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43 Cards in this Set
- Front
- Back
Define diabetes mellitus
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Diabetes mellitus is a multisystem disease,
characterised by hyperglycemia, caused by absolute or relative lack of insulin production or action. |
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Name the different types of diabetes
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Diabetes mellitus types 1 & 2
gestational diabetes diabetes insipidus |
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Common signs and symptoms of diabetes?
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Acute signs:
glycosuria ketones on breath weight loss polyuria polydipsia fatigue/lethargy |
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What is polydipsia?
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Abnormally intense thirst
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What is polyuria?
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Production of large volumes of dilute, pale urine
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What is the criteria for diagnosis of diabetes mellitus?
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Fasting plasma glucose = > 7mmol/L. (WHO)
NB Random glucose tests are unreliable. |
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What is an HbA1c test and what does it represent?
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reflects glycosylated haemoglobin levels over prev 3mths
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What is the action of insulin?
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Insulin is a potent hypoglycemic hormone, produced by Beta cells.
Target= muscle cells, WBCs and connective tissue Action= reduces circulating glucose by enhancing membrane transport of glucose into certain cells |
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What is the action of glucagon?
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Glucagon is a potent hyperglycemic hormone, produced by Alpha cells.
Target= liver Action= release glucose into bloodstream |
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Three cardinal signs of diabetes mellitus?
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1. polyuria (copious wee)
2. polyphagia (intense hunger) 3. polydypsia (intense thirst) |
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What is the range of blood glucose levels that drug therapy aims at in DM?
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DM blood glucose ranges:
4-7 mmol/L fasting <9 mmol/L after meals |
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What is HbA1c?
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A test of glycosylated haemoglobin.
HbA1c should be 6.5-7.5% |
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What is the current prevalence of diabetes in the UK?
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Current UK diabetes prevalence is 5%.
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How does excess blood sugar lead to diabetic complications?
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Excess blood glucose reacts with proteins in body tissue to form advanced glycation end-products (AGE)s. These cause inflammation in the vasculature which causes heart disease and organ damage.
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Outline the process of insulin secetion by a Beta cell.
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Increase in blood glucose.
Glucose enters B-cell via Glut2 channel. Glucose is metabolised in cell, producing ATP. ATP blocks K+/ATP channels and depolarises membrane. This causes Ca2+ channels in membrane to open, allowing influx of Ca2+. This signal induces insulin granules to be secreted from B-cell. |
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Standard Tx for T1D?
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T1D treated by:
- insulin (short or medium acting) - injections (thigh, abdomen, upper arms) |
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Tx for type 2 diabetes?
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Tx algorithm for T2D=
1) diet only 2) diet + tabs 3) diet + tabs + insulin |
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Categories of oral antidiabetic agents?
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Oral antidiabetic agents:
1. Biguanides 2. Sulphonylureas 3. Intestinal Alpha-glucosidase inhibitors 4. Thiazolidinediones (TZDs) 5. Insulin secretion stimulators |
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Example of a biguanide
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biguanide=metformin
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example of a sulphonylurea
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sulphonylureas
1st generation=Tolbutamide 2nd generation=Gliclazide, Glibenclamide |
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Give two examples of the thiazolidinediones
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Thiazolidinediones=
Pioglitazone Roziglitazone |
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Name one intestinal alpha-glucosidase inhibitor
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Acarbose is an intestinal alpha-glucosidase inhibitor
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When are Repaglinide and Nateglinide indicated?
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Repaglinide and Nateglinide are indicated:
- |
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Which antidiabetic agents are insulin secretagogues?
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Insulin secretagogues
= sulphonylureas = thiazolidinediones |
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What is the action of a thiozolildinedione? Give an example of the drug.
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Thozolidinedione drugs
=Rosiglitazone or Pioglitazone promotes expression of genes influencing insulin signalling in liver, fat cells and muscle |
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Name three sulphonylurea drugs.
State their action. Give advantages and disadvantages of this class. |
Sulphonylureas
= Tolbutamide, Gliclazide, Glibenclamide Action: insulin secretagogues. Bind to the K+/ATP channels in Beta cell membrane, causing depolarisation and opening of the Ca2+ channels leading to influx of calcium and secretion of insulin. Advantages: - usually well-tolerated - can be combined - useful in early T2D when Beta-cells still functioning Disadvantages: - hypoglycemia - stimulates appetite - drug interactions (NSAIDs, warfarin, alcohol increase effect) - GI disturbance |
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State the indications and contraindications for Metformin.
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Metformin
Indications=first line antidiabetic drug, no hypoglycemia, no weight gain, can be combined Contraindications=liver or renal impairment, heart failure, hypoxic pulmonary disease (lactic acidosis) |
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If a patient cannot tolerate metformin or other drugs and their diabetes cannot be controlled by diet, what drug may be used?
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Acarbose - an intestinal Alpha-glucosidase inhibitor.
Acarbose blocks carbohydrate absorption in the gut. |
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Side effects of Thiazolidinediones?
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Thiazolidinedione side effects?
=weight gain =fluid retention =higher LDL and HDL =liver toxicity |
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Side effects of Sulphonylureas?
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Sulphonylureas side effects?
=hypoglycemia =weight gain =GI disturbance =drug interactions (NSAIDs, imazole antifungals, warfarin increase hypoglycemic effect) |
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Side effects of intestinal Alpha-glucosidase inhibitors?
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Intestinal Alpha-glucosidase inhibitors side effects:
=flatulence =loose stools =abdominal pain |
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Side effects of Metformin
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Metformin side effects:
=initial GI disurbance =loss of taste =vitamin B12 deficiency =lactic acidosis (can be fatal) |
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Side effects of Meglitinides?
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Meglitinides side effects:
= |
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State the NICE guidelines for treatment of T2D.
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NICE T2D algorithm:
Diet (always included) Diet + Metformin (or Sulphonylurea) Diet + Metformin + Sulphonylureas (or Repalglinide/Nateglinide or Thiazolidinediones) D + M + S + Insulin/TZD Then...increase insulin dose |
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What HbA1c level means that diet control is not working?
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HbA1c of >6.5% with diet control means that diet control not working
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If a patient is on Metformin and Sulphonylurea, at what HbA1c should their medication be altered?
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If a patient is on Metformin and a Sulphonylurea and their HbA1c rises above 7.5%, then Insulin or TZD should be added.
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Which antidiabetic drug is a black triangle drug? Why?
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Rosiglitazone is a Black Triangle drug.
Adverse reactions in patients with CV disease have been noted. |
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What are the initial symptoms of hypoglycemia?
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sweating
headache nervousness tremor hunger |
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What should you go in the event of a pt having a hypoglycemic attack in clinic?
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-stop procedure
-give glucose -monitor pt's condition -call ambulance?? |
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How might Tx differ between T1 and T2D?
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T1D = always insulin
T2D = depends on stage and severity of diabetes |
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What are the types of insulin used?
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Various sources
Various durations |
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Name the drug categories for Tx of T2D
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T2D:
-Biguanides -Sulphonylureas -Thiazolidinediones -Meglitinides -Intestinal Alpha-glucosidase inhibitors -Enantide |
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List the actions of the drugs for Tx of T2D?
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1-Insulin Secretagogues
2-Stimulate expression of genes for insulin signalling 3-Stimulate uptake and utilisation of glucose by muscles 4-Block carbohydrate absorption by the gut |