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Flashcards in Diabetes Deck (26)
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1

Type 1 diabetes is

a progressive metabolic disorder of catastrophic beta cell failure with normal tissue insulin sensitivity
Immune mediated

2

Type 2 diabetes is

a progressive metabolic disorder of beta cell dysfunction and/or insulin resistance where fasting gluscose is > 7mmol/L

3

What defines metabolic syndrome?

Waist >102cm
BP> 130/85
TG>1.7mmol/l
Glucose>6mmol/L
HDL

4

Actions of insulin

Anabolic hormone
Increased glycogenesis and glucose uptake
Decreased hepatic gluconeogenesis
TG synthesis and protein synthesis
Decreased ketones

5

What is hormone sensitive lipase activated by?

Starvation
Low glucose
Low insulin
Therefore lipolysis can occur

6

Signs and symptoms of DKA

High blood glucose (>15mmol/L)
Ketones in blood/urine
Diuresis
Thirst
Tired/lethargy
Blurry vision
Nausea and vomiting
Deep sighing breaths
Smell of ketones on breath
Collapse/unconciousness

7

Why does ketone synthesis occur in DKA?

Low glucose in cells, low insulin -> lipolysis
NEFA from lipolysis enter carnitine shuffle
Not enough insulin for acetyl coA for fatty acid synthesis (acetyl-coA carboxylase doesn't work) to occur so instead ketones are made

8

Name the 3 ketones

Acetone, acetoacetate and 3-hydroxybutyrate

9

Why does glucose build up in the blood in DKA?

Glucose can't enter cells because of lack of insulin
Oxaloacetate can't be used in FA synthesis so is used in hepatic gluconeogenesis

10

Treatment of DKA?

Resuscitation (0.9% IV saline)
Insulin (0.1units/kg/hr IV)
Potassium IV

11

What % of diabetic patients develop foot ulcers?

15%

12

Why does retinopathy occur in diabetes?

Microvascular disease -> increased vascular permeability and haemorrhage
Inflammatory changes and angiogenesis
Osmotic effects and cell damage
Plaques, exudate, haemorrhage
Ischaemic changes, proliferative retinopathy

13

Erectile dysfunction affects up to:

50% of men with chronic diabetes

14

3 pathophysiology pathways?

Glycosylation of proteins
Polyol pathway
Protein kinase C activation

15

Explain the glycosilation of proteins pathophys?

Glycation-> abnormal function
Glycated collagen-> LDL trapped in arterial walls
Glycated cell surface receptors-> activation of inflammatory cells and cytokine release

16

Explain the polyol pathway

Raised intracellular glucose conc
-> sorbitol and fructose
-> cellular swelling
-> impaired protein/ion pump function
-> pro-inflam cytokine production
-> damage to cells

17

Explain the protein kinase C activation

Hyperglycaemia
-> PKC activation
-> intracellular signal transduction pathway
-> VEGF -> new vessels
->pro inflam cytokines
-> endothelin-1, lowered NO -> vasoconstriction

18

2 main types on insulin regimen

Premixed insulin 1/2/3 times per day
Basal bolus (long acting at bedtime, soluble/rapid at meals)

19

What proportion of inpatients have diabetes?

10-15%

20

When a diabetic patient is unwell, what happens?

Stress of illness increases need for insulin due to catabolic hormone action
Never withhold insulin in a type 1 diabetic!
IV insulin + glucose may be needed if pt not eating

21

Primary treatment of type 2 diabetes mellitus

Lose weight & achieve healthy BMI
Decrease fat intake, esp sat
Decrease sugar intake
Eat food with low GI, slower absorption
Increase wholegrains, veg and fibre
150mins moderate exercise/week
Smoking cessation

22

What is the aim for blood sugar levels in critically ill/elderly patients?

6-12
Avoid risk of hypos

23

Main complications of diabetes?

Kidneys
Retina
UTI
Hypos/hypers
Feet
Macrovascular

24

Why hyperglycaemic?

Missed oral hypoglycaemic dose?
Are doses sub-optimal?
Insulin device failure?
New diagnosis of diabetes?
Stress of infection/illness?
Steroid treament?
Vomiting/new pancreatic disease?

25

Features of hypoglycaemia

Sweating, palpitations
Hunger, shaking
Confusion, drowsiness
Odd behaviour
Speech difficulty
Headache, nausea

26

Causes of hypoglycaemia?

Missed meal?
Less snacks?
NBM/nausea/vomiting?
Gastric surgery
Terminal illness
Steroids acutely stopped
Incorrect dose of insulin
IV insulin without glucose
Renal failure/hepatic dysfunction
Insulin out of date?