Diabetes and its treatment Flashcards Preview

Year 3 Human Disease > Diabetes and its treatment > Flashcards

Flashcards in Diabetes and its treatment Deck (48):
1

how is insulin made

beta cells of pancreas --> proinsulin --> breaks down in to C peptide and insulin

2

effects of insulin

decreases blood glucose
increases glucose in liver, kidneys, muscle

3

normal range of blood glucose levels

4-7M/m

4

define diabetes

metabolic disorder characterised by chronic hyperglycaemia resulting from defects in insulin secretion/ action/ both

5

difference between type 1 and type 2 insulin

type 1: insulin deficiency. autoimmune destruction of pancreas
type 2: insulin resistance (due to other hormones/ obesity)

6

why is obesity linked to insulin type 2 diabetes 2

hormones linked to obesity prevent insulin binding to receptor IRS1
mutations of 2nd messengers

7

what is cut off point for having diabetes

4-7m/M normal
8-10 impaired glucose tolerance
11 M/m DIABETES

8

IGT stand for and relevance to diabetes

impaired glucose tolerance
50% go on to develop diabetes

9

how doe HbA1c test for diabetes work

looks at glucose over ast 2-3 months (lifetime of current haemoglobin

10

HbA1c cannot pick up rapid changes, so do not use...

cannot pick up rapid changes, so do not use:
-children/ young people
-symptoms suggesting type 1 diabetes
-short duration diabetes symptoms
-pts at high risk of diabetes who are acutely ill
-pts taking medication that may cause rapid glucose rise eg corticosteroids

11

when HbA1c can be innacurate

**TABLE ON DIAGNOSIS VALUES**

-HIGH HbA1c 2: persistant HbF (thalassaemia), uraemia (carbamylates Hb) *high HbF Fucking High)
-LOW HbA1c 2: haemolysis, inc red cell turnover, blood loss (HbS, HbC, Low and SexC)

12

3 types of diabetes

1,2, gestational

13

2 types of pre diabetes

impaired fasting glycaemia
impaired glucose tolerance

14

impaired fasting glycaemia:
a. cause
b. risk of diabetes
c. risk of disease
d. treatment
e. preventing progress to diabetes

a. cause: unknown, ?glucose sensitising
b. risk of diabetes: 50%, 50% recovery to normal
c. risk of disease: not known
d. treatment: healthy diet, yearly glucose checks
e. preventing progress to diabetes: not known

15

impaired glucose tolerance:
a. cause
b. risk of diabetes
c. risk of disease
d. treatment
e. preventing progress to diabetes

a. cause: insulin resistance
b. risk of diabetes: 50%, 50% return to normal
c. risk of disease: heart disease, cerebrovascular disease
d. treatment: diabetic diet, yrly glucose checks, tx of cardiac risk factors
e. preventing progress to diabetes: exercise, weight loss

16

causes other than diabetes for
a. insulin deficiency
b. insulin resistance

a. insulin deficiency: cancer/ alcohol --> destroy pancreas
b. insulin resistance: receptor abnormalities (leprechaunism, insulin resistance symptoms A and B)
excessive hormones (cushing's, acromegaly)

17

type 1 diabetes:
a. incidence
b. cause
c. pathology

a. incidence: 1/10 000, M>F, normally

18

6 symptoms of type 1 diabetes

-polyuria (bedwetting)
-thirst esp for sugary drinks
-weight loss
-dehydration
-ketoacidosis
-coma

19

possible genes for type 1 diabetes

DR3, DR4

20

new options for type 1 diabetes tx

-insulin pumps (continuous insulin --> less hypos but v expensive)
-inhaled insulin (only 1/10 dose absorbed. long term safety not known)
-islet cell transplant (beta cells)
-pancreas transplant

21

type 2 diabetes
a. incidence
b. cause
c. pathology

a. incidence: 1/1000 (more undiagnosed), m=f, normally >40
b. cause: genetic > environment
c. pathology: insulin resistance, insulin deficiency

22

relationship between birthweight and type 2 diabetes

low birthweight, go on to be heavy adults --> higher risk of diabetes

23

4 things which contribute to type 2 diabetes development

birthweight
genetics
exercise
fat distribution (upper body obesity ie in abdomen mroe risk of diabetes)

24

2 step model of type 2 diabetes

genetic predispositon -->
insulin resistance -->
relative lack of insulin -->
hyperglycaemia

diet/ activity levels/ level of obesity all contribute to this process

25

3 types of presentation of type 2 diabetes

-non-symptomatic: routine screening urine/ RPG
-metabolic: thirst, polyuria (less acute than type 1)
-non-metabolic 8: blurred vision, intertrigo, peripheral neuropathy, angina/MI, UTI, pruitis vulvae/ balanitis, peripheral vascular disease, foot ulcers

26

type 2 diabetes tx for
a. thin people
b. fat people

a. thin people: diet, exerise -> sulphonylureas -> +metformin -> +newer drugs -> insulin
b. fat people: diet, exercise, weight loss -> metformin -> +sulphonylureas -> +newer drug -> insulin

27

what is the incretin effect

twice as much insulin released when glucose taken orally compared to IV due to GLP1 (glucagon like receptor 1)

28

5 effects of GLP1 and what does it stand for

glucagon-like-receptor 1
pancreas (2):-- enhances glucose-dependent insulin secretion in beta cells of pancreas
--alpha cell suppression of postprandial glucagon secretion
-reduces hepatic glucose production
-slows rate of gastric emptying
-promotes satiety, reduces appetite

29

what causes GLP-1 secretion

ingestion of food

30

what is HbA1c and its relationship with diabetes

glycated haemoglobin
indicates blood glucose level --> high HbA1c, high risk of diabetes

31

mechanism of dapagliflozin

*TABLE ON DIABETES DRUGS*

Blocks SGLT2 in proximal tubule of kidney --> less reabsorption

32

list
a. insulin sensitisers
b. insulin releasers
c. insulin replacement

a. insulin sensitisers: thiaolidinediones, metformin
b. insulin releasers: sulphonylureas, meglitinides
c. insulin replacement: insulin

33

treatment of gestational diabetes

85% diet
15% diet + insulin

34

4 factors increasing risk of gestational diabetes

obese
previous diabetes in pregnancy
asian
age >35

35

when in pregnancy does gestational diabetes often occur

2nd/3rd trimester

36

future prospect of gestational diabetes

50% get diabetes in next 5 yrs
15% get diabetes in next pregnancy

37

complications of gestational diabetes 3

-large baby
-stillbirth
-death of mother

38

acute complications of diabetes 2

hypoglycaemia
diabetic comas

39

chronic complications of diabetes 6

microvascular 3: neuropathy, retinopathy, nephropathy
macrovascular 3: IHD, CVA, PVD

40

symptoms of hypoglycaemia:
a. early warning
b. mild
c. more advanced
d. unconsious

a. early warning: shaking, trembling, sweating, pins&needles, hunger, headache, palpation
b. mild: double vision, slurred speech, difficulty concentrating
c. more advanced: confusion, change of behaviour
d. unconscious: epileptic fits, weakness

41

draw diagram of normal hormonal responses to hypoglycaemia
list whats missing in diabetes

see lecture
diabetes:
-no adrenaline to increase hepatic glucose production
-no glucagon to increase hepatic glucose production

42

3 causes of hypoglycaemia

-missed meal
-too much insulin
-alcohol

43

treatment of hypoglycaemia if the pt is:
a. conscious
b. drowsy
c. unconscious

a. conscious: oral glucose
b. drowsy: hypostop
c. unconscious: s/c glucagon, IV 50% dextrose

44

2 types of diabetic comas

-diabetic ketoacidosis (DKA) with type 1 diabetes
-hyperosmolar non-ketoic hyperglycaemia (HONK)

45

risk of these with each type of diabetes
a. retinopathy
b. neuropathy
c. nephropathy

a. retinopathy: 100% type 1 pts
b. neuropathy: increase with time. 70-100%
c. nephropathy: 30-40% type 1, less in type 2 pts

46

are micro/ macrovascular complications present in impaired glucose tolerance (IGT)

macrovascular

47

what reduces risk of macrovascular complications

metformin

48

what is made in the following pancreatic cells
A cells
B cells
D cells

A cells: glucagon (A away, glucose away)
B cells: insulin
D cells: somatostatin