Diabetes And Hypoglycaemia Flashcards by Amal Seghir

How are blood glucose levels maintained?

Dietary carbohydrates

Glycogenolysis

Gluconeogenesis

How well did you know this?

Not at all

Perfectly

What is the effect of increased insulin?

Decreased liver production of glucose

Liver nutrients uptake

Increase peripheral uptake + decrease peripheral catabolism

How well did you know this?

Not at all

Perfectly

What occurs to the insulin levels in the fasting state?

Insulin levels decrease to try increase glucose production

How well did you know this?

Not at all

Perfectly

How does decreased insulin increase glucose production in the fasting state?

Increase liver gluconeogenesis

Decrease peripheral uptake

Increase proteolysis and lipolysis

How well did you know this?

Not at all

Perfectly

Why is it important to maintain plasma glucose level?

Enough to fuel the body.

Brain and erythrocytes require a continuous supply of glucose

How well did you know this?

Not at all

Perfectly

How is high plasma glucose level regulated in the body?

High blood sugar levels are detected by beta cells in the pancreas
Beta cells release insulin into the blood stream
Insulin stimulates glucosereuptake from the blood into tissues
Insulin also stimulates glycogen formation in the liver

How well did you know this?

Not at all

Perfectly

How is low plasma glucose concerntration maintained?

Low blood sugar is detected by alpha pancreatic cells
Glucagon released from alpha cells
Glucagon breaks down glycogen in the liver
Increases blood glucose level

How well did you know this?

Not at all

Perfectly

What is the role of insulin in the liver?

Decrease Gluconeogenesis

Increase glycogen synthesis

Increase lipogenesis

How well did you know this?

Not at all

Perfectly

What is the role insulin the striated muscle?

Increase glucose uptake

Increase glycogen synthesis

Protein synthesis

How well did you know this?

Not at all

Perfectly

What is the role of insulin in adipose tissue?

Increase glucose reputake

Increase lipogenesis

Decrease lipolysis

How well did you know this?

Not at all

Perfectly

What is the role of epinephrine in controlling blood glucose concerntration?

Mobilises fuels in acute stress

Stimulates glycogenolysis

Stimulates fatty acid release

How well did you know this?

Not at all

Perfectly

What is the role of cortisol in controlling plasma glucose concerntration?

Changes long term

Stimulates glyconeogenesis And amino acid mobilisation

How well did you know this?

Not at all

Perfectly

What is the role of growth hormone in controlling plasma glucose concerntration?

Inhibits insulin action

Stimulates lipolysis

How well did you know this?

Not at all

Perfectly

What is diabetes mellitus?

A metabolic disorder charecterised by chronic hypoglycemia

And often associated with abnormalities of lipid and protein metabolism

How well did you know this?

Not at all

Perfectly

What are the 4 types of diabetes patients can be classified into?

Type 1

Type 2

Secondary

Gestational

How well did you know this?

Not at all

Perfectly

What is type 1 diabetes?

Deficiency in insulin secretion

Sudden onset (days/weeks)

In young children or young adults.

Appearance of symptoms may be proceeded by a “pre diabetic” period of several months

How well did you know this?

Not at all

Perfectly

What is type 2 diabetes?

Insulin secretion is retained but there is target organ resistance to its actions

Slow onset (months/years)

Patients middle aged/elderly

How well did you know this?

Not at all

Perfectly

What is secondary diabetes?

Chronic pancreatitis

Pancreatic surgery

Secretion of antagonists

How well did you know this?

Not at all

Perfectly

What is gestational diabetes?

Occurs for the first time in pregnancy

How well did you know this?

Not at all

Perfectly

What causes type 1 diabetes?

Autoimmune destruction of B cells

Due to interaction between genetic and environmental factors

strong link with HLA genes on chromosome 6

How well did you know this?

Not at all

Perfectly

What is the pathogenisis of type 1 diabetes?

Auto antigens form on insulin producing beta cells and circulate in the blood stream and lymphatics
Processing and presentation of auto antigens by antigen presenting cells (T lymphocytes)
Activation of
- macrophages
- autoantigen specific cytotoxic T cells
- B lymphocytes to product islet cell auto antibodies + antiGADs antibodies

Most commonly detected antibody associated with type 1 is islet cell antibody

Destruction of beta cells with decreased insulin secretion

How well did you know this?

Not at all

Perfectly

What is amylin?

Study These Flashcards

A glucoregulatory peptide hormone co-secreted with insulin

Lowers blood glucose by slowing gastric emptying + suppressing glucagon output from pancreatic cells

What causes hyperglycemia?

Study These Flashcards

Deficiency in insulin and amylin

What is polyphagia?

Study These Flashcards

Excessive eating or appetite

Due to to hyperglycemia

What is polydipsia?

Excessive thirst or drinking Due to increased volume depletion in urine

How can ketoacidosis occur as a result of insulting deficiency in type 1 DM?

1. Increased lipolysis 2. Increased fatty acids 3. Increased fatty acid oxidation in the liver 4. Ketoacidosis (DKA)

What causes type 2 diabetes?

Genetic predisposition and obesity + lifestyle factors Insulin resistance - Beta cell disfunction

What is the pathophysiology of type 2 diabetes?

1. Combination of genetic predisposition and obesity and lifestyle factors cause insulin resistance 2. Compensatory beta cell hyperplasia (normoglycaemia) 3. Early Beta cell failure (impaired glucose tolerance 4. Late Beta cell failure (diabetes)

What are the metabolic complications of type 2 diabetes?

Dehydration Thrombosis Cerebral dehydration

Explain how type 2 diabetes can cause dehydration.

1. Glycosuria due to hyperglycemia 2. Osmotic diuresis 3. Loss of water and electrolytes

Explain how type 2 diabetes can cause thrombosis

Increased blood viscosity due to the increased plasma osmolarity

Explain how type 2 diabetes causes cerebral dehydration.

Increased plasma osmarity due to hyperglycemia

How diabetes diagnosed?

When symptoms are present: Random plasma glucose > 11.1 mmol/l Fasting plasma glucose > 7.0 mmol/l Oral glucose tolerance test (OGTT) - plasma Glu > 11.1 mmol/l In abscense of symptoms: Test blood samples on 2 separate days

How can glycated Haemoglobin (HbA1c) be used to detect diabetes?

Reflects the average plasma glucose over 8 to 12 weeks Performed any time of the day Initially used as glycaemic control, but now used for diagnosis > 6.5% is diabetic HOWEVER, may be effected by a variety of genetic, haematologic disorders

How is impaired glucose tolerance (IGT) diagnosed in pre-diabetes?

Fasting plasma glucose > 7 mmol/L OGTT value of 7.8 - 11.1 mmol

How is impaired fasting Glycaemia (IFG)?

Fasting plasma glucose 6.1 to 6.9 mmol/L OGTT value of < 7.8 mmol/L

What is the use of the oral glucose tolerance test?

To check the body’s ability of metabolising glucose - in patients with IFG - in unexplained glycosuria - in clinical features of diabetes with normal plasma glucose values

How is the oral glucose tolerance test carried out?

75g oral glucose and test after 2 hour Blood samples collection at 0 and 120 mins after glucose

What are the treatments of type 2 diabetes?

- Diet and exercise - Oral monotherapy (metformin) - Oral combination - insulin injection and oral agents

What drugs are used to treat type 2 diabetes?

Metformin Sulfonylureas Thiazolifinediones SGLT2 inhibitors Incretin targeting drugs: - DPP-4 inhibitors (prevent breakdown of natural incretins) - GLP-1 agonist

What is the aim of monitoring glycaemic control?

To prevent complications or avoid hypoglycaemia

What are ways to monitor glycaemic control?

Self monitoring to be encouraged: using analysis and capillary blood measurement 2-3 months: blood HbA1c Others: urinary albumin

What are long term complications of type 1 and 2 diabetes?

Micro vascular disease - retinopathy, neuropathy, nephhropathy Macro vascular disease - related to atherosclerosis heart attack/stroke MECHANISMS OF COMPLICATIONS UNCLEAR

What is hypoglycaemia?

Plasma glucose level < 2.5 mmol

What are the causes of hypoglycaemia?

Drugs are the most common cause - common in type 1 diabetes - less common in type 2 diabetes taking insulin Tumour in the pancrease

What are some sulfonylureas that cause hypoglycaemia?

Glyburide Glipzide Glimepiride

How can hypoglycaemia occur in patients without diabetes?

Drugs such as alcohol Endocrine diseases eg. Cortisol disorder Inherited metabolic disorders eg. Hereditary fructose intolerance Insulinoma - tumour in beta cells

What is the role of ethanol in hypoglycaemia?

Inhibit Gluconeogenesis but not glycogeolysis Hypoglycaemia will typically follow several days alcohol binge with limited food intake

What is the role of sepsis in hypoglycaemia?

Cytokines acceleration glucose utilisation nduced inhibition of gluconeogenesis in the setting of glycogen depletion.

What is the role of CDK in hypoglycaemia?

Mechanism not clear - impared Gluconeogenesis Reduced renal clearance of insulin Reduce renal glucose production

What is reactive hypoglycaemia (hypo after eating)?

Drop sin blood sugar level usually reccurant and occur within four hours after eating

What is the cause of reactive hypoglycaemia?

CAUSE UNCLEAR Possibly a benign tumour in the pancreas may cause overproduction of insulin Too much glucose may be used by the tumour itself Deficiency’s in counter regulatory hormones eg. Glucagon

What are the NEUROGENIC (autonomic) signs and symptoms of hypoglycaemia?

Mediated by sympathoadrenal release of catecholamines and ACh Mood changes Paleness Trembling Sweating Dizziness Blurred vision Headache Extreme tiredness Hunger

What are the NEUROGLYCOPAENIA signs and symptoms of hypoglycaemia?

Due to neuronal glucose deprivation Confusion Difficulty speaking Ataxia Parenthesia Seizures Coma Death

Diabetes And Hypoglycaemia Flashcards

(54 cards)