Diabetes Flashcards
(294 cards)
1
Q
what is the function of GLUT2
where are they
A
pancreatic cells
allow diffusion of glucose for insulin production
2
Q
what is the function of GLUT4
where are they
A
in peripheral cells
allow the diffusion of glucose at peripheral cells in the presence of insulin
3
Q
where do GLUT4 transporters originate
where do they translocate to
A
in cytoplasm of cell
move to cell membrane
4
Q
which cells secrete insulin
A
pancreatic islets of Langerhans (beta cells)
5
Q
when is insulin secreted (a change in what…)
A
increase in blood glucose
6
Q
what is the most common cells in the pancreas
what does it secrete
A
beta cells
insulin
7
Q
what is broken down to give insulin and C peptide
A
pre-proinsulin
8
Q
what is the ration of C peptide to insulin after they have been cleaved
A
1:1
9
Q
what can be monitored to measure insulin levels
what is the ratio of this compound to insulin
A
C peptide
1:1
10
Q
which GLUT transporter is on pancreatic cells
A
GLUT2
11
Q
what enzyme phosphorylates glucose
A
glucokinase
12
Q
what is the product of glucose phosphorylation by glucokinase
A
glucose-6-phosphate
13
Q
what is the Km and affinity of glucokinase for glucose
A
high Km (5mmol) low affinity
14
Q
which molecule directly correlates to insulin secretion
A
glucokinase
15
Q
what happens after glucose-6-phosphate is made
A
increase in intracellular ATP = blocks ATP sensitive K channel (KATP)
16
Q
what type or Kir are in the KATP channel in the pancreas
A
Kir6.2
17
Q
what 2 things can close the KATP channel in the pancreas
A
ATP
sulphonylurea inhibitors
18
Q
what is released when KATP channels are blocked (by ATP or sulphonyl urea inhibitors)
A
insulin
19
Q
which part of the KATP channel does ATP bind to (and hence block)
A
Kir6.2
20
Q
what does KATP channel closure cause in the cell membrane
A
depolarisation = Ca2+ influx
21
Q
what does presence of insulin cause in adipose tissue and the liver
A
lipogenesis
22
Q
what does the absence of insulin cause (3)
A
lipolysis - creates ketones
gluconeogenesis in the liver
23
Q
which part of the world has highest prevalence of diabetes
A
middle east
24
Q
diabetes definition
A
insufficient insulin secretion/action to maintain glucose homeostasis leading to hyperglycaemia
25
what % of diabetics are type 2
90%
26
aetiology of type 1 diabetes
autoimmune (islet autoantibodies)
| genetic (mainly) and environmental
27
which age group does type 1 diabetes present in (3)
preschool children early puberty
| late 30s
28
what physique of children get type 1 diabetes
lean
29
which other paediatric condition is closely associated with type 1 diabetes
cystic fibrosis
30
which 2 autoimmune conditions is type 1 diabetes associated with
coeliac disease
| thyroid disease
31
pathogenesis of type 1 diabetes
loss of insulin secreting beta cells in pancreas = absolute insulin deficiency
32
how much insulin do type 1 diabetics make
none
33
what does having no insulin result in
hyperglycaemia (need insulin to transport glucose from blood to cells, to recruit GLUT4)
34
presentation of a kid with type 1 diabetes (4)
```
TTTT;
toilet
tired (TATT - tired all the time)
thinner
thirsty
```
35
investigations for type 1 diabetes (5)
```
anti-islet cell antibodies (anti-ICA)
ketones
c peptide
anti-GAD antibodies
glucose (random, fasting)
```
36
what is c peptide results in type 1 diabetes (think about it)
low
bc you dont produce any insulin...
37
what is c peptide results in MODY
high
38
how do you differentiate between type 1 diabetes and MODY
c peptide
39
can you cure type 1 diabetes
no
40
treatment of type 1 diabetes
insulin
| drugs (if insulin ineffective)
41
lifestyle recommendations for kid with type 1 diabetes (1)
carb counting/food diary
42
which drug is the only drug that WONT work in type 1 diabetes (though none are ideal)
sulphonylureas
43
how many grams of carbs does a type 1 diabetic need to take 1 unit of insulin for
10g
44
which type of surgery could be used LAST LINE for a kid with type 1 diabetes
pancreatic islet cell transplant
45
which type of diabetes is also known as 'type 1.5'
latent autoimmune diabetes of adulthood (LADA)
46
what is similar between LADA and type 1 diabetes
what is similar between LADA and type 2 diabetes
aetiology - autoimmune
age of onset - adulthood
47
investigations for LADA
islet cell autoantibodies
48
aetiology of type 2 diabetes
genetic and environmental (mainly environmental)
49
risk factors for type 2 diabetes (3)
middle aged
obesity (BMI >30)
genetics/family history
50
what is the pathophysiology of type 2 diabetes
reduced pancreatic beta cell function = reduced insulin secretion
51
is there insulin secreted in type 2 diabetes
yes just not much
52
is type 2 diabetes reversible
how
yes
lifestyle and drugs
53
as BMI increases, what happens to insulin sensitivity
decreases
54
presentation of type 2 diabetes
tired all the time (TATT)
thirsty
polyuria
55
how can type 2 diabetes present on the penis
balanitis - inflammation of the head of the penis
56
first line treatment for type 2 diabetes (3)
lifestyle change;
diet
exercise
smoking cessation
57
how long after someone with type 2 diabetes has changed their lifestyle can you give drugs
3 months
58
second line treatment for type 2 diabetes (after lifestyle change)
metformin
59
third line treatment for type 2 diabetes (after lifestyle change and metformin)
metformin + something else (sulphonylurea/gliptin/GLP1 analogue/SGLT2 inhibitor/glitazone)
60
forth line treatment for typ 2 diabetes (after lifestyle change, metformin and something else)
metformin + sulphonylurea + insulin
61
which 3rd line drug is used alongside metformin in type 2 diabetes if there is weight gain
SGLT2
62
what other drugs might you consider for type 2 diabetes treatment
why
ACE inhibitors
statins
for CVD risk
63
what is type 3 diabetes also known as
gestational diabetes
64
when does type 3 diabetes occur
2nd/3rd trimester of pregnancy
65
treatment of type 3 diabetes (4)
metformin
insulin
lifestyle!!!!
folic acid
66
complications in baby if mother has type 3 diabetes
why
hypoglycaemia after birth = fits (as baby has been used to producing extra insulin to cope with mums hyperglycaemia)
67
is the baby of mother with type 3 diabetes likely to be overweight or underweight
overweight
68
what risk is increased postnatally in a mother with type 3 diabetes during pregnancy
how would you monitor this
type 2 diabetes
GTT 6 weeks after birth
69
aetiology of type 4 diabetes (3)
pancreatic disease
endocrine disease
drugs
70
definition of neonatal diabetes
diabetes in <6 month old
71
2 types of neonatal diabetes
transient neonatal diabetes (TNDM)
| permanent neonatal diabetes (PNDM)
72
what is the treatment of all neonatal diabetes
1. SU
| 2. insulin if SU not effective
73
what is transient neonatal diabetes
diabetes that 'goes away' after 12 weeks in a baby
74
aetiology of neonatal diabetes (and pathophysiology)
Kir6.2 mutation = no insulin release
75
what is permanent neonatal diabetes
when after 12 weeks a baby still has diabetes (if it resolves it was just transient neonatal diabetes)
76
when do you stop insulin/SU in neonatal diabetes
after 12 weeks if it resolves
never if it doesnt resolve
77
what is maturity onset diabetes of the young (MODY)
early onset type 2 diabetes
78
what age group does MODY present in
15-30
79
aetiology of MODY
genetic - mutation or familial
80
examples of monogenic diabetes (2)
MODY
| neonatal diabetes
81
MODY1 aetiology
HNF4 alpha transcriptase factor mutation
82
MODY2 aetiology
glucokinase mutation
83
MODY3 aetiology
HNF1 alpha transcriptase factor mutation
84
which type of diabetes presents as stable/non progressive hyperglycaemia
MODY2
85
what is the pathophysiology of MODY2 (non progressive hyperglycaemia)
normal beta cells, they just aren't being stimulated enough = high levels of glucose occur before the insulin is made to compensate
86
which type of diabetes has NON FUNCTIONING beta cells
type 1 diabetes
87
which type of diabetes has REDUCED beta cell function
type 2 diabetes
88
which type of diabetes has NORMAL beta cells, but they need more glucose to be stimulated than normal
MODY2
89
treatment of MODY1 and MODY3
diet
insulin
SU
90
treatment of MODY2
diet
| no drugs can help - you just need to be aware they will always have hyperglycaemia
91
general presentation of diabetes (4)
thirsty
polyuria (pee lots)
blurred vision
lethargy
92
investigations for diabetes (7)
```
c peptide
ketones
anti-islet cell antibodies
HbA1C
OGTT
fasting glucose
blood plasma glucose (finger prick)
```
93
which type of diabetes has positive anti-islet cell antibodies
type 1
94
which type of diabetes has low c peptide
why
type 1
bc they dont produce any insulin at all!!
95
which type of diabetes has high c peptide
type2/MODY
96
which unit do we measure HbA1C in
what is the old unit
mmol/mol
%
97
how do you convert from % to mmol/mol for HbA1C
minus 2, minus another 2, add answers together
eg 12%; 12-2=10, 10-2=8 so 12% = 108
98
HbA1C in diabetes
>48mmol/mol (6.5%)
99
target HbA1C in diabetes after treatment
<53mmol/mol (7%)
100
target HbA1C in diabetic pregnancy
<43mmol/mol (6.1%)
101
normal HbA1C (not diabetes)
<42mmol/mol (6%)
102
what is oral glucose tolerance testing (OGTT)
fast overnight, test blood glucose at 9am then give glucose and keep testing levels
103
what is fasting blood glucose
fast overnight, test blood glucose at 9am
104
which glucose measurement is needed for diagnosis of diabetes
fasting blood glucose
105
advantages of finger prick test (blood plasma glucose)
can be done at home
106
alternatives to blood plasma glucose for diabetics on insulin (mainly type 1) (2)
```
continuous glucose monitoring (attached to a pump)
flash glucose (device on arm you scan with phone)
```
107
annual screening for diabetics (6)
```
retinal screening (with pics)
diabetic foot exam
renal impairment
weight/BMI
BP
HbA1C
```
108
what is the Tayside programme used for recording diabetic screening results on
SCI-DC
109
fasting glucose diabetes diagnosis
>7mmol/mol
110
HbA1C diabetes diagnosis
>48mmol/mol
111
OGTT diabetes diagnosis
>11.1mmol/mol
112
random blood glucose
>11.1mmol/mol
113
which type of diabetes doesnt get complications
MODY2
114
are the aims of diabetes treatment to prevent hypoglycaemia or hyperglycaemia
both
115
lifestyle modification for type 2 diabetes (3)
diet - lower cholesterol
exercise - 150mins moderate intensity per week
stop smoking
116
what type of diabetes uses insulin
type 1
| type 2 if other medications ineffective
117
why do type 1 diabetics need endogenous insulin
they dont have functioning beta cells so cant make their own insulin
118
consequence of too much insulin
hypoglycaemia
119
more or less modifications in the protein makes insulin last longer
more modifications = lasts longer
120
what type of insulin is taken at meal times
prandial/bolus insulin
121
what type of insulin is taken OD or BDS to provide a constant level of insulin in blood
basal insulin
122
what are basal insulins made of
a mixture of insulins that last different lengths, to cover the entire day
123
example of long acting insulin
glargine
124
example of rapid acting insulin (2)
novorapid
| humolog
125
what is the standard insulin regime for type I diabetic kids
insulin QDS;
3 prandial insulin before meals
1 basal insulin before bed
126
what is the total number of insulin units required for a type I diabetic (standard)
18 units
127
what type of insulin regime can a teenager with bad compliance with a TDS regime be changed to
BDS insulin;
| taken with breakfast and dinner
128
is someone takes insulin and plays football one night a week, what would you suggest them to do on that night
consequence of not altering insulin in this case
take less insulin
monitor blood glucose levels
hypoglycaemia
129
if someone on insulin had a meal with no carbs in it, how should they alter their insulin
take less/none at that meal time
130
if a patient phones in worried bc they gave themselves too much insulin, what do you recommend
eat more to compensate, lots of sugar
131
standard insulin administration method
subcut injection
132
what can happen if a patient doesnt rotate their insulin injection site
lipohypertrophy
| infection
133
how often should a patient change their insulin needle
every use
134
what are the insulin injection sites (4)
abdo
upper outer thigh
upper outer arm
buttock
135
alternative insulin administration to insulin pens that gives 24 hour insulin administration
insulin pump
136
what type of insulin does an insulin pump deliver
short acting basal insulin
137
what do diabetics with an insulin pump still need to do
take prandial insulin
| inject themselves at meal times
138
how can insulin be administered in someone acutely unwell with diabetes (eg DKA)
IV insulin
139
if a patient eats 50g of carbs in their lunch meal, how many units of insulin should they take
5
140
ratio of insulin (units) to carbs (g)
1 unit : 10g
141
how much does 1 unit of insulin reduce your blood glucose by
2mmol
142
why does prandial insulin need to be taken 30 mins before a meal
exogenous insulin takes longer to work than endogenous insulin
143
what are the 2 options for home monitoring of blood glucose
fingerprick tests
| continuous glucose monitor (eg in pump or on arm)
144
what is the glucose target before a meal for a diabetic on insulin
4-7mmol/l
145
what is the glucose target 1-2 hours after a meal for a diabetic on insulin
<10mmol/l
146
how often should a diabetic on insulin check their blood glucose
when else should they check it
4 times per day
before they drive
147
side effects of insulin
weight gain
| hypoglycaemia
148
what is it called when hyperglycaemia occurs to compensate with hypoglycaemia
somogyi effect
149
example of a biguanide
metformin
150
dose of metformin (start and final)
500mg OD to 1g BD
151
is metformin safe in pregnancy
yes
152
does metformin cause weight loss/gain
in who
weight loss in obese people
153
contraindication of metformin
renal failure
154
if renal function is eGFR <30ml/min what should you do to metformin dose
stop metformin
155
what eGFR result (renal function) requires metformin dose to be halved to 500mg BD
30-45ml/min
156
metformin side effects
GI disturbance
| B12 deficiency anaemia
157
sulphonylurea drug examples (2)
glibenclamide
gliclazide
(start in 'gli-' and end in '-amide' or '-azide')
158
what do sulphonylurea drugs cause the potassium channels to do (bc of them binding to the SU1 receptor)
close it
159
when sulphonylureas cause the potassium channel to close what do they cause (3)
depolarisation of cell = Ca2+ influx = insulin released
160
what is important about the B cells that are present when sulphonylureas are used as treatment for diabetes
(and hence why they dont work in type 1 diabetes)
need to be functioning, just need a stimulus
161
why is sulphonylureas preferred as second line drug in addition to metformin (instead of GLP1 analogues, gliptins etc)
cheaper
162
side effects of sulphonylureas (2)
weight gain
| hypoglycaemia in elderly
163
which 2 diabetes treatments have the side effects of weight gain and potential hypoglycaemia
insulin
| sulphonylureas
164
contraindication to sulphonylureas (4)
pregnancy
renal failure
hepatic failure
obesity
165
what class of drugs are gliptins
DPP4 agonists
166
example of a gliptin
sitagliptin
| all end in 'gliptin'
167
do gliptins cause weight gain
no
168
how effective are glitpins
not very
169
which drug do gliptins work similarly to
GLP1 analogues
170
which pathway does GLP1 analogue and DPP4 agonist (gliptins) stimulate
incretin pathway
171
in the use of GLP1 analogues and DPP4 agonist (gliptins), stimulating the incretin pathway causes release of... from...
insulin from pancreas
172
what drug class is an exenatide
GLP1 analogue
173
what does DPP4 break down
| hint: something you want lots of to secrete insulin, so you dont want to break it down = DPP4 antagonists
GLP1 and GIP
174
which diabetes treatment is injectable (2)
```
insulin
GLP1 analogues (exenatide)
```
175
what is the incretin pathway (think about what it stands for)
INtestinal seCRETion of INsulin
176
when are GLP1 and GIP usually secreted
what does increased GLP1 and GIP secretion cause
food ingestion
insulin secretion
177
does GLP1 analogues cause weight loss
how
yes
causes increased incretin pathway = increased insulin AND early satiety = reduces appetite
178
what type if drug is a flozin (eg dapagliflozin)
SGLT2 inhibitor
179
how do SGLT2 inhibitors work
make you pee out glucose by decreasing glucose reabsorption
180
side effects of GLP1 analogues (2)
nausea
| increased risk of pancreatitis
181
side effects of SGLT2 inhibitors
why (think about it!)
thrush
UTI
peeing out glucose!
182
what drugs are safe to use in renal failure
gliptins
GLP1 analogues
glitazones (TZDs)
183
what diabetes drugs promote weight loss
metformin
GLP1 analogue
SGLT2 inhibitor
DPP4 analogues are weight neutral
184
what diabetes drugs cause weight gain
sulphonylureas
insulin
glitazones (TZDs)
185
what class of drug is pioglitazone (glitazone)
thiazolidinediones (TZDs)
186
example of a glitaZone (thiaZoldinedione)
piaglitazone
187
which part of the body does glitaZones (thiaZoldinediones) work
peripheral adipose tissue (not the pancreas like most drugs)
188
how do glitaZones (thiaZoldiinediones) work (2)
fat redistribution (from visceral fat to adipocytes (subcut fat))
water retention (dk why lol)
189
side effects of glitaZones (thiaZoldinediones)
increased fracture risk
CVD (from fluid retention)
weight gain (from fluid retention)
190
generally what is the add on drug to metformin in someone with type 2 diabetes
sulphonylurea
191
what is the add on drug to metformin in someone with type 2 diabetes and obesity (3)
GLP1 analogue (exenatide)
gliptins
SGLT2 inhibitors
192
what is the add on drug to metformin in someone with type 2 diabetes and renal failure
GLP1 analogue (exenatide)
gliptins
glitazones
193
what is the add on drug to metformin in someone with type 2 diabetes, renal failure and obesity (2)
GLP1 analogue (exenatide)
gliptins
194
which drug is superior, GLP1 analogues (exenatide) or gliptins
why
GLP1 analogue (exenatide)
more potent
195
if someone with type 2 diabetes is on metformin and exenatide (GLP1 analogue) and is experiencing nausea, what drug would you switch them to
gliptin
196
what may a child with a diabetic mother present with after birth
why
fits from hypoglycaemia
if mother is hyperglycaemic baby is used to producing enough insulin to cope with that (so after birth will produce too much insulin)
197
macrovascular complications of diabetes (1)
cardiovascular disease
198
how does cardiovascular disease associated with diabetes present in the legs (peripheral vascular disease)
leg ulcers
199
where on the foot do vascular complications (macrovascular) of diabetes occur
dorsum
200
microvascular complications of diabetes (3)
retinopathy
neuropathy
nephropathy
201
where on the foot do neuropathic complications (microvascular) of diabetes occur
plantar surface
202
which pathway is involved in the microvascular complications of diabetes
poyol/aldose-reductase pathway
203
what can diabetic retinopathy result in (3 conditions)
blindness
cataract clouding of lens
glaucoma (from optic nerve damage)
204
what are the 4 stages of diabetic retinopathy
```
R0 = no retinopathy
R1 = mild non proliferative retinopathy
R2 = moderate non proliferative retinopathy
R3 = severe non proliferative retinopathy
R4 = proliferative retinopathy
```
205
which type of retinopathy;
<4 haemorrhages (dot/blot haemorrhages, superficial flame)
cotton wool spots
R1 = mild non proliferative retinopathy
206
which type of retinopathy;
new vessel formation
vitreous haemorrhages (sudden change in vision)
tractional retinal detachment
R4 = proliferative retinopathy
207
which type of retinopathy;
hard exudates
>4 haemorrhages (dot/blot haemorrhages, superficial flame)
R2 = moderate non proliferative retinopathy
208
which type of retinopathy;
venous bleeding
>8 haemorrhages (dot/blot haemorrhages, superficial flame)
R3 = severe non proliferative retinopathy
209
why does ischaemia of the eye cause new vessel formation in diabetic retinopathy
induces TNF
210
what do you do for someone with non proliferative diabetic retinopathy (R1, R2 or R3)
review in 1 year
211
what do you do for someone with proliferative diabetic retinopathy (R4)
refer to ophthalmology
212
how do cotton wool spots arise in diabetic retinopathy
ischaemic areas with nerve damage
213
what are hard exudates in diabetic retinopathy
lipid breakdown products
214
what type of injections might someone with proliferative diabetic retinopathy get
why
anti-VEGF injections
prevent further new vessel formation
215
what is the treatment of someone with nephropathy on screening (2)
ACE inhibitor or ARB for hypertension
| renal replacement therapy - dialysis or transplant if decreasing GFR
216
what examination is used to screen for diabetic neuropathy (2)
microfilament exam
| low pitch tuning fork
217
what sort of distribution does diabetic neuropathy typically present with
glove stocking distribution
218
what is the programme used for recording diabetic screening called
sci-dc
219
what is the first microvascular complication of diabetes (typically)
peripheral neuropathy
220
what are complications of diabetic neuropathy (3)
bc of the lack of sensation
foot ulcers
charcot foot ('bag of bones')
painless trauma
221
why do foot ulcers occur in diabetic neuropathy
decreased blood supply to feet
222
what microorganism usually causes diabetic ulcers
staph aureus
223
what are the signs of AUTONOMIC neuropathy in diabetics (5)
erectile dysfunction
changes in bladder function
gastroparesis - weight loss, vomiting, bloating, loss of appetite
atypical sweating
no hypoawareness (when having a hypo they cant tell)
224
what level of blood glucose is hypoglycaemia
<4mmol/l
| '4 is the floor'
225
which type of diabetics get hypoglycaemia
type 1 (on insulin)
226
prevention of hypoglycaemia (3)
frequent blood glucose monitoring
eating regularly
tailoring insulin to meals (dont take too much!)
227
aetiology of hypoglycaemia (4)
after drinking alcohol
excessive
missed/delayed meals
too much insulin
228
presentation of hypoglycaemia (6)
```
hunger
irritability
palpitations
fatigue
cold
loss of consciousness/seizures
```
229
which condition is typically associated with hypoglycaemia (in exams!)
addisons
230
what happens when a non diabetic gets hypoglycaemia
counter regulation = increased glucose release from glycogen stores
231
treatment of hypoglycaemia in a conscious patient (3 options)
100ml Lucozade
4-5 glucotabs
15-20g of carbs/glucose
232
treatment of hypoglycaemia in a conscious but drowsy patient
where
glucose gel subbucally (absorbed in mouth)
233
treatment of hypoglycaemia in an unconscious patient (2 options)
IV glucose over 12 mins
| 1mg IM glucagon
234
what should you do after treating hypoglycaemia
then
recheck blood glucose 15 mins after treatment
if still hypo = fast acting glucose
if fine = carb snack
235
what is hyperosmolar hyperglycaemic state (HHS)
hyperglycaemia causing high osmolarity but without ketoacidosis
236
hyperosmolar hyperglycaemic state (HHS) risk factors (2)
elderly
| steroids
237
level of hyperglycaemia in hyperosmolar hyperglycaemic state (HHS)
v high <60
238
what is the difference between HHS and DKA
no ketoacidosis in HSS
239
how do you calculate osmolarity (equation)
2(Na + K) + urea + glucose
240
treatment of hyperosmolar hyperglycaemic state (HHS) (3)
diet
metformin
IV insulin
241
which has higher mortality HHS or DKA
HHS (hyperosmolar hyperglycaemic state)
242
aetiology of diabetic ketoacidosis (DKA) `
insulin omission
infection
intoxication (alcohol)
illness
the 4 i's
243
where are ketone bodies formed
by which process
liver mitochondria
lipolysis (breakdown of fat)
244
what happens when ketone bodies are in the blood
turn blood acidic
245
where do ketone bodies come from (biochemistry)
acetyl-CoA (from beta oxidation of fatty acids)
246
why are ketone bodies released in hyperglycaemia
no insulin = cells dont have glucose (its all in the blood), so need energy from somewhere else (ie ketones)
247
how do ketone bodies provide cells with energy
converted back into acetyl-CoA then go into TCA cycle = ATP generated
248
what do ketone bodies smell like
pear drops
249
what is the initial state of potassium in DKA
why
hyperkalaemia (but low in the cells)
no insulin = potassium cant be transferred into cells = build up of K in blood
250
what happens after hyperkalaemia in DKA
why (2)
hypokalaemia
1. so much K in blood that it is secreted in urine and vomiting
2. treatment of insulin starts to make the potassium go back into cells
251
how does insulin act on the Na/K pump
moves K into cells
252
consequence of hypokalaemia in DKA
arrhythmias (U waves on ECG)
253
presentation of DKA (6)
```
thirsty
nausea
vomiting
abdo pain
hyperventilation/kussmauls breathing
pear drop breath
```
254
what is the ABGs in DKA
metabolic acidosis from ketone bodies in blood
255
what is done to try and compensate for the metabolic acidosis in DKA
hyperventilation/kussmauls breathing
| to 'blow off' the acid in the blood
256
glucose levels in DKA
high >11
257
ketone levels in DKA
high >3
258
bicarb levels in DKA
low (acidosis
259
investigations for DKA (4)
urinalysis - ketones, potassium, glucose
bloods - glucose, ketones
ABGs
ECG
260
what is measured for ketones in blood
beta-hydroxybutarate
261
what is measure for ketones in urine
acetoacetate
262
treatment of DKA (4)
oxygen (ABCDE)
IV insulin slowly
IV fluids
IV potassium
263
is treatment of DKA different in kids and adults
yes slightly
| higher risk of cerebral oedema
264
which diabetes drug is associated with lactic acidosis
metformin
265
why is metformin contraindicated in renal failure
can cause lactic acidosis
266
investigations (and results) for lactic acidosis in a diabetic on metformin (4)
lactate >5
bicarb low
H+ high
raised anion gap
267
anion gap equation (for lactic acidosis, to tell if its different from other types of acidosis)
(Na + K) - (HCO3 + Cl)
268
why must ALL diabetics inform DVLA of condition
risk of hypo = collapse
269
which diabetes presents in young people
type 1
270
which diabetes does BMI not affect
type 1
271
which diabetes is family history more significant
type 1
272
which type of diabetes is likely to present with DKA
type 1
273
which type of diabetes is likely to present with HHS (hyperosmolar hyperglycaemia)
type 2
274
which type of diabetes is anti-GAD/IA2 antibodies present in
type 1
275
which type of diabetes is associated with no C peptide
type 1
276
kimmelstiel-wilson lesions
diabetic nephropathy
277
which glomerular layers are affected in diabetic nephropathy (2)
what does this result in
basement membrane thickening
podocyte dysfunction
proteinuria (proteins can leak through this barrier layer)
278
what is the initial GFR in diabetic nephropathy
| think about it!
increased GFR
to compensate for glomerular hypertension
279
what is the GFE in diabetic nephropathy after 20 years
| think about it!
reduced GFR
280
first sign of diabetic nephropathy
microalbuminurea
281
why do people pee lots in diabetes (hyperglycaemia) (3 steps)
1. hyperglycaemia = glucose excreted in urine
2. increase in urine osmolarity (high glucose conc) = creates an osmotic pull (osmotic diuresis)
3. pulls water into urine to compensate = increased urine output
282
what reabsorbs 90% of glucose from filtrate in tubules of the kidneys (normally and in hyperglycaemia)
SGLT1
283
in normal people what reabsorbs about 10% (remaining) glucose form the filtrate in the tubules of the kidney
SGLT2
284
in hyperglycaemia (glucose >11mmol/l), which transporter in the kidneys isnt able to reabsorb ALL the remaining glucose (like it usually does)
SGLT2
285
what happens to the glucose that isnt able to be reabsorbed by SGLT1 and SGLT2 in hyperglycaemia
excreted in urine
286
first sign of diabetic nephropathy
microalbuminuria
287
how might diabetic nephropathy present (2)
oedema
ascites
(nephrotic syndrome)
288
which other complication of diabetes is basically what causes diabetic nephropathy
hypertension
289
diabetic nephropathy
what does glomerular hypertension cause (5 steps)
```
increased glomerular pressure
= thickening of membrane
= nodular glomerulus sclerosis (scarring)
= non effective filter in kidneys
= proteinuria
```
290
diabetic nephropathy
histology appearance (and hence pathology)
nodular glomerular sclerosis (scarring of kidney)
291
diabetic nephropathy
scarring of membrane causes ineffective what
filtration
292
diabetic nephropathy
ineffective filtration at glomerulus causes leakage of ... into urine (+ clinical condition)
proteins (proteinuria)
293
another name for diabetic nephropathy
kimmelsteil Wilson syndrome/lesion
294
what syndrome does diabetic nephropathy present as (nephrotic or nephritic)
why
nephrotic
proteinuria = oedema
