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Flashcards in Scenario 17 Deck (64)
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31

What are the causes of DKA?

Infection, poor compliance, newly diagnosed, failure of care

32

What are the signs and symptoms of DKA?

Polyuria, polydipsia, weight loss, blurred vision, vomiting abdominal pain, weakness, leg cramps, confusion

Kaussmaul respiration, ketotic factor, dehydration, hypotension, tachycardia, drowsiness, coma

33

What is the treatment for DKA?

  1. Fluid replacement- IV saline- slowly to avoid cerebral oedema
  2. Insulin replacement- 0.1 units/kg/hour
  3. Potassium replacement- once fluid and insulin started must replace K as soon as it begins going back into cells
  4. Identify and treat the cause
  5. Venous thromboembolism prophylaxis

34

What is HHS?

State of severe uncontrolled diabetes but enough insulin to suppress ketogenesis- type 2

35

What is HHS characterised by?

Hypervolaemia, hypoglycaemia (>30mmol/l), hyperosmolality (>320mosmol/kg) no significant ketonaemia or acidosis

36

Complictions of HHS 

Life threatening, develops over days and metabolic disturbance is more severe than DKA, cerebral oedema, central pontine myelinolysis, seizures, thrombosis, co-morbidity likely 

37

What is the treatment for HHS?

  1. Fluid replacement
  2. Insulin replacement (slower than DKA- 0.05 units/kg/hour)
  3. Identify and treat cause
  4. Venous thromboembolism prophylaxis

38

What is hypoglycaemia defined as?

Blood glucose <3.5mmol/l

39

What is an example of a biguanides?

Metformin

40

What does metformin do?

Absorbed in SI (half life 3 hours), decreased blood glucose by decreasing hepatic glucose production and potentiatinf insulin action, stimulate glycolysis

41

Does metformin cause hypoglycaemia?

No (or weight gain)

42

What are the side effects of metformin?

Diarrhoea, nausea, metallic taste, decreased absorption of folate and B12

43

What are sulphonlyureas and s/e?

Activate K channel independent of glucose so more insulin is released. Side effects mainly hypoglycaemia

44

What is the action of thiazolidineodines?

Activates insulin responsiveness genes that contorl carb and lipid metabolism- reduces glucose production by liver and uotake in muscle and liver. Eg Proglitazone- can cause weight gain and fluid retention 

45

What are meglitinides?

Repaglinide and Nateglinide- half life 1 hour, close K ATP channels on beta cells

46

What are incretins?

Stimulates insulin release by acting on incretin receptor also suppresses glucagon secretion, reduces appetite and weight

47

What are DPP4 inhibitors?

Stop breakdown of incretins 

48

What are alpha-glucosidase inhibitors?

Inhibit intestinal brush border alpha-glucosidase, inhibit carb breaksown and reduce post prandial blood glucose increase (in both types) S/E flatulance and diarrhoea

49

How do S-GLUT2 inhibitors work?

Inhibit glucose reuptake in the kidney

50

What are amyline analogues?

Decrease gastric emptying, inhibits glucagon release (type 1 or 2)

51

What treatment can be used for retinopathy?

Laser Photocoagulation

52

What is the role of VEGF in retinopathy?

Tries to produce new bood vessels 

53

What is GFR by end stage renal disease?

<10ml/min

54

What is the average amount of time until ESRD?

23 years 

55

How many men with long standing diabetes get erectile dysfuntion?

50%

56

Is the risk of complications the same for everyone with similar sugar control?

No it is also genetically influenced

57

What is glycosylation?

Glucose binding non-enzymatically to free AA residues- lysine

58

What damage can glycosylation cause to proteins?

Complex cross-linking, loss of flexibiltiy and functionality

59

Where does glycosylation occur?

Kidney, eye lens, arterial collagen, nerve myelin proteins, circulating LDL

60

What do glycated proteins form?

AGEs- basis for oxidative stress hard to turn over proteins