Diabetes and Metabolic Syndrome Flashcards Preview

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Flashcards in Diabetes and Metabolic Syndrome Deck (24):
1

Alpha Cells

secrete glucagon --> which elevates glucose and causes liver/kidney to secrete and retain glucose

2

Beta Cells

secrete insulin, C-peptide, and amylin

3

Type 1 Diabetes

autoimmune destruction of beta-cells in islet of Langerhans leading to absolute insulin deficiency
- rapid onset, 50% concordance in monozygotic twins
- "honeymoon" phase can be present
- antibodies to glutamic acid decarboxylase-65

4

Type 2 Diabetes

progressive insulin secretory defect on background of insulin resistance (80% of beta-cell function is lost at time of diagnosis)
- insidious onset, environmental factors contribute
- abnormal insulin action and secretion
- impaired suppression of glucagon

5

Things that lead to hyperglycemia

1. Decreased incretin
2. Decrease insulin secretion
3. Increased glucagon secretion
4. Increased HGP
5. Neurotransmitter dysfunction
6. Decreased glucose uptake
7. Increased glucose reabsorption
8. Increased lipolysis

6

Gestational Diabetes

diagnosed during pregnancy with glucose tolerance test
- first hour challenge if >140, do more

7

Screening for diabetes

Overweight individuals with >1 risk factor
- physical inactivity
- 1st degree relative
- high risk ethnicity
- woman with baby > 9lbs
- HTN
- high cholesterol/triglycerides
- women with POCS
- history of CVD

8

Diagnosis of Diabetes

- fasting glucose of >126 on 2 occasions
- random glucose of >200 with symptoms
- plasma glucose >200 after glucose load
- glycosylated hemoglobin >6.4% (GOLD STANDARD)

9

Complications of diabetes

Microvascular
- retinopathy, neuropathy, nephropathy
Macrovascular
- CVD, claudication, CAD

10

Labs for diabetes

glucose, A1c, lipids, renal panel, microalbumin (urine), TSH, hepatic
- every diabetic should be on a statin

11

Treatment of Type 1 diabetes

INSULIN!
- intensive therapy with tight control decreases risk of chronic microvascular complications

12

Treatment of Type 2 diabetes

First line therapy --> diet, exercise, education
MANY DRUGS
- always metformin
- sulfonylureas
- alpha-glucosidase inhibitors
- thiazolinediones
- amylinomimetics
- incretin modulators

13

Metformin (glucophage)

decreases hepatic glucose production
- no hypoglycemia, weight neutral, lipid lowering
- decreases macrovascular complications!
- S.E. = GI
- contraindicated in someone with renal impairment (high creatinine) --> lactic acidosis

14

Sulfonylreas

bind sulfonylurea receptors on beat-cells and stimulate insulin release --> requires pancreas function!
S.E. = hypoglycemia, weight gain, potential impairment of cardiac ischemic preconditioning
- decreased effectiveness with prolonged use

15

Thiazolidinediones

increases amount of glucose taken up by muscle cells --> keeps liver from over-producing glucose
- no hypoglycemia, lipid lowering, and reduces macrovascular complications
S.E. = edema, CHF, fractures in women, MI?
EXPENSIVE

16

Incretin Mimetics

GLP-1 -> activates GLP-1 receptors -> increase glucose-dependent insulin secretion, decrease glucagon, delay gastric emptying (affects other drug administration)
DPP-IV inhibitors -> inhibit degradation of GLP-1
- no hypoglycemia
S.E. = N/V, pancreatitis
EXPENSIVE

17

Risk of pancreatitis with diabetes drugs

Linked to both DPP-IV inhibitors and GLP-1 agonists --> not really sure --> inconclusive evidence

18

Sodium Glucose Cotransporter 2 inhibitor

inhibits SGLT 2 transporter in kidney -> less glucose reabsorbed --> lower blood glucose

19

Insulin therapy

GOAL IS TO MIMIC NATURAL INSULIN RELEASE`

20

Glycemic Targets

HbA1C = <7
- if A1c elevated, consider dual therapy, or triple therapy

21

Associated Metabolic Abnormalities

steatohepatitis -> fatty liver
elevated TAG, low HDL
hyperuricemia
acanthosis nigricans

22

Metabolic Syndrome

3 or more of following factors
1. waistline >40 inches (men), >35 inches (women)
2. BP >130/85 or taking BP medication
3. Triglycerides above 150
4. Fasting blood glucose >100 or taking meds
5. HDL <50 (women)

23

When lifestyle modifications aren't enough

Statins -> cholesterol
ACEi -> BP control
other diabetic drugs may be useful, possible metformin

24

Risks with metabolic syndrome

Heart disease, diabetes, stroke all increase with # of factors you have
- most common in mexican americans