Treatment Of Diabetes Flashcards
(56 cards)
What does insulin stimulate through enzymatic activity
Catalyses oxidation of glucose for ATP prod
Polymerises glucose to glycogen
Converts glucose to fat
How does the body respond to insulin deficiency
Decreased uptake of glucose uptake and utilisation
Glycogenolysis
Protein catabolism
Gluconeogenesis
Lipolysis
Ketogenesis
Conditions due to diabetes mellitus
Hperglycemia
Glycosuria - glucose in urine
Osmotic diuresis - increased urine
Lipidemia + ketoacidosis
Ketonuria
Loss of Na and K
Electrolyte and acid base imbalances
Signs and symptoms of diabetes mellitus due to hyperglycaemia
Polyuria - dehydration and soft eyeballs
Poydipsia - thirst
Polyphagia - hunger
Fatigue
Weight loss
Signs and symptoms due to ketoacidosis
Acetone breath
Hypernea
Nausea/ abdominal pain
Cardiac irregularities
CNS depression
How is secretion of insulin regulated
Mostly by glucose levels
GI hormones
Mechanism of how insulin is secreted
Glucose enters beta cells via GLUT 1/3 transporter
Produce ATP (via glycolysis pathway)
Reduces activity of ATP sensitive K channel
Reduces K efflux causing depolarisation (when glucose low beta cell in hyperpolarised state)
Opens Ca channels which cause exocytosis of insulin
Diabetes caused due to glucose transporters becoming:
Unresponsive
Less sensitive
What is biphasic insulin release
Allows glucose to reach cells to be metabolised
2 peaks of insulin secretion
1st peak: stimuli of food causes pancreases to rapidly secrete insulin. Allows feelings of satiety.
2nd peak: when food passed through to stomach to small intestine. Allows glucose absorption.
Which peaks do type 1 and type 2 miss in the biphasic release of insulin
Type 1: both peaks not present
Type 2: 1st peak missing
So diabetes patients can eat more because dont have feelings of satiety (1st peak)
Biological structure of insulin receptor
2 alpha subunits - extracellular binding site
2 beta subunits - transmembrane tyrosine kinase
What happens when substrate binds to insulin receptor
- Phosphorylation of insulin receptor substrate proteins
- Enzyme activation and gene transcription
- Increase in glucose uptake via expression of GLUT 4 transporter
- Increased glycogen synthesis
What are the main groups of drug given by injection
Insulin in various forms/ formulations
Incretin mimetics e.g. exenatide, liraglutide - mimic hormones tat regular activity of insulin (GI hormones)
Main groups of oral drugs
Biguanides - metformin
Sulfonylureas & related drugs
Thiazolidinediones
Gliptins
Glucose transporter inhibitors
Causes of diabetes mellitus type 1
Genetics
Autoimmune response leading to beta cell loss
Management of type 1
Carbohydrate counting
Dietary advice
Managing insulin doses to minimise glucose fluctuations when changing diet (patient specific)
How exercise effects type 1 diabetes patients
Reduced cardiovascular risk
Effects to insulin dosage and carb intake
Regular HbA1c measurement (lower the measurement the better)
Self monitoring of plasma glucose
Finger prick
Continuous monitoring devices
Why does insulin need to be injected
Peptide hormone
Broken down by digestive tract enzymes
Types of human (recombinant DNA) insulin
Short acting: onset 30 mins, peak 2-4 hrs, soluble insulin, insulin lispro
Long acting: onset 1-2 hrs, peak 4-12 hrs, insulin complexes , insulin glargine
Different Dose regimes for insulin
- Short acting 3 times before meals + intermediate/ long acting once or twice
- Pre mixed short and intermediate acting insulin
- Continuous infusion - for patients that poorly manage treatment
Complications of insulin treatment
Fluctuations of blood glucose: hypo/hyper
Allergy
Lipodystrophy - inject to same set can cause change in fat consumption
Contraindications of insulin
Insulin compliance - psychosocial impacts (complex and demanding patients)
Eating disorders
Restrictions - driving/ jobs
Complex cause of diabetes mellitus type 2
Genetics
Socioeconomic factors - poor diet due to poverty
Demographic factors - diff populations have diff likelihood
