Diabetes mellitus Flashcards by Nick Bradfield

What are Kimmelstiel-Wilson lesions?

Nodular glomerulosclerosis

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What is the most common cause of amputation in Australia?

Diabetic peripheral neuropathy

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What are the 3 ways of monitoring diabetes control?

BSL. Hb1Ac. Fructosamine.

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If a diabetic patient has HbA1c of 7%, but high BSLs, what should you consider?

Bleeding

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Which cells make up 80% of the islets of Langerhans?

Beta cells

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List three reasons for why is there increased atherosclerosis in DM

1 Increased hepatic production of atherogenic lipoproteins 2 Suppression of lipid uptake in peripheral tissues 3 Abnormal endothelial function with pro-coagulant effects

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Which conditions are a contraindication for alpha-glucosidase inhibitors?

Cirrhosis or IBD

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What is insulin glulisine?

Short acting insulin

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Which enzyme converts pro-insulin => insulin?

Prohormone convertase 1

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What are the side effects of sulphonylureas?

Weight gain and hypoglycaemia

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What is the molecular target of metformin?

AMP kinase

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Is more insulin released after IV or oral administration of glucose?

Oral

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How do sulphonamides work at an organ level when treating diabetes?

Increase insulin release from the beta cells of the pancreas

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Which cells have receptors for AGEs?

Macrophages, endothelial, vascular smooth muscle, T cells

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What is exenatide?

A GLP-1R agonist

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Which hormone is released with a fall in BSL?

Glucagon

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What is the molecular action of sulphonylureas?

Inhibit ATP-dependent K+ channels

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What class of drug is metformin?

Biguanide

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What class of drug are the -liptins

DPP-IV inhibitors (prevents breakdown of GLP-1 to treat diabetes)

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What does ‘diabetes’ mean?

Production of abundant urine

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Which conditions are a contraindication for metformin?

Renal impairment

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What is the tissue level effect of alpha-glucosidase inhibitors?

Reduce digestion and absorption of CHOs from small intestine

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What type of cells kill beta islet cells in T1DM

Cytotoxic T cells

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What are the main side effects of alpha-glucosidase inhibitors?

Flatulence, abdominal discomfort, loose stools

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What is insulin lispro?

Short acting insulin

What is HbA1c?

Glycosylated haemoglobin - a marker for diabetes control

Which three tissue are particularly vulnerable to complications in diabetes mellitus?

Kidneys, retina, nerves

Name 2 main effects of GLP-1

Delays gastric emptying Stimulates pro-insulin syntheis

How doe DPP-4 drugs treat diabetes on a tissue level?

Inhibit breakdown of incretins, thus increasing insulin:glucagon ratios

How does diabetes cause peripheral neuropathy?

Ischaemic damage AGEs damage axons and schwann cells

What are the 4 main actions of metformin at a tissue level?

GAIL Gluconeogenesis in liver is inhibited Absorption of carbohydrates is reduced Insulin-mediated glucose uptake is enhanced LDL and TAG levels are decreased

What is the cascade for insulin release from beta cells?

Glucose enters through GLUT-2 Glycolysis and TCA cycle yields ATP ATP displaces ADP from K+ ATP channel K+ influx depolarises cell Depolarisation opens voltage gated Ca2+ channel Ca2+ enters cell and causes vesicles to exocytose insulin

Which country has the highest prevalence of Type 1 diabetes?

Finland

What type of drug is exenatide?

Glucagon-like peptide-1 agonist

How long does the second phase of insulin release last for?

As long as the stimulus is present

What do fructosamine levels tell you in a diabetic patient?

How good BSL control has been over the past 6 to 8 weeks

Why is there polyuria in DM?

Hyperglycaemia =\> glucosurea =\> osmotic diuresis =\> polyurea

Which is the most potent incretin?

GLP-1

What are the 2 classical symptoms of Type 1 diabetes?

Polyuria and polydipsia

Name 3 effects of amylin

Delays gastric emptying Inhibits glucagon secretion Reduces food intake

What do theta cells of the pancreas secrete?

Pancreatic polypeptide

What is detemir insulin?

A long acting form of insulin

What are the two long acting forms of insulin?

Glargine and determir

What are the three short acting forms of insulin?

Glulisine, lispro, aspart

How do you treat an unconscious diabetic patient with hypoglycaemia?

IV glucose or glucagon

Which cells secrete GIP ()glucose-dependent insuinotropic polypeptide)?

K cells of duodenum

How is exenatide administered?

S.C.

What is the most common cause of blindness in Australia?

Diabetic retinopathy

What do HbA1c levels tell you in a diabetic patient?

How good BSL control has been over the past 3 months

Name 5 ways that AGEs may lead to atherosclerosis?

Stimulate macrophages to release pro-inflammatory cytokines Stimulate vascular smooth muscles to proliferate Generate ROS in endothelial cells Cause endothelial cells to become pro-coagulant AGEs can cross-link with collagen, trapping LDL

What effect does insulin have on potassium?

Lowers plasma K+ but transferring it intracellularly

Which phase of insulin release is most impaired in T2DM?

Initial spike

How long does the first phase of insulin release last for?

2-5 mins

What is the magic number for HbA1c?

What are the main side effects of metformin?

GI upset and lactic acidosis

What is the eponymous name for nodular glomerulosclerosis?

Kimmelstiel-Wilson lesions

What degrades GLP-1?

DPP-IV Di-peptidyl peptidase-IV

What is the most common cause of kidney failure in Australia?

Diabetic nephropathy

What is the main macrovascular complication of DM?

Atherosclerosis

What does glucagon do?

Causes liver to release glucose via GNG or glycogenolysis

Why does orally administered glucose cause a greater increase in insulin levels?

It activates incretins (Glucagon-like peptide 1 and glucose-induced insulinotropic polypeptide)

What is insulin aspart?

Short acting insulin

What are 3 candidates for diabetes-mediated pathology?

Advanced glycation end products Activation of Protein Kinase C Polyol pathways

What is the glycosylated form of haemoglobin?

HbA1c

What are three typical pathological effects of diabetes in the kidneys?

Kimmelsteil-Wilson nodules Thickening of glomerular basement membrane Hyaline arteriolosclerosis

Which cells secrete GLP-1?

L cells of small intestine

What does dipeptidyl-peptidase do?

Breaks down incretins

What is glargine insulin?

A long acting form of insulin

What BSL levels indicate hypoglycaemia?

\< 4 mmol/L

What is the advantage of detemir insulin?

It has a FA added, meaning it has a longer half life and can cross BBB

What effect does insulin have on fat metabolism?

Decreases lipolysis

What is the most common precipitating event for diabetic ketoacidosis?

Infection

What is released with insulin?

C-peptide and amylin

How do sulphonylureas work at an organ level when treating diabetes?

Increase insulin release from the beta cells of the pancreas

Diabetes mellitus Flashcards

(74 cards)