ongoing attendance behaviour change: challenging but realistic goals  manageable written materials  tell people ‘how’ rather than ‘what’

Answer 25

uptake:  offer incentives  highlight benefits retention: add an element of competition  make sessions a ‘game behavioural change: emphasise immediate/ short-term benefits  tailor to audience

Answer 26

uptake: normalise attendance  testimonies from a range of patients  use commitment devices/apps retention:  delivery in group sessions  use of commitment contracts behavioural change: include social support aspect  consider different messengers (not just doctors but other figures)

Answer 27

uptake: provide a deadline for signing up  send a text saying that their invite letter will follow (‘priming’) retention: text reminders to attend sessions behavioural change:  time-orientated goals  select the optimal time for each patient (consider personal/religious/cultural aspects)

Answer 28

Normal metabolism - Fasting glucose <6.1 mmol/ Post prandial glucose* <7.8 mmol/l Random <11.1 mmol/l

Answer 29

Smoking cessation treatments  reduces the risk of developing or worsening of smoking-related illnesses  benefits begin as soon as a person stops smoking  may be associated with temporary withdrawal symptoms caused by nicotine dependence, making it difficult for people to stop  symptoms include nicotine cravings, irritability, depression, restlessness, poor concentration, light-headedness, sleep disturbances, and increased appetite  weight gain is a concern for many people who stop smoking, but is less likely to occur when drug treatment is used to aid smoking cessation

Answer 30

Non-drug treatment  all smokers (including e-cigarettes smokers), should be advised to stop and be offered support to facilitate smoking cessation  stopping in one step (‘abrupt quitting’) offers the best chance of lasting success, and that a combination of drug treatment and behavioural support is likely to be the most effective approach  'abrupt quitting' is when a smoker makes a commitment to stop smoking on or before a particular date (the quit date), rather than by gradually reducing their smoking  smokers who wish to stop smoking should be referred to their local NHS Stop Smoking Services, where they will be provided with advice, drug treatment, and behavioural support options such as individual counselling or group meetings.  smokers who decline to attend their local NHS Stop Smoking Services should be referred to a suitable healthcare professional who can also offer drug treatment and practical advice

Answer 31

nicotine replacement therapy (NRT), varenicline and bupropion hydrochloride, are effective drug treatments to aid smoking cessation  choice of drug treatment should take into consideration the smoker’s age, likely adherence, preferences, whether they’re pregnant or breastfeeding, medical conditions, and previous experience of smoking-cessation aids, as well as contra-indications and side-effects of each preparation  varenicline, or a combination of long-acting NRT (transdermal patch) and short-acting NRT (lozenges, gum, sublingual tablets, inhalator, nasal spray and oral spray), are the most effective treatment options and thus the preferred choices  if the combination option is not appropriate, bupropion hydrochloride or single therapy NRT should be considered instead  there is no evidence that one form of NRT is more effective than another  any combination of NRT, varenicline, and bupropion hydrochloride should not be prescribed together  a quit date should be agreed when drug treatment is prescribed for smoking cessation, and treatment should be available before the person stops smoking  smokers should be prescribed enough treatment to last 2 weeks after their agreed quit date and be reassessed shortly before their supply finishes

Answer 32

E-cigarettes  electronic device that delivers vapour composed of nicotine without the toxins found in tobacco smoke e.g. tar or CO  evidence suggests that e-cigarettes are substantially less harmful to health than tobacco smoking, but long-term effects are still largely unknown  some smokers have found e-cigarettes useful for smoking cessation, however they cannot be prescribed or supplied by smoking cessation services (you have to buy them)  people who wish to use e-cigarettes should be advised that although these products are not licensed drugs, they are regulated by the Tobacco and Related Products Regulations 2016  are most effective if used with support from an NHS stop smoking service  in the UK, sale of e-cigarettes is prohibited in children under 18 years of age

Answer 33

Concomitant drugs  polycyclic aromatic hydrocarbons found in tobacco smoke increase the metabolism of some drugs by inducing hepatic enzymes, often requiring an increase in dose

Answer 34

Pregnancy  pregnant females should be advised to stop smoking completely, and be informed about the risks to the unborn child of smoking during pregnancy, and the harmful effects of exposure to second-hand smoke for both mother and baby  all pregnant females who smoke or have stopped smoking in the last 2 weeks should be referred to their local NHS Stop Smoking Services, and ongoing support should be offered during and following pregnancy  smoking cessation should also be encouraged for all members of the household  pregnant females who smoke should be advised to contact the NHS Pregnancy Smoking Helpline for further information  NRT should only be used in pregnant females if non-drug treatment options have failed  clinical judgement should be used when deciding whether to prescribe NRT following a discussion about its risks and benefits  subsequent prescriptions should only be given to pregnant females who have demonstrated they are still not smoking

Answer 35

mechanism: beta-2 agonists; sympathetic nervous system dilates airways through beta adrenergic receptors  muscarinic antagonists; antagonistically works against parasympathetic nervous system that keeps airways constricted  both come in long acting and **short acting forms** examples: short acting beta agonists (SABA)  Salbutamol (Ventolin)  short acting muscarinic antagonists (SAMA)  Ipratropium bromide (Atrovent)

Answer 36

mechanism:  beta-2 agonists; sympathetic nervous system dilates airways through beta adrenergic receptors  muscarinic antagonists; antagonistically works against parasympathetic nervous system that keeps airways constricted  both come in long acting and short acting forms examples: long acting beta agonists (LABA)  Formoterol, Salmeterol (Serevent)  long acting muscarinic antagonists (LAMA)  Tiotropium (Spiriva), Glycopyrronium

Answer 37

Mechanism:  anti-inflammatory for airways  reduces the risk of flare-ups or exacerbations  useful for people whose condition is an overlap of asthma and COPD  numerous different inhaler devices exist  numerous drug combinations exist within a single inhaler examples:  alone - not licensed in COPD  Beciomestasone, Fluticasone (Flixotide)  in combination e.g. with a LABA  Fluticasone + Vilaterol (together = Relvar)

Answer 38

the main reason people smoke is because they’re addicted to nicotine  the amount of nicotine in NRT is much lower and less addictive than in smoking tobacco, and does not contain the poisonous chemicals e.g. tar, CO, present in tobacco  NRT can help with unpleasant withdrawal symptom

Answer 39

works in 2 ways: 1) reduces cravings for nicotine like NRT 2) blocks the rewarding and reinforcing effects of smoking Evidence suggests it's the most effective medicine for helping people stop smoking

Answer 40

aka zyban - originally used to treat depression, has since been found to help people quit smoking  it's not clear exactly how it works, but it's thought to have an effect on the parts of the brain involved in addictive behaviour

Answer 41

Nicotine replacement therapy can be bought from pharmacies and some shops  is available on prescription from a doctor or NHS stop smoking service It's available as:  skin patches  chewing gum  inhalators (which look like plastic cigarettes)  tablets, oral strips and lozenges  nasal and mouth spray  patches release nicotine slowly  nicotine transdermal patches are applied for 16 hours, with the patch removed overnight  if smokers experience strong nicotine cravings upon waking, a 24-hour patch can be used instead  short-acting nicotine preparations e.g. inhalators, gum, and sprays are used whenever the urge to smoke occurs or to prevent cravings  using a combination of long and short acting NRT is more effective  treatment usually lasts 8-12 weeks before gradually reducing the dose and eventually stopping

Answer 42

only available on prescription; usually need to see GP or contact an NHS stop smoking service to get it  taken as 1-2 tablets a day  start taking it a week or 2 before trying to quit  a course of treatment usually lasts 12 weeks, but can be continued for longer if necessar

Answer 43

only available on prescription; usually need to see GP or contact an NHS stop smoking service to get it  taken as 1-2 tablets a day  start taking it a week or 2 before trying to quit  a course of treatment usually lasts 7-9 weeks

Answer 44

smokers who are unwilling or not ready to stop smoking may benefit from the use of NRT as part of a 'harm reduction approach'  harm reduction approaches include stopping smoking whilst using NRT to prevent relapse, and smoking reduction or temporary abstinence with or without the use of NRT NRT will make it easier to reduce how much they smoke and improve their chance of stopping smoking in the long-term Most people are able to use NRT, including:  adults and children over 12 years of age; children under 18 should not use the lozenges without getting medical advice first  pregnant women  breastfeeding women  get medical advice first e.g. if you have kidney or liver problems, or you've recently had a heart attack OR stroke

Answer 45

skin irritation when using patches  irritation of nose, throat or eyes when using a nasal spray  difficulty sleeping (insomnia), sometimes with vivid dreams  an upset stomach  dizziness  headaches Any side effects are usually mild. But if troublesome, contact GP as dose or type may need to be changed

Answer 46

feeling and being sick  difficulty sleeping (insomnia), sometimes with vivid dreams  dry mouth  constipation or diarrhoea  headaches  drowsiness  dizziness Contact GP if side-effects are troublesome.

Answer 47

safe for most people to take, although there are some situations when it's not recommended, e.g.  children under 18 years of age  women who are pregnant or breastfeeding - people with severe kidney problems

Answer 48

 dry mouth  difficulty sleeping (insomnia  headaches  feeling and being sick  constipation  difficulty concentrating  dizziness Contact GP if sideeffects are troublesome

Answer 49

safe for most people to take, although there are some situations when it's not recommended, e.g.  children under 18 years of age  women who are breastfeeding or pregant people with epilepsy, bipolar disorder, eating disorders

CSI - Diabetes Flashcards

(74 cards)