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Medicine > DM > Flashcards

DM Flashcards

1
Q

Def of dm?

A
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2
Q

Insulin structure?

A

Prepro insulin
Pro insulin (endoplasmic reticulum)
Insulin + C peptide (golgi apparatus of beta cells)

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3
Q

Insulin secretion?

A

5

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4
Q

Insulin receptor structure?

A

3

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5
Q

Mechanism of insulin transport glucose into the cells?

A

5
Then
Metabolism (glycolysis,lipogenesis)
Storage (glycogenesis)

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6
Q

Funtions of incretine?

A

Glucose dependent ,

  • Increase insulin from beta cells (GLP-1 N GIP)
  • reduce glucagon from alpha cells (GLP-1)
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7
Q

Diagnosis of dm?

A

4

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8
Q

Pre diabetic values?

A

Impaired fasting glycaemia
FPG- 5.6-7 (6.9) mmol/l
2HR PG during OGTT -7.8-11(10.9)

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9
Q

Factors interfere with HBA1C measurement?

A
  1. genetic varients (Hbs,Hbc)
  2. elevated Fhb n checmically modified derivatives of hb (carbamethylated hb in RF)
  3. And condition that shortens erythrocyte lifestyle (recover from blood loss,hemolytic anemia)
  4. IDA (high)
  5. ^ red cell turnover
  6. transfusion
  7. iron replacement therapy (lowers)
  8. late preg (high)
  9. in CKD, renal anemia,erythropoietin intake etc
  10. Dialysis (low)
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10
Q

Type 1 n type 2 differences?

A 
Deficiency 
Age
Presentation 
Complications at diagnosis- not in 1,25% in 2
Fhx
Fasting C peptides
Ab- HLA DR3 n DR4 in >90% , anti GDA (glutamic acid decarboxylase)  in type 1
Genetic (1-HLA DQB1,DR3,DR4 2-TCF7L2)
Association 
Tx
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11
Q

Type 1 dm features?

A
  • Presence of 2 or more ab
  • Rate of progression dependent on, age at first detection og ab,no.of ab, ab specificity,ab titer
  • tupe qA had ab where as 1B has no ab
  • 3stages
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12
Q

3 stages of type 1 dm?

A 
Stage 1-
Autoimmunity 
Normoglycemia
Presymptomatic
Multiple ab (dx)
Stage 2-
Autoimmunity 
Dysglycemia(pre dm)
Presymptomatic
Multiple ab,dysglycemia (dx)

Stage 3-
New onset hyperglycemia
Symptomatic
Clinical symptoms,dm usual criteria (dx)

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13
Q

Causes of insulin resistance?

A

13

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14
Q

Types of dm?

A

Monogenic

  • neonatal diabetes
  • MODY (maturity onset diabetes of the young)

LADA (latent autoimmune diabetes in adults)

Gestational dm

Secondary causes

Post transplant dm

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15
Q

Neonatal diabetes?

A

<6 months of age

80-85% hv am underlying monogenic cause

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16
Q

MODY?

A 
Monogenic dm (1-2%)
<25 yrs
AD (>2generations)
Ab -
C peptide + (ar dx and even after potential honeymoon period of 5yrs)
Low insulin requirement
4 types (1,2,3 most common,5)
17
Q

When to suspect monogenic dm?

A

In a setting of T1 DM,

  • absent ab at presentation
  • normal C peptide (even after 5yrs
  • Fhx of parent having normal c peptide levels

In the settings of T2Dm,
Absence of obesity,acanthosis nigricans,PCOS
-N or high HDL (suggest 3, hdl low in mody 1)
-elevated high sensitive CRP favours T2DM over MODY

Stab,e mild fasting hyperglycemia,stable A1c netween 5.6-7.6%

18
Q

LADA?

A
  • Adult onset diabetes
  • Auto ab +
  • Treatable with oral hypoglycemics at onset
  • need insulin within 6 months-few years (in type 1 need from beginning)
  • higher titers predict earlier need for insulin
19
Q

GDM?

A

Lifelong screening at least every 3 yrs

Use metformin/intensive lifestyle interventions in pre diabetic

20
Q

Secondary causes of dm?

A
  1. Pancreatic- chronic pancreatitis,CF, hereditary hemachromatosis
  2. endocrine- cushings, thyrotoxicosis, phaechromocyyoma, glucanoma, acromegaly
  3. drugs- thiazide, beta blockers steroids
  4. Genetic - friedrich’s ataxia,dystropia mytonica
21
Q

Criteria of testing dm?

A
  1. obese adults who have 1 or more risk factors (8)
  2. prediabetic-yearly
  3. gdm -3 yearly
  4. 45 yrs
  5. If normal should repeat min 3 yr interval
22
Q

Pre diabetic mx? 3 places of prediabetic where metformin is used?

A

Lifestyle interventions

  • 7% loss of body weight
  • moderate intensity physical activity (150min/week)
  1. BMI:35 kg/mw
  2. > 60yrs
  3. prior GDM

long term metformin-periodic measurement of vit B12

23
Q

HbA1c goals?

A
  1. diagnosis->6.5%
  2. diabetic <7%
  3. <8% if hx of hypoglycemia,elderly,complications etc
24
Q

Glycemic recommendation in diabetics?

A

Hba1c <7
Preprandial capillary plasma glucose- 80-130 mg/dl
Peak postprandial capillary plasma glucose <180 mg/dl

25
Q

Levels of hypoglycemia and tx?

A

Level 1- <70 - 15-20g glucose
Level 2 - <54 - glucogan(intranasal ,autoinjector also available)
Level 3 - altered mental status or physical status requiring assistance for tx if hypoglycemia

26
Q

Presentation of dm?

A

6

27
Q

Complications of DM?

A

Macrovascular

  1. cvs- CAD,PVD
  2. CNS- TIA n stroke
Micro vascular 
1.diabetic nephropathy
2.diabetic retinopathy 
3.diabetic neuropathy 
(Sensory poluneuropathy, diabetic amyotrophy,mononeuropathy,autonomic neuropathy)

Other- foot complications,recurrent infections

Acute- hypo and hyper

28
Q

Indications to take insulin?

A
  1. evidence of ongoing catabolism
  2. symptoms of hyperglycemia
  3. A1c >10 or blood glucose levels very high (>300)
29
Q

Diabetic drugs and mechanism and SEs?

A
  1. biguanides- metformin
  2. sulphonylureas- tolbutamide, gliclazide, glipizide.glibenclamide,glimipiride
  3. meglitinides- repaginide,nateglinide
  4. thiazolidenadiones (glitazones)- pioglitazone,rosiglitazone
  5. alpha glucosidase inhibitors- acarbose
  6. GLP1 analogoues- exenatide,liraglutide
  7. DPP4 inhibitors- sitagliptin,vidagliptin
  8. SGLT2 inhibitors- gliflozins
30
Q

Mx of complications?

A

Tute

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