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Medicine Y3 TCD 1-12 > 5. Diabetes Presentation and Management > Flashcards

5. Diabetes Presentation and Management Flashcards

1
Q

What are the main presenting complaints in someone with T2 DM

(hint glucose is an osmotic diuretic)

A 
fatigue 
Polydipsia and polyuria (thirsty and urinating a lot)
unintentional weight loss
opportunistic infections 
slow healing 
glucose in urine
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2
Q

for pre-diabetes what does impaired fasting glucose mean

A

their body struggles to get their blood glucose levels in to normal range, even after a prolonged period without eating carbs

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3
Q

for pre-diabetes what does impaired glucose tolerance mean

A

their body struggles to cope with processing a carb meal

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4
Q

diabetes can be diagnosed if a patient fits what criteria for;
HbA1c
random glucose
fasting glucose
OGTT2 hour result (fast and then have 75g glucose drink)

A

HbA1c: greater than 48 mmol/mol
random glucose greater than 11 mmol/l
fasting glucose greater than 7 mmol/l
OGTT 2 hour result greater than 11 mmol/l

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5
Q

in men what is a common opportunistic infection of the penis

A

Candida balantis

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6
Q

although rare, what its diabetes insipidus and what are the common PC

A

disorder of the posterior pituitary gland which causes inadequate ADH secretion therefore imbalance of fluids (ADH causes more aqua porin channels init the DCT

symptoms are, polyuria, dilute urine and polydipsia

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7
Q

A differential for DM could be hypercalcaaemia, what are the common symptoms of this

A 
loss of appetite 
nausea and vomitting
constipation and abdo pain 
tiredness/ weakness and muscle pain !!!!!
confusion/headaches
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8
Q

weight loss even though you are eating more

is this a common T1 or T2 DM presentation

A

T1

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9
Q

tingling, pain, or numbness in the hands/feet

is this a common T1 or T2 DM presentation

A

T2

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10
Q

what is the main hyperglycaemic emergency in type ! DM and then type 2DM

A

T1 is diabetic ketoacidosis DKA

T2 is hyperosmolar hyperglycaemic state

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11
Q

What are the main treatment goals in management of diabetes

A

minimise treatment side effects (hypoglycaemia and weight gain)
as near normal glucose as possible (to minimise complications)
cardiovascular risk management (optimise risk factors)

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12
Q

In management of diet what things would you advise

A

eat vegetables and only fish
low glycemic, high fibre diet
low carb diet (not mainstream yet)

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13
Q

What risk factors do you want to optimise and how would you advise this

A

exercise and weight loss
stop smoking
optimise treatment for other illnesses, eg hypertension, hyperlipidaemia and CVD

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14
Q

what lifestyle changes cause the following;
improving islet function
reduces insulin resistance
improves insulin sensitivity

A

reduced calories improving islet function
weight loss reduces insulin resistance
Exercise improves insulin sensitivity with or without weight loss

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15
Q

What is the first line treatment for T2 diabetes after lifestyle management and how does it work

A

metformin 500mg once daily

“biguanide” which increases insulin sensitivity and decreased liver production of glucose

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16
Q

what are the main side effects of metformin

A

diarrhoea and abdo pain (lowering dose resolves symptoms)
Lactic acidosis
note that it does NOT typically cause hypoglycaemia

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17
Q

What is the second line treatment for T2 DM

A

lifestyle changes +metformin + one of the following;
Sulfonylureas, pioglitazone, DPP-4 inhibitor, SGLT-2 inhibitor

based on individual factors and drug tolerance

18
Q

what is the third line treatment for T2 DM

A

triple therapy with metformin and two of the second line drugs combined or
metformin plus insulin

19
Q

SIGN guidelines suggest the use of which second line drugs in particular for pt with CVD

A

SGLT-2 inhibitors and GLP-1 inhibitors

20
Q

How does pioglitazone work

A

it is a thiazolidinedione which increases insulin sensitivity and decreases liver production of glucose

21
Q

How does Sulfonylureas work

A

it is a gliclazide. Stimulates insulin release from the pancreas

22
Q

How do incretins work

A

incretins are hormones produces by the GI tract in response to meals and act to reduce blood sugar by

  • increasing insulin secretions
  • inhibiting glucagon production
  • slow absorption by the GI tract

the main incretin is GLP-1 and they are inhibited by an enzyme called DPP4

23
Q

how do DPP4 inhibitors work such as sitagliptin

A

inhibits the DPP-4 enzyme and therefore increases GLP-1 activity

24
Q

how do SGLT-2 inhibitor work (have the suffix -glifloziini)

A

SGLT-2 protein responsible for reabsorbing glucose from the urine ini to the blood in PCT
SGLT-2 inhibitors block the action of this protein and cause glucose to be excreted in the urine

25
Q

which kind of T2DM treatments have side effect of weight gain

A

Sulphonylurea
Thiazolidinediones
insulin

26
Q

which kind of T2DM treatments have side effect of hypoglycaemia

A

any that increase beta cell activity

insulin

27
Q

which kind of T2DM treatments have side effect of GI symptoms

A

Incretins (GLP-1)

sometimes metformin

28
Q

which kind of T2DM treatments have side effect of weight loss

A

metformin
incretins/ GLP-1 agonist
SGLT-2 inhibitors

29
Q

which T2 DM drug can cause osteoporosis and which can causes UTIs

A

osteoporosis is pioglitazone

UTI is SGLT-2 inhibitors

30
Q

what should be the ideal treatment target of HbA1c levels

A

48 mmol/mol for new T2 diabetics

53 mmol/mol for diabetics that have moved beyond metformin alone

31
Q

Describe rapid acting insulins and give some examples

A

start to work after 10 mins and last around 4 hours

novorapid, Humalog, apidra

32
Q

describe short-acting insulins and give some examples

A

start to work in around 30 mins and last around 8 hours

act rapid, humbling S and inhuman rapid

33
Q

describe intermediate acting insulins and give some examples

A

start to work in around 1 hour and last around 16 hours

insulatard, humulin I, insuman basal

34
Q

describe long actin insulins and give some examples

A

start to work in an hour and last around 24 hours

Lantus, Levemir, Degludec (lasts over 40 hours)

35
Q

describe combinations insulins

A 
contain a rapid acting and intermediate acting insulin 
Humalog 25 (25:75)
Humalog 50 (50:50)
novomix 30 (30:70)
36
Q

why is venous gases acceptable as routine use

A

less painful for patient
similar Ph and bicarb to arterial values
gives potassium and glucose levels too

37
Q

in what instances would an arterial blood gas be favoured over a venous one

A

if you are concerned about the patients respiration (or ventilation) as O2 and CO2 in venous samples are not useful clinically to guide treatment

38
Q

What would be a classic presentation to A&E which would suggest type 1 diabetic

A 
high blood glucose 
ketones
young age
ethnicity (white)
low weight
39
Q

what is the name of the structured education programme for type 1 diabetics that should be started 6-12 months after initial diagnosis

A

DAFNE - diabetes adjustment for normal eating

40
Q

What is the DVLA guidance regarding type 1 diabetics

A

they must take their blood sugars before driving

41
Q

before falling pregnant what is advised in pt with diabetes

A

low HbA1c levels and start taking folate supplements

42
Q

If anti-GAD are positive what is the diagnosis more likely to be

A

this would indicate type 1 diabetes

Medicine Y3 TCD 1-12 (30 decks)

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