Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 3 OSCE > Case 5- Diabetes Mellitus > Flashcards

Case 5- Diabetes Mellitus Flashcards

1
Q

Causes of DM

A

Steroids
Pancreatitis
Pancreatic surgery
Acromegaly
Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Metformin

A

Increased insulin sensitivity
Decreases hepatic gluconeogenesis

GI disturbance (if intolerable, the MR version can be trialled)
Lactic acidosis
Contraindicated in reduced eGFR (below 30)
Stop in MI (due to lactic acidosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pioglitazone (Thiazolidineione)

A

Activate PPARgamma receptors in adipocytes to promote adipogenesis and fatty acid uptake and reduce peripheral insulin resistance

Weight gain
Fluid retention (contraindicated HF)
Bladder cancer
Liver impairment
Increase fracture risk

NB- rarely Used second line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sulfonylurea (glicazide/glimperide)

A

Stimulate pancreatic beta cells to secrete insulin

Weight gain (apetite)
Hypoglycaemia
Hyponatraemia (due to SIADH)
Hepatotoxicity (cholestasis)
Increased risk of CVD when used as a mono therapy

Avoid in breast feeding and pregnancy
Overdose- hyperinsulinaemia and increased C peptide levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DPP4 Inhibitor (sitagliptin)

A

Increases incretins (inhibits breakdown) which inhibit glucagon secretion

GI disturbance
Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

GLP 1 Mimetics (liraglutide/ exenatide)

A

Incretin mimetic which inhibits glucagon secretion

GI disturbance
Weight loss
Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SGLT 2 Inhibitors (empaglifozin)

A

Inhibits glucose resorption in kidney (proximal convoluted tubule SGLT2 transporter), increases urinary glucose

Glucose excreted in urine- UTI
Reduced risk of CVD
Weight loss
DKA
Necrotising fasciitis if the genitalia or perineum eg. Fourniers gangrene
Increased risk of lower limb amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Meglitinides SE

A

Hypoglycaemia
Weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

DM blood glucose ranges

A

Random >11.1
OGTT >11.1
Fasting >7
HbA1c >48

NB- OGTT: don’t eat for 8-12 hours prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

HbA1C Targets

A

48 if on one medication
53 if one 2 or more/ hypo risk drug monotherapy/ elderly at risk of fall
If above 58- step up management
If above 80- need insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms of hypoglycaemia

A

Autonomic- tremor, pallor, anxiety, tachycardia, palpitations, hunger, nausea and vomiting

Neuroglycopenic- agitation, confusion, behavioural changes, seizures, somnolence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hyperglycaemia symptoms

A

Polyuria, polydipsia, n & v, volume depletion signs, altered mental status, lethargy, coma, blurred vision, weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diabetes Mellitus type 1 Sx

A

Typical hyperglycaemia Sx eg. Polyuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Diabetes type 2 investigations and management

A

Finger prick BM
Urine- ketones and glucosuria
Bloods- HBA1c, OGTT, plasma ketones, fasting blood glucose, UE (diabetic nephropathy)
Tests for complications- fundoscopy and diabetic foot exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DKA and HHS Investigations

A

Urinalysis- ketones
Bloods- FBC, ketones, UE (K will be normal but it is extra cellular so need to replace to make it intra cellular), ABG (metabolic acidosis, resp compensation), blood cultures, BM
ECG and CXR

Needs acidaemia, ketonaemia, hyperglycaemia

Replace potassium!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

C peptide levels

A

Indicate amount of endogenous insulin being produced- very low levels indicative of type 1

NB- GAD autoantibodies serve as a marker for autoimmune diabetes in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HHS vs DKA

A

No ketones or acidaemia in HHS, and history is usually longer (glucose often more than 35 in DKA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diabetic foot exam

A

Compare one foot to another (inspection and all other steps)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Statins

A

QRISK greater than 10% (and no known heart disease) for type 2 diabetics or T1DM or CKD if eGFR less than 60, offer 20mg OD atorvastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diabetes type 2 management

A

Lifestyle modifications- diet, exercise, weight loss, smoking cessation, statin and ACE-I (ARB if Afro Caribbean)
Monitoring for complications

Drug therapy- as per the 2 diagrams on passmedicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Normal blood glucose ranges

A

Random <7.8
OGTT <7.8
Fasting 4-6.0
HBA1c <42

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hall marks of DKA

A

Acidaemia
Ketonaemia
Hyperglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hallmarks of HHS

A

Hyperglycaemia
Hyper osmolarity
Volume depletion
NO KETOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diagnose DKA

A

pH <7.3 (or bicarbonate <15)
Ketones >3 or more than 2+ on dipstick
BM >11 or known diabetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Diagnose HHS
Glucose >11 Osmolarity >320 Absence of significant ketosis
26
Management of HHS
IV fluids IV Insulin (sometimes not even needed) Stop metformin for 2 days Prophylactic LMWH NB- continue long acting insulin but stop other forms
27
Management of DKA
IV fluids (0.9% saline/isotonic) IV insulin (0.1unit/kg/hour)- 5% dextrose when glucose starts dropping below 15 Potassium replacement (after first saline bag)- if potassium is within 3.5-5.5 Treat cause NB- continue long acting insulin but stop other forms
28
Impaired glucose tolerance (pre diabetes) ranges
Random 7.8-11.1 OGTT 7.8-11.1 Fasting 6.1-7.0 HBA1c 42-47
29
Investigations for type 1 DM
Finger prick BM Urine- ketones and glucosuria Bloods- OGTT, plasma ketones, fasting blood glucose, UE (diabetic nephropathy), c peptide (low), diabetes specific autoantibodies Tests for complications- fundosdopy and diabetic foot exam NB- HbA1c isn’t helpful in T1DM
30
Diagnosing between T1DM and T2DM
See gallery For those in whom there is a doubt, C-peptide levels (low in T1DM) and diabetes-specific autoantibodies are the investigations of choice (positive in T1DM)
31
Diagnosing type 1 diabetes
Fasting greater than 7 or Radom glucose/ OGTT greater than 11.1 If patient is asymptomatic, above criteria must be demonstrated on 2 separate occasions
32
Diagnosing type 2 diabetes
Fasting greater than 7, Radom glucose/ OGTT greater than 11.1, HBA1c measurement of 48 or greater If patient is asymptomatic, above criteria must be demonstrated on 2 separate occasions (even HBA1c)
33
What is type 1 DM
Autoimmune disorder where insulin producing beta cells of islet of langerhans in pancreas are destroyed by immune system
34
What is type 2 DM
Relative deficiency of insulin due to an excess of adipose tissue
35
Maturity onset diabetes of the young (MODY)
A group of inherited genetic disorders affecting the production of insulin Young patients with symptoms similar to T2DM eg. Asymptomatic hyperglycaemia Autosomal dominant condition
36
Latent autoimmune diabetes of adults (LADA)
A small group of patients who develop autoimmune diabetes later in life (check c peptide and diabetes as often misdiagnosed as T2DM)
37
Side effects of insulin therapy
Hypoglycaemia (tell patients about symptoms, 10-20g of short acting carb, glucagon kit at home) Weight gain Lipodystrophy (rotate injection site, causes erratic insulin absorption)
38
Management of T1DM
Monitor HBA1c every 3-6 months Self monitor blood glucose 4 times a day (before each meal and before bed- more if unwell, during and after sport, should be 5-7 on waking and 4-7 at other times of day) Insulin
39
Hypertension and type 2 diabetes
Blood pressure targets are the same as those without diabetes ACE-I is preferred except in Afro-Caribbean patients where ARB is first line
40
Ramadan and diabetes
Eat a long acting carbohydrate meal prior to sunrise Patients should have access to BM monitoring Some changes with metformin and glicazide (sulfonylureas)
41
Diabetes Mellitus sick day rules
Increase frequency of blood glucose monitoring (should be able to access urinary ketone monitoring too) Increase fluid intake (3 litres in 24 hours) Drink sugary drinks if can’t eat Continue taking oral hypoglycaemics (don’t take metformin in dehydration) Don’t stop insulin NB- low threshold of admitting these patients eg. Persistent vomiting, no one at home in case they are unconscious, persistently high BM’s
42
Features of DKA
Abdominal pain Polyuria, polydipsia, dehydration Deep hyperventilation (Kussmaul breathing) Acetone breath (pear drops)
43
Resolution of DKA
Ketonaemia and acidosis should resolve within 24 hours If labs suggest it has resolved and patient is eating and drinking normally, revert to insulin regime
44
Complications of DKA
VTE Arrhythmia Gastric stasis ARDS AKI Cerebral oedema (children)- headache, irritability, visual disturbance, focal neurology (usually 4-12 hours post treatment)
45
Management of diabetic neuropathy
Optimise glycaemic control Amitriptyline, duloxetine, gabapentin, or pregabalin (if one doesn’t work, try another one) Tramadol for exacerbations Topical capsaicin Pain management clinics if persistent
46
Gastrointestinal autonomic neuropathy
Gastroporesis- Erratic blood glucose control, bloating, vomiting Chronic diarrhoea GORD
47
DVLA and diabetes
Diet controlled- no need to inform If on tablets- no need to inform If on sulfonylurea (glicazide) or hypo causing tablet, mustn’t have had more than 1 episode of hypoglycaemia requiring the assistance of another on the preceding 12 months If on insulin- tell DVLA, need hypoglycaemic awareness, no visual impairment, mustn’t have had more than 1 episode of hypoglycaemia requiring the assistance of another on the preceding 12 months Drivers on insulin can have type 2 (HGV) license but need to follow standards above and do regular glucose monitoring (machine with a memory function), no complications of disease, there has not been any severe hypoglycaemic event in the previous 12 months
48
Causes of a reduced HBA1c (reduced RBC life span)
Sickle cell anaemia GP6D deficiency Hereditary spherocytosis NB- haemolysis/increased turnover
49
Causes of an increased HBA1c
Iron deficiency anaemia Vitamin B12 or folate deficiency Splenectomy NB- reduced turnover ie. less Fe/B12 to create new cells
50
Insulinoma
Tumour derived from pancreatic islets of langerhans cells (endocrine tumour) Weight gain, high insulin, hypoglycaemia, high c peptide Symptoms and signs of hypoglycemia Plasma glucose < 2.5 mmol/L Reversibility of symptoms on the administration of glucose Diagnose- prolonged fasting (72 hours), CT pancreas Management- surgery or diazoxide/somatostatin NB- C-peptide production does NOT fall on exogenous insulin injection in patients with an insulinoma (it does with self-administration of insulin)
51
Kallman’s syndrome
Delayed puberty secondary to hypogonadotropic hypogonadism (x Linked recessive) Usually anosmia in a boy with delayed puberty Other features- cryptorchidism, hypogonadism, low sex hormone levels, LH and FSH levels are low/normal, normal or above average height May also have cleft lip/palate and visual/hearing defects
52
Management of hypoglycaemia
Unconscious- 150ml 10% glucose IV or glucagon 1mg IM Conscious can’t swallow- 2 tubes glucose gel around teeth Conscious can swallow- 15-30g fast acting carbs eg. 5-7 glucose tabs or 150ml fruit juice, and long acting carbs eg, biscuit, toast
53
Estimate serum osmolarity
2 x Na+ + glucose + urea
54
In newly diagnosed adults with type 1 diabetes, what is the first-line insulin regime
basal–bolus using twice‑daily insulin detemir
55
Causes of hypoglycaemia
Diabetics; Insulin or sulfonylurea treatment with an increase in activity or a missed meal or non-accidental overdose. Non-diabetics (EXPLAIN); Exogenous drugs such alcohol, aspirin poisoning, pentamidine, quinine sulfate, ACE-inhibitor Pituitary insufficiency Liver failure Addison's disease Islet cell tumours eg insulinoma Non-pancreatic neoplasms
56
Causes of hypoglycaemia
Diabetics; Insulin or sulfonylurea treatment with an increase in activity or a missed meal or non-accidental overdose. Non-diabetics (EXPLAIN); Exogenous drugs such alcohol, aspirin poisoning, pentamidine, quinine sulfate, ACE-inhibitor Pituitary insufficiency Liver failure Addison's disease Islet cell tumours eg insulinoma Non-pancreatic neoplasms
57
Impaired fasting glucose and impaired glucose tolerance
NB- 2 different things A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG) Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
58
Thiazides and glucose tolerance
Thiazides worsen glucose tolerance (and predispose to digoxin toxicity)
59
Diabetic medications and elective surgery
Omit agents that can precipitate hypoglycaemia ie. glicazide (but continue others ie. metformin)
60
Diabetic medications and elective surgery
Omit agents that can precipitate hypoglycaemia ie. glicazide (but continue others ie. metformin)
61
Conditions where HBA1c cannot be used for diagnosing diabetes
haemoglobinopathies haemolytic anaemia untreated iron deficiency anaemia suspected gestational diabetes children HIV chronic kidney disease people taking medication that may cause hyperglycaemia (for example corticosteroids)
62
T1DM and BMI 25+
NICE recommend considering adding metformin if the BMI >= 25 kg/m²
63
Metformin and surgery
OD or BD: take as normal TDS: miss lunchtime dose assumes only one meal will be missed during surgery, eGFR > 60 and no contrast during procedure
64
Adding and sglt2 inhibitor
add even if diabetes is well controlled ie. hba1c is <48

Year 3 OSCE (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions