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17 Cards in this Set
- Front
- Back
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Lifestyle measures to reduce BP |
Weight reduction Less salt Less alcohol Less fat and sat fat Increased exercise Increased fruit and veg |
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Lifestyle measures to reduce CV risk |
Stop smoking Reduce fat and sat fat Replace sat fat with mono-unsat Increase oily fish consumption |
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Metabolic disease |
Combination of disorders Increase risk of CV disease and diabetes Fasting hyperglycemia High BP Midriff fat Decreased HDL High TG |
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Pancreatic cells What do they secrete |
Beta - insulin Alpha - glucagon Delta - somatostatin |
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Diabetes |
Hyperglycemia Polyuria Macrovascular disease (atherosclerosis) Microvascular disease (retinopathy, neuropathy) |
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Type 1 Diabetes |
Insulin dependent Early onset Auto immune destruction of islet cells, no insulin production Muscle cramps, faintness, cardiac arrhythmias, infections |
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Type 2 Diabetes |
Non-insulin dependent Late onset Impaired secretion, only get second phase secretion Insulin resistance, impaired receptor functioning Overweight, obese, physically inactive, family history |
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What does diabetes treatment aim for? |
Achieve glucose homeostasis between 4-8mmol/L Relieve symptoms and prevent acute complications: polyuria, blurred vision, weakness Reduce long term complications: micro and macrovascular disease Restore metabolism and metabolic disease |
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Treatment for diabetes |
Targeting glucose absorption: alpha-glucosidase inhibitors (acarbose) Target insulin secretion: meglitinides (repaglinide) Targeting insulin actions: biguanides (metformin), dipeptidyl peptidase-4 inhibitors (sitagliptin), glucagon like polypeptide antagonists (exenatide) |
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Acarbose |
alpha-glucosidase inhibitors block enzymes that digest and absorb starches in small intestine SE: flatulence, abdominal discomfort, loose stools, contraindicated in patients with IBS or cirrhosis |
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Repaglinide |
meglitinides stimulate insulin secretion rapidly for short duration inhibit Katp channels on beta cells depolarises islet cells, causing calcium influx calcium stimulates exocytotic release of insulin granules SE: less risk of hypoglycemia and weight gain than sulphonylureas |
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Metformin |
Biguanides increase peripheral glucose utilisation and decrease hepatic glucose production decrease LDL and TG activates AMPK SE: GIT disturbances, possible weightloss, lactic acidosis. contraindicated in renal impairment because excretion unchanged in urine |
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Sitagliptin |
dipeptidyl peptidase-4 inhibitors DPP-4 increase native GLP-1 levels by inhibiting their metabolism increases insulin and decreases glucagon GLP-1 are incretins released from GIT after food, increase insulin and decrease glucagon SE: upper respiratory tract infections, headaches, pancreatitis, potential hypoglycemia in combination |
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Exenatide |
Glucagon like polypeptide 1 (GLP1) receptor agonist potentiate glucose mediated insulin secretion suppress glucagon release slow gastric emptying reduce appetite SE: nausea, vomiting, diahhorea, weight loss, immune reactions, endocrine neoplasias in pituitary |
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How is insulin stimulated for release |
1. GLUT2 transporters on islet cells, uptake glucose 2. Glucose moves through Glucose-6-phosphate pathway to make ATP 3. ATP inhibits ATP sensitive K+ channels on islet cells 4. Depolarisation, calcium influx to cell 5. Calcium stimulates exocytotic release of insulin granules |
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How does insulin work? |
1. Binding of insulin to TyrK insulin receptor 2. Switch on intracellular phosphorylation cascades via PI3K 3. Activation of mitogenesis, protein synthesis, glycogen synthesis and glucose transport 4. GLUT4 on subcellular vesicles to translocate to membrane 5. Uptake of glucose into cell and utilisation |
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How do incretins work? |
Released from GIT after food intake Increase insulin and reduce glucagon Incretins deactivated by DPP-4 |
