diabetes and its treatments Flashcards
(20 cards)
Distinguish between the 2 types of diabetes
Which is more common?
Type 1 - insulin deficiency Type 2 - impaired beta-cell function and/or loss of insulin sensitivity (more common)
List at least 3 signs and symptoms of DM
An additional 2 more common in T1DM?
DM: glucosuria polyuria, thirst fatigue and malaise blurred vision infections
T1DM - weight loss
ketoacidosis (N&V, acetone breath)
what is the normal fasting, random plasma glucose ranges, and OGTT (oral glucose tolerance test)
fasting <7
random <11.1
OGTT = if above >11.1 diagnosis of diabetes
What is the normal range of HBA1C? Above what is diabetes?
normal = 20-42 mmol/mol diabetes = >48mmol/mol
What is HBA1C a measure of?
indicator of glycaemic control during the previous 2-3 months
What conditions required for a person to be diagnosed with DM?
presents with signs and symptoms and levels of plasma are not in the normal ranges for fasting, random, OGTT or HbA1c
what are the ranges for impaired glucose control? Impaired fasting glycaemia?
Impaired glucose control
normal fasting, random or OGTT >7.8 but <11.1
Impaired fasting glycaemia
fasting >6.1 but <7
so one the high end
they have pre-diabetes and at an increased risk of diabetes and CVD
What kind of disease is T1DM? Treatment options?
autoimmune progressive destruction of islet beta-cells treatment: -insulin -regular exercise -healthy diet
What’s ketogenesis (what are the ketones)? What are the acidic parts? Why does this happen more commonly in T1DM rather than T2DM?
ketogenesis - synthesis of ketone bodies by the liver, from fatty acid breakdown products
acidic parts are the acetoacetate = beta-hydroxybutyrate part
happens more commonly in T1DM as they lack insulin, the process of ketogenesis isn’t inhibited. As insulin in T2DM insulin is present, ketogenesis is inhibited.
How is hepatic ketogenesis usually regulated?
inhibited by insulin
stimulated by glycagon
What danger does this pose?
in starvation and T1DM, ketosis can lead to metabolic acidosis (decrease in blood pH)
What’s the main principle behind the insulin schedule for T1DM?
based on the lifestyle of patient
What is lipodystrophy and how can you avoid it?
complication of subcutaneous insulin injection
avoid by rotating injection areas
Explain the natural history of T2DM in terms of insulin levels, glucose levels, and insulin insensitivity
insulin levels increase to compensate for resistance, rise in prediabetes
glucose levels is maintained for a while but then increase when beta-cell starts to struggle
insulin insensitivity can happen years before pre-diabetes
What are 4 other causes of T2DM?
secondary:
endocrine: Cushing’s, acromegaly
pancreatic disease: chronic pancreatitis, surgery, cystic fibrosis
genetic disorders: Down’s syndrome, Prader-Willi
drug induced: steroids, beta blockers, diuretics
Explain all the steps of treatment of T2DM
diet/lifestyle interventions metformin or SU or DPP-4i or pioglitazone duel therapy triple therapy start insulin intensify insulin regime or add drugs
How do the following drugs work? Metformin, Sulphonylureas, Prandial Glucose regulators, pioglitazone
METFORMIN = might activate AMP kinase, decreases gluconeogensis and increase glucose utilisation
SULPHONYLUREAS and PRANDIAL GLUCOSE REGULATORS - stimulate insulin secretion - via blockade of islet beta-cell and bind to ATP-sensitive K+ channel cells to release insulin
PIOGLITAZONE - promotes lipid met
Acarbose? Incretin mimetics? DPP-4 inhibitors?
ACARBOSE - delays digestion and absorption of starch and sucrose
INCRETIN MIMETICS - incretin response to decrease, promotes insulin release, reduce glucagon secretion and reduces gastric emptying and promotes satiety (controls food intake)
DPP-4 INHIBITORS - same as above
SGLT-2 inhibitors – how do they work?
Sodium-glucose co-transporter 2 inhibitors
inhibit renal glucose reabsorption to increase urinary glucose excretion
Under what circumstances would bariatric surgery be indicated for patients with T2DM?
BMI >40
or BMI >30 (failed to lose weight and failed drug intervention)
