11/01 Flashcards
What is first line blood pressure management in patients with T2DM?
Non afrocaribbean = ACEi
Afrocaribbean= ARB
How many units of insulin are in a standard ml?
Approx 100units
How should steroid therapy be altered in patients with Addison’s disease and intercurrent illness?
Double glucocorticoid (e.g. hydrocortisone) dose and keep fludrocortisone dose the same
What are symptoms of an insulinoma?
Hypoglycaemia with fasting or exercise Symptoms relieved after eating Low BMs Features of hypoglycaemia early in the morning or after exercise Rapid weight gain High C peptide
What are side effects of SGLT2 inhibitors e.g. Dapagliflozin?
Urinary and genital infection e.g. thrush
Normoglycaemic ketoacidosis
Increased risk of lower limb amputation
What is the method of action of SGLT2 inhibitors?
E.g. Dapagliflozin
Stop the resorption of glucose in the proximal convoluted tubule causing increased glucose secretion in the urine
What are the investigations for acromegaly?
Serum IGf-1 levels
- if raised then
Oral Glucose Tolerance test with serial GH levels
-OGTT should suppress GH but in acromegaly it does not
What are adverse effects of Thiazolidinediones?
E.g. Pioglitazone
Weight gain Fluid retention- contraindicated in HF Liver impairment- monitor LFTs Bladder cancer Increased risk of fractures
What are the target HbA1cs in patients with T2DM?
On metformin alone HbA1c of <48
If HbA1c >58 then add another drug
Then new target HbA1c would be <53
What is the mode of action of orlistat?
Pancreatic lipase inhibitor
How is subclinical hypothyroidism managed?
TSH between 4-10 and free thyroxine in normal range
- <65 with symptoms suggestive of hypothyroidism then trial levothyroxine
- older people trial of watch and wait
- if asymptomatic then observe and repeat thyroid function in 6 months
TSH >10 and free thyroxine in normal range
- start treatment even if asymptomatic in pts <70
- in older patients= watch and wait
What are the two main causes of hypercalcaemia?
Hyperparathyroidism
Malignancy
