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Chemical pathology > Diabetes > Flashcards

Flashcards in Diabetes Deck (10)
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1
Q

Diabetic values

A

> 11.1 random
7 fasting
11.1 OGTT
48 HbA1c

2
Q

Diagnostic criteria DM

A

Symptoms + Random / Fasting / OGTT

No symptoms + 2 of Random / Fasting / OGTT

3
Q

Impaired glucose tolerance values

A

6-7mmol/L fasting

7.9-11mmol/L OGTT

4
Q

Inhibits alpha glucosidase in brush border of small bowel, leaving undigested sugar in the bowel
Side effect = wind

A

Acarbose

5
Q

Inhibits DPP-IV enzyme

DPP-IV degrades GLP-1 (GLP-1 stimulates insulin release)

A

Gliptin

6
Q

How does glucose stimulate insulin release?

A

Glucose is absorbed into B-cells and used to generate ATP
ATP closes ATP-sensitive K+ channel so K+ can’t leave cell
Cell depolarises and releases insulin

7
Q

Closes K+ channels on B-cells independent of ATP

Can cause hypoglycaemia

A

Sulphonylureas (e.g. gliclazide, glibenclamide)

8
Q

Block SGLT2 in kidney to stop glucose absorption

A

SGLT2 inhibitors (gliflozins)

9
Q

Regarding ACEi in diabetics

A
  • Diabetic nephropathy is a problem in diabetics
  • ACEi prevent progression to end stage renal failure - given to diabetics UNLESS CI like bilateral renal artery stenosis
  • BUT ACEi initially cause a worsening renal function + rise in creatinine
  • Normally JGA detects reduced GFR + secretes renin to increase angiotensin II production + constrict the efferent arteriole, raising glomerular pressure + increasing GFR
  • ACEi inhibits this from happening so there is a slight decrease in GFR (but this will recover over time)
  • The real reason we give ACEi in diabetes though is to reduce microalbuminuria + the benefit over this outweighs the initial reduction in GFR
  • SO the overall message is to continue giving ACEi despite initial decrease in GFR
10
Q

What are the main diabetic drugs?

A

Acarbose - inhibits alpha-glucosidase in brush border
Gliptin - inhibits DPP-IV to stop degradation of GLP-1
Sulphonylureas (gliclazide, glibenclamide) - close K+ channels independent of ATP to depolarise and release insulin
SGLT-2 inhibitors - inhibit SGLT glucose uptake channels in kidney