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Endocrine > 1(E) T2DM, HHS > Flashcards

1(E) T2DM, HHS Flashcards

1
Q

What is T2DM

A

Insulin resistance which leads to hyper-secretion of insulin from pancreatic B islet cells causing dysfunction

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2
Q

What is MODY

A

Maturity onset diabetes of the young. T2DM - onsets in young people

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3
Q

When doe T2DM usually onset

A

Over 40

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4
Q

In which ethnicity is T2DM more common

A

Asian

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5
Q

Explain inheritance of T2DM

A

80% concordance in twins

Greater genetic heritability than T1DM

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6
Q

What are 3 other causes of T2DM

A
  • Cushing’s disease
  • Prolonged steroid use
  • Pancreas: surgery removing 90%, pancreatitis, trauma
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7
Q

What are 5 RF for T2DM

A
  • Obesity
  • Asian
  • HTN
  • Sedentary
  • Metabolic Syndrome
  • Dyslipidaemia
  • GDM
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8
Q

What does T2DM usually develop from

A

pre-cursor phase: either impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)

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9
Q

What are classic symptoms of T2DM

A

Polyuria

Polydipsia

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10
Q

What are 4 non-specific T2DM symptoms

A
  • Visual disturbance
  • Fatigue
  • Poor wound healing
  • Recurrent infections (UTI)
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11
Q

What do WHO state is pre-diabetes

A

State of impaired glucose tolerance - insufficient to diagnose DM

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12
Q

What causes impaired fasting glucose

A

Liver resistance to insulin

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13
Q

What defines impaired fasting glucose

A

Fasting glucose of 6.1. - 7mmol/L

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14
Q

What should patients with impaired fasting glucose be offered

A

Oral Glucose Tolerance Test (OGTT)

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15
Q

What causes impaired glucose tolerance

A

Muscle resistance to insulin

Remember T for tone

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16
Q

Are patients more likely to develop diabetes in impaired glucose tolerance or impaired fasting glucose

A

Impaired glucose tolerance test

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17
Q

what defines impaired glucose tolerance

A

OGTT of 7.8 - 11.1 mmol/L

FG < 7

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18
Q

What defines impaired fasting glucose

A

Fasting glucose < 7

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19
Q

What defines impaired glucose tolerance

A

Fasting glucose < 7

OGTT - 7.8 - 11.1 mmol/L

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20
Q

Explain diagnostic criteria for diabetes if symptomatic

A

Symptoms (polyuria, polydipsia, weight loss) and one of:

  • Random plasma glucose >11.1
  • Fasting glucose >7
  • OGTT >11.1
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21
Q

Explain diagnostic criteria for diabetes if asymptomatic

A

Requires two of:

  • Random plasma glucose > 11.1
  • OGTT > 11.1
  • Fasting plasma glucose >7
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22
Q

Explain oral glucose tolerance test

A

75g anhydrous glucose solution is given and blood sugar measured 2h later

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23
Q

Explain HbA1c is diagnosis of T2DM

A

HbA1c is not included in diagnostic testing. A positive test supports diagnosis of T2DM. A negative test does not exclude it

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24
Q

What HbA1c indicates diabetes

A

> 48mmol/mol (6.5%)

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25
Q

If suspect HbA1c but less than 48 (6.5%) what should be done

A

treat as high-risk of developing diabetes and repeat test in 6 months or when develops symptoms

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26
Q

Who should HbA1C not be used

A
  • Children
  • T1DM
  • Pancreatic surgery
  • Steroids
  • Symptoms <2 months
  • Acutely ill
  • Pregnancy
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27
Q

What fasting plasma glucose defines gestational DM

A

FPG: >5.6

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28
Q

What OGTT defines gestational diabetes mellitus

A

OGTT >7.8

29
Q

What is first-line management for T2DM

A

Lifestyle advice

30
Q

Using lifestyle management, what HbA1c target is aimed for

A

48mmol/mol

31
Q

How often is HbA1c measured initially

A

Every 3-months

32
Q

If HbA1c increases beyond 48mmol/mol, what is added

A

Metformin

33
Q

What HbA1c is aimed for on metformin

A

Less than 58mmol/mol (7.5%)

34
Q

If HbA1c increases beyond 58mmol/mol what is added

A

Dual therapy:

  • Metformin and DPP4-i
  • Metformin and pioglitazone
  • Metformin and sitagliptin
  • Metformin and SGLT-2i
35
Q

If HbA1c increases beyond 58mmol/mol (7.5%) in dual therapy what is done

A

Triple therapy:

  • Metformin, DPP4I, SU
  • Metformin, pioglitazone, SU
  • Metformin, SU, pioglitazone, SGLT-2i
36
Q

If HbA1c increases beyond 58 on triple therapy what is done

A

Insulin therapy

37
Q

What are the two types of insulin based therapies

A

Basal-bolus regimen:

  • Long-acting before bed
  • Short-acting before meals

Biphasic:
- Novomix BD

38
Q

When is biphasic regimen preferred

A

If regular lifestyle

39
Q

What are two glucagon like peptide analogues

A

Exenatide

Liraglutide

40
Q

What is the MOA of glucagon-like peptide analogues

A

Augment insulin release

41
Q

When are glucagon like peptide analogues indicated

A

Triple therapy ineffective or not tolerated

42
Q

What is the criteria for glucagon like peptides to be prescribed

A
  1. BMI >35 and psychological complications of obesity

2. BMI <35 and significant occupational CI to insulin or where weight loss would benefit other co-morbidities

43
Q

What BP is aimed for in T2DM

A

<140/90.

Unless, end-organ damage then <130/80

44
Q

What BP medication are all diabetics put on

A

ACEi

45
Q

What dose of statin is given as primary prevention if QRISK score >10%, T1DM of GFR <60

A

20mg

46
Q

What is HHS

A

Hyperosmolar Hyperglycaemic state

Emergency associated with T2DM

47
Q

What did HHS used to be called

A

Hyperglycaemic non-ketotic coma

48
Q

What is a mnemonic to remember criteria for diagnosing HHS

A

VAGO

49
Q

What is the criteria to diagnose HHS

A

hypoVolaemia

NO Acidosis or NO ketosis

Glucose high

Osmolality >320

50
Q

What osmolality is required to diagnose hyperglycaemic hyperosmolar state

A

> 320

51
Q

How is plasma osmolality calculated

A

= 2Na+ + Glucose + Urea

52
Q

Explain history of symptoms in HHS

A

Usually longer history compared to DKA. Symptoms present over one-week

53
Q

What are 2 general symptoms of HHS

A
  • Lethargy

- N+V

54
Q

What are 4 neurological symptoms of HHS

A
  • Headache
  • Papilloedema
  • Decrease consciousness
  • Weakness
55
Q

Explain HHS

A
  • Insulin deficiency causes hyperglycaemia
  • Glucose in circulation causes osmotic diuresis
  • Less water, means relative increase in electrolytes in serum causing increase osmolality and hyperviscosity of blood (can cause MI. stroke, PAD)
56
Q

Why do HHS patients not appear shocked

A

Despite massive water loss, glucose in circulation maintains osmotic pressure and intravascular volume

57
Q

In which patients is HHS seen

A

T2DM

58
Q

What is criteria to diagnose HHS

A
  • HypoVolaemic
  • No acidosis (pH >7.3) or ketosis (<3)
  • hyperglycaemia
  • osmolality >320
59
Q

Why must HHS be differentiated from DKA

A

As treating HHS with insulin has adverse consequences

60
Q

Where should HHS patients be managed

A

HDU

61
Q

What are the 3 aims for managing HHS

A
  • Correct osmolality
  • Replace fluid and electrolytes
  • Normalise BG
62
Q

What is first-line management for HHS

A

0.9% NaCl over 48h [slow rehydration]

63
Q

Why is fluid corrected slowly in HHS

A

Too rapid correction of hypernatraemia will cause cerebral pontine myelinolysis

64
Q

When is K+ replaced

A
  • Urine starts to flow

- Potassium 3.5-5.5

65
Q

How is hyperglycaemia corrected in HHS

A

Fluid replacement

66
Q

Why is insulin not used in HHS

A

insulin will cause glucose to enter cells - this will cause cardiovascular collapse as water moves out of intravascular space

67
Q

When is insulin only given in HHS

A

if ketosis (mixed DKA, HHS picture)

68
Q

What does HHS cause

A

Hyperviscosity

69
Q

What are 3 potential complications of hyper viscosity

A
  • MI
  • Stroke
  • PAD

Endocrine (20 decks)

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