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endocrine - diabetes
n/a
20
Architecture
Undergraduate 1
03/02/2010

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Cards

Term
what is the criteria for the dx of diabetes mellitus?
Definition
fasting plasma glucose >=126 mg/dL; 2 hour plasma glucose >=200 mg/dL
Term
what is the criteria for dx of "pre diabetic state"?
Definition
fasting plasma glucose >=100 and <126 mg/dL; 2 hour plasma glucose >=140 and <200 mg/dL
Term
what is metabolic syndrome?
Definition
clustering of sx: high visceral fat, high trigs, low HDL, impaired glucose tolerance, measure waist circumference at level of iliac crest (>40 in men and >35 in women). any 3 out of these 5 sx = metabolic syndrome
Term
what are the 3 most common organs affected by microvascular complications of db?
Definition
retina, kidney, nerves
Term
why do diabetics have an increase in CV disease?
Definition
hyperglycemia, hypertension, dyslipidemia, pro-coagulant state
Term
what HLA types are assoc with type 1 db?
Definition
HLA DR3 and HLA DR4 (HLA DR2 provides protection)
Term
what are the 3 autoantibodies assoc with type 1 db?
Definition
anti-insulin, anti-glutamic acid decarboxylase, anti-ICA512 (presence of one ab is mildly predicative of type 1 db, but presence of all 3 is highly predictive)
Term
etiology of type 2 db?
Definition
genetic cause for beta cell abnormality; usually type 2 db is beta cell abnormality + insulin resistance (from metabolic syndrome). metabolic syndrome --> increase in visceral adipodisity --> increased intracellular lipid in liver, muscle, pancreatic beta cell --> activates PKC and IKKB pathways to activate serine and threonine phosphorylases --> act on IRS and PI-3 kinase to reduce their availability to carry out intracellular insulin signaling --> reduces glucose uptake in muscle and adipose tissue, reduces glycogen synthesis in liver and NO prod in endothelial cells
Term
why do diabetics get fasting hyperglycemia (remember, first step is post-prandial then if it worsens get fasting)?
Definition
the liver is regulated by levels of INSULIN (not glucose). in diabetics, the liver becomes insulin resistant and therefore needs 3x as much insulin to regulate it --> B cell function decreases and it cannot put out that much insulin --> liver thinks it has low glucose --> overproduces glucose
Term
what are incretins and how do they contribute to db?
Definition
GI hormone that is secreted post-prandially --> acts on beta cells to amplify the insulin response to glucose (DB pts deficient incretin action)
Term
is fasting or post-prandial glucose primarily responsible for hyperglycemia in type 2 diabetes?
Definition
in poorly controlled diabetics, FASTING glucose is responsible for hyperglycemia. in WELL controlled diabetcis, POSTPRANDIAL glucose is responsible
Term
what do we use to decrease glucose in the fasting state?
Definition
sulfonylureas, metformin, nighttime basal insulin (glargine insuline)
Term
what do we use to treat hyperglycemia in the post-prandial state?
Definition
rapid acting insulin analogues and inhaled insulin (acarbose, nateglinide, pramlintide, exenatide)
Term
how do we decrease both fasting AND post-prandial glucose?
Definition
sulfonylrueas+metformin; thiazolindeinediones, repaglinide, exenatide, sitagliptin
Term
AE of thiazolidinediones?
Definition
most potent tx; small increase in edema and CHF, weight gain, bone fracture
Term
AE of incretin mimetics?
Definition
n/v, acute pancreatitis?
Term
how do sulfonylurea drugs work?
Definition
close the K channel independent of glucose (normally glu generates ATP --> ATP causes K channel to close --> Ca channel opens --> insulin secretion)
Term
how do GLP receptor drugs work?
Definition
stimulate insulin secretion by activating cAMP pathway in B cell --> AMPLIFY insulin secretion d/t glucose (GLP receptor = receptor on K channel that will lead to closure) so same amt of glucose will cause twice as much insulin output
Term
how does metformin work?
Definition
decreases glucose (mechanism unknown)
Term
how do thiazolidinediones work?
Definition
activates PPAR which inhibits lipoprotein lipase which causes peripheral fat to make more smaller cells with less fat and causes apoptosis of visceral fat
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