Diabetes Mellitus Flashcards
(121 cards)
1
Q
How does Hyperglycemia present? (5)
A
Polydipsia Polyuria Blurred Vision Weight Loss Infection
2
Q
How to Diagnose Diabetes? (4)
A
Venous Plasma Fasting >7
Random Plasma Fasting >11.1
OGTT >11.1
HBA1C >48
3
Q
What is Hba1c?
A
Glycated Haemoglobin
4
Q
Hba1c provides indication of what?
A
Blood Glucose over last 8-12 Weeks
5
Q
Hba1c cannot be used to diagnose diabetes in who? (8)
A
Children Pregnant or <2 Months Pregnant Short Duration Symptoms Acutely Ill Meds that increase glucose eg corticosteroids, antipyschotics Pancreatic Surgery Renal Failure HIV
6
Q
What is the only hormone to lower blood glucose?
A
Insulin
7
Q
What hormone dominates absorptive state?
A
Insulin
8
Q
Pancreatic A cells act on?
A
Glucagon
9
Q
Pancreatic B Cells act on?
A
Insulin
10
Q
What happens to Lipolysis in Type 1 Diabetes?
A
Increased
11
Q
What happens to Glucose in Type 1 Diabetes?
A
Increased
12
Q
What happens to Glucose Uptake in Type 1 Diabetes?
A
Decreased
13
Q
Monozygotic Twins Genetics of Type 1 Diabetes percentage?
A
30-50%
14
Q
Father Genetics of Type 1 Diabetes percentage?
A
6%
15
Q
Mother Genetics of Type 1 Diabetes percentage?
A
1%
16
Q
Siblings Genetics of Type 1 Diabetes percentage?
A
8%
17
Q
Non Identical Twin Genetics of Type 1 Diabetes percentage?
A
10%
18
Q
Both Parents Genetics of Type 1 Diabetes percentage?
A
30%
19
Q
identical twin Genetics of Type 2 Diabetes percentage?
A
90-100%
20
Q
1 parent Genetics of Type 2 Diabetes percentage?
A
15%
21
Q
both parents Genetics of Type 2 Diabetes percentage?
A
75%
22
Q
Siblings Genetics of Type 2 Diabetes percentage?
A
10%
23
Q
Non Identical twin Genetics of Type 2 Diabetes percentage?
A
10%
24
Q
Type 2 Diabetes can present with what infections (3)?
A
Low Grade Infection
Thrush
Balantitis
25
A big baby >4kg can make mother at risk of what type of Diabetes?
Type 2
26
What type of diabetes is genetic?
MODY
27
MODY in Diabetes is what genes?
Autosomal Dominant
28
What is impaired in MODY Diabetes? (3)
Beta Cell Function
Glucokinase Mutations
Transcription Factor mutations
29
Glucokinase Mutations in MODY are what? (3)
Onset at Birth
Stable Hyperglycemia
Treat through Diet
30
Transcription Factor Mutations in MODY are what?
HNF1a, 1b or 4a
31
Transcription Factor Mutations in MODY happen when?
Adolescence/Young Adult
32
What is Haemochromotosis?
Excess Iron
33
Secondary Diabetes can present when? (4)
Haemochromotosis
Pancreatic Destruction
Cystic FIbrosis
Pancreactomy
34
Gestational Diabetes does what to insulin?
Increased Insulin Resistance
35
Gestational Diabetes risks?
Family History of Type 2 Diabetes
36
Gestational Diabetes presents particularly when?
2nd/3rd Trimester
37
What neonatal problems does gestational diabetes bring? (3)
Neonatal Hypoglycemia
Respiratory Distress
Macrosomia
38
How long should someone wait to drive after a hypo?
45 minutes
39
What can a diabetic not eat?
Simple Carbs
40
Alcohol does what to Glycogenolysis?
Decreases
41
How many units of alcohol does it take to increase hypo risk?
2-3 Units
42
If HBA1C is high in Type 1 diabetes what does that increase risk of?
DKA
43
How to early diagnose Type 1 Diabetes?
Finger Prick Capillary Glucose >11
44
Insulin Features? (3)
Polypeptide
Inactivated by GI Tract
Hexamer into Monomer
45
Increased Risk of Absolute Insulin Deficiency with? (4)
Cortisol
GH
Glucagon
Catecholamines
46
Insulin deficiency does what to Free Fatty Acids in Liver?
Increased
47
Insulin deficiency does what to Gluconeogenesis?
Increased
48
DKA presents with? (4)
Ketonuria
Ketonaemia
Metabolic Acidosis
Hyperglycemia
49
Sick Day Rules of Type 1 Diabetes?
Ketones +3 = Hospital
50
How to Treat DKA? (3)
Actrarapid
0.9% Saline
10% Dextrose
51
Complications of DKA? (8)
```
Hypo/Hyper Kalaemia
Hypoglycemia
Rebound Ketosis
Arrythmia
Cerebral Oedema (Kids in Particular)
Aspiration Pneumonia
Thromboembolism
ARDS
```
52
Hypoglycemia: Blood glucose is what?
<4
53
Causes of Hypoglycemia (3)
Too much Insulin
Exercise
Alcohol
54
How to treat Mild Hypoglycemia?
Dextrosol or 200ml Fruit Juice
55
How to treat Severe Hypoglycemia?
IV Glucose
56
Which four drugs can be used to treat Insulin Release?
Sulphanylureas
Metiglinides
Incretin
DDDIV Inhibitors
57
What drug can increase excretion of glucose?
SGLT1 Inhibitors
58
What drugs can increase insulin action? (4)
Biguamides
Thiazidones
Reduce Weight
Exercise
59
1st Line Diabetes Treatment?
Lifestyle then Metformin
60
2nd and 3rd Line Diabetes Treatment when have CV Disease? (2)
GLP1 Agonist
| SGLT2 Inhibitor
61
Name 2 GLP1 Agonists?
Liraglutido
| Semaglutide
62
Name a SGLT 2 Inhibitor?
Empagliflozin
63
What diabetes drugs should not use together? (2)
DPPIV inhibitor and GLP1 Agonist
64
Metformin acts on? (2)
Liver and Muscle
65
SGLT2 Inhibitor acts on?
Kidney
66
Glitazone acts on?
Adipose, Muscle and Liver
67
Metformin is what type of drug?
Biguanide
68
Action of Metformin?
Increase Insulin Sensitivity and Decrease FA Synthesis
69
Risks of Metformin (3)
Renal and Liver Failure
Malabsorption
Don't use with EGFR <30
70
Name 3 Sulphonylureas?
Glimepiride, Glicazide and Glipzide
71
When are Sulphonylureas first choice? (3)
Osmotic Symptoms or Hba1c Increases
| Peeing More/More Thrush
72
Sulphonylureas binds to?
SUR1 Receptors or Beta Cells
73
Sulphonylureas does what to potassium?
Decreased Potassium Influx Depol of Beta Cell Membrane
74
Sulphonylureas are metabolised where?
Liver
75
Sulphonylureas have risk of?
Hypos
76
Sulphonylureas should not be used when? (4)
Renal or Liver Issues
| Pregnant/Breast Feeding
77
Pioglitzaone stimulates?
PPAR-Gamma
78
Pioglitozone does what to insulin?
Decreases Insulin resistance
79
Pioglitozone does what to Hba1c?
Decreased Hba1c in Blood, Glucose and Insulin
80
Pioglitozone increases risk of? (3)
Bladder Cancer, Fluid Retention and Fractures in Females
81
Name 3 DPPIV Inhibitors?
Saxagliptin, Sitagliptin and Vildagliptin
82
Action of DPPIV Inhibitors? (4)
Decreased breakdown of Incretins
Increased Insulin from Peripheral Glucose
Increased GLIP1 and GLP Gut Hormones
Decreased Glucagon from Alpha Cells
83
What drug in diabetes has no hypo risk?
Pioglitozone
84
When can Pioglitozone not be used?
Pregnant/Breastfeeding
85
GLP1 Analogue are what drugs?
Tides
86
Actions of GLP1 Analogue? (2)
Decreased Glucagon
| Increased Insulin
87
GLP1 Analogue can be used with BMI of?
>35
88
GLP1 Analogues should be avoided when?
Low EGFR
89
GLP1 Analogues should not be used when?
Pregnant/Breastfeeding
90
Normally renal glucose is reabsorbed by?
SGLT2 at Proximal Tubule
91
Which diabetic drug selectively inhibits SGTL2?
Glioflozin
92
Which diabetic drug increases glucose excretion at renal proximal tubule?
Glioflozin
93
What side effects of Glioflozin? (3)
Postural Hypotension
Decreased Systolic BP
Increased Risk of Infection
94
Gliflozin carries what major risk?
Amputation
95
Gliflozin contraindicated in? (4)
Pregnancy/Breastfeeding
Renal Impairment
Ever DKA/Ketones or Low BMI
96
Sulphonureas side effects?
Hypos and Increased Weight Gain
97
SGLT2 Inhibitor side effects?
Thrush/UTI Worse
98
Thiozidones risks? (3)
Bladder Cancer
Congenital Heart Failure
Thigh Bone Fracture
99
HBA1C target if taking drugs associated with Hypos?
53
100
HBA1C target?
48
101
Microvascular complications of diabetes (3)
Retinopathy
Nephropathy
Neuropathy
102
Physiology of Atherosclerosis? (4)
Foam Cells
Low HDL Cholesterol
High Trigylycerides
LDL causing Oxidation
103
How to treat Retinopathy?
Laser Photocogulation
104
Nephropathy does what to albumin?
Microalbuminia
105
What is the single biggest cause of End Stage Renal DIsease needing Dialysis?
Diabetes
106
How to prevent Nephropathy?
Screen Urine for Albumin
107
How to treat Nephropathy?
Ace Inhibitors or ARB's
108
Neuropathy risks?
Silent MI
109
Obesity Surgery when?
BMI >35
110
2/3 of Pancreatic Islet cells are?
B Cells
111
Insulin into blood in capillaries drive glucose into?
Adipocytes
112
Increased Glucose does what to Insulin?
Increases Insulin and Glucose Uptake by Cells which Decreases Glucose in Serum
113
Type 1 Diabetes is affected by what genetic molecule?
HLA
114
What happens to Beta Cells in Type 1 diabetes?
Decreased
115
Decreased Islets and Insulin in Type 1 Diabetes does what to glucose?
Increased
116
What happens to tissue sensitivity in insulin in Type 2 Diabetes?
Decreased
117
What happens to fatty acids in blood in Type 2 Diabetes?
Increased
118
Commonest cause of Death in Type 2 Diabetes?
MI
119
Arteriolar Disease causes what physiology changes?
Increased Hyaline
120
Small Vessel Disease in Diabetes causes what physiology changes?
Increased Connective Tissue around Capillaries
Glycosylation
Covalent Bonds
121
Glycosylation physiology changes?
Stuck in Subendothelial Space
Cross Linked Basal Lamina Protein
Proteins in Arteriole Wall
