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Medicine, Year 3, Metabolic Medicine > Clinical Topic 5: Diabetes > Flashcards

Clinical Topic 5: Diabetes Flashcards

1
Q

When does Type 1 Diabetes commonly present? What sort of onset is associated with the disease?

A

< 25 year old patients

Sudden onset with a short history

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2
Q

What HLAs are associated with Type 1 Diabetes?

A

HLADR3

HLADR4

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3
Q

What three antibodies are associated with Type 1 Diabetes?

A
  • Glutamic acid decarboxylase (GAD)
  • Anti-tyrosine phosphate (ATP)
  • Islet cell antibody
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4
Q

What are the three classic features of Type 1 Diabetes?

A

Polydypsia
Polyuria
Weight loss

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5
Q

Which skin condition is characteristic of Type 1 and 2 Diabetes? What does it look like?

A

Necrobiosis Lipiodica

Shiny red / yellow patches on skin

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6
Q

What is the diagnostic value of HbA1c for Diabetes? How many values are required?

A

48 mmol (6.5%)
If symptomatic -> 1 value required
If asymptomatic -> 2 values required

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7
Q

What is the diagnostic value of one-off glucose measurements for Diabetes? How many values are required?

A

Fasting glucose >7
Random glucose >11

If symptomatic -> 1 value required
If asymptomatic -> 2 values required

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8
Q

What conditions are associated with reduced cell survival, leading to a falsely low HbA1c?

A

Haemoglobinopathies
Splenomegaly
Blood loss
Blood transfusion

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9
Q

What conditions are associated with increased cell survival, leading to a falsely high HbA1c?

A

Splenectomy

B12 / folic acid / iron deficiency

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10
Q

What is the pre-diabetes range for HbA1c and fasting glucose in diabetes?

A

HbA1c: 42 - 47

Fasting glucose: 6 - 7

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11
Q

How is impaired fasting glucose defined?

A

A fasting glucose between 6 and 7

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12
Q

How is impaired glucose tolerance defined?

A

Fasting glucose <7

OGTT 2-hour value between 7.8 and 11.1

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13
Q

What is the C-peptide result in Type 1 and Type 2 Diabetes?

A

Type 1: Low

Type 2: High

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14
Q

1 ml of Insulin = how many units?

A

100 units

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15
Q

What is the initial target HbA1c for Type 1 Diabetics?

A

48

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16
Q

What are the recommended day to day values for blood glucose in Type 1 Diabetic?

A

During the day, 4-7 mmol/L

On waking, 5-7 mmol/L

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17
Q

What is recommended number of times a Type 1 Diabetic patient should check their blood glucose a day?

A

Check glucose four times a day, including before each meal and before bed

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18
Q

What is the first-line recommendation of Insulin for Type 1 Diabetes?

A

Basal bolus twice daily Insulin Determir

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19
Q

What are the two regimens of Insulin for Type 1 Diabetes?

A 
Mixed (rapid acting + intermediate acting)
Basal Bolus (short acting + long acting)
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20
Q

What is the main side effect of Insulin administration?

A

Lipoatrophy and lipohypertrophy

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21
Q

What patients may require Insulin pumps? What does the infusion comprise of?

A

Suitable for those with total insulin deficiency

Comprises a continuous basal infusion + patient activated bolus at meal times

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22
Q

What rate of fixed-rate insulin is administered to DKA patients?

A

0.1 unit / kg / hr

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23
Q

What is the initial management of DKA, and what are the risks of it?

A

IV saline 0.9%

Risk -> Cerebral oedema

24
Q

What is a the normal range of Ketones?

25
Q

What auto-immune diseases are associated with Type 1 Diabetes?

A

Coeliacs

Graves / Hashimotos

26
Q

What skin condition is associated with insulin resistance?

A

Acanthosis nigricans

27
Q

What things may suggest a Hyperosmolar Hyperglycaemic state?

A

Hypovolaemia
High glucose >30
Raised serum osmolality

28
Q

What is the initial treatment for HHS?

A

IV fluids STAT

29
Q

If a patient has recently been diagnosed with Type 2 Diabetes, how often should their HBA1c be checked?

A

Every 3-6 months until stable initially

Then when stable -> 6 monthly

30
Q

What is the HbA1c target for a patient who is newly diagnosed Type 2 Diabetic with lifestyle treatment?

31
Q

What is the HbA1c target for a patient who is newly diagnosed Type 2 Diabetic with lifestyle treatment and Metformin and has a HbA1c of 49?

32
Q

What is the HbA1c target for a patient who is newly diagnosed Type 2 Diabetic (HbA1c of 49) with a drug which causes hypoglycaemia?

33
Q

What is the HbA1c target for a patient who has a HbA1c of 58?

34
Q

What is the MoA of Metformin?

A

Biguanide

Increases glucose uptake
Increases muscle metabolism
Decreases gluconeogenesis

35
Q

Adverse effects of Metformin?

A

Diarrhoea, bloating, epigastric discomfort
Lactic acidosis in renal / hepatic failure
DOES NOT CAUSE WEIGHT GAIN

36
Q

What is the MoA of Sulfonyurea?

A

Binds to ATP dependent K channels

37
Q

Example of a Sulfonyurea?

A

Gliclazide

38
Q

Adverse effects of Sulfonyurea?

A

Weight gain

Hypoglycaemia

39
Q

What is the MoA of DPP4i drugs? Give examples of them

A

Inhibit DPP4i, hence prevents breakdown of GLP-1

Examples: -Gliptin drugs

40
Q

What is the MoA of Thiazolidinediones? Give examples of them

A

PPARy inhibitor, increases insulin sensitivity

Examples: Pioglitazine

41
Q

Adverse effects of Thiazolidinediones (Pioglitozone)?

A

Bladder cancer
Osteoporosis / fractures
Do NOT give to heart failure patients

42
Q

What is the MoA of SGLT2 inhibitors? Examples?

A

SGLT2 inhibitor, inhibits glucose reabsorption in kidneys

Examples: -Flozin drugs

43
Q

Adverse effects of SGLT2 inhibitors?

A

Increased risk of UTI due to glycosuria

WEIGHT LOSS

44
Q

What is the affect of DPP4i on weight?

A

No change in weight

45
Q

What is the inheritance pattern of Maturity Onset Diabetes of the Young (MODY) / Monogenic Diabetes?

A

Autosomal Dominant

46
Q

What two gene mutations are associated with Maturity Onset Diabetes of the Young (MODY) / Monogenic Diabetes?

A
  • Glucokinase

- HNF-1a (Human Nuclear Transcription Factor 1a)

47
Q

What is the treatment for Maturity Onset Diabetes of the Young (MODY) / Monogenic Diabetes?

A

If Glucokinase mutated -> no treatment

If HNF-1a mutated -> Sulfonyureas

48
Q

When does Gestational Diabetes commonly develop in pregnancy?

A

2nd / 3rd trimester

49
Q

Why does Gestational Diabetes occur?

A

Increased production of growth hormone, placental oestrogen, progesterone, cortisol

50
Q

Outline the findings of the DCCT trial

A

DCCT found that tighter glycaemic control of Diabetes had a significant reduction in risk of CVD

T1D were randomised to two groups; one with intensive glycaemic control therapy and one with usual therapy. The ones on the intensive therapy had a 42% reduction of CVD risk over 17 years compared to usual therapy

51
Q

DIABETIC KETOACIDOSIS

  1. What is the pathophysiology of DKA?
  2. What may precipitate DKA in a patient?
  3. How is it diagnosed?
  4. What is the management of DKA?
  5. What are the complications of DKA?
A
  1. Caused by lipolysis, causing excess free fatty acids which are converted to ketones
  2. Missing insulin doses, infections, post-myocardial infarction
  3. Hyperglycaemia (>11), ketosis (>3), acidosis (below 7.3)
  4. FIG-PICK mnemonic
    F = Fluids: 1 ltr NaCl STAT, followed by 4 litres in the next 12 hours + potassium
    I = Insulin: Stop their shorting acting, continue long acting, and 0.1units / kg / hour fixed rate Actrapid
    G = Glucose, monitor and if below 14, give dextrose
    P = Potassium monitoring 4 hourly, correct if required
    I = Treat underlying infection / sepsis
    C = Chart fluid balance
    K = Monitor ketones or bicarbonate levels
  5. Cerebral oedema, arrhythmias secondary to hyperkalaemia, gastric stasis, thromboembolism, ARDS, AKI
52
Q

TYPE 1 DIABETES

  1. What are the features?
  2. What are the investigations for diagnosis?
  3. What is the management of T1D?
  4. What are the complications of diabetes?
  5. What is diagnostic for “high” fasting glucose?
  6. What is diagnostic for “pre-diabetes” fasting glucose?
  7. What is diagnostic for “normal” fasting glucose?
  8. What is diagnostic for “high” HbA1c?
  9. What is diagnostic for “pre-diabetes” HbA1c?
  10. What is diagnostic for “low” HbA1c?
  11. What is diagnostic for “high” random glucose?
  12. What is “impaired glucose tolerance” defined as?
  13. What skin manifestation is associated with T1D?
A
  1. Polyuria, polydipsia, weight loss, muscle cramps, fatigue, diabetic ketoacidosis
  2. Urine dip for glucose and ketones, fasting glucose (>7) and random glucose (>11.1), HbA1c, c-Peptide will be low, antibodies anti-GAD, islet cell antibody
  3. Check HbA1c every 3-6 months, aim for 48 mmol, check glucose at least 4 a day, with each meal and also before bed, increase monitoring if hypoglycaemic, illness, during pregnancy or breast feeding. Keep glucose targets between 5-7 on waking and 4-7 every other time, basal bolus regimen, Metformin if BMI >25
  4. Macrovascular complications such as stroke, hypertension, coronary artery disease, peripheral ischaemia. Microvascular complications such as diabetic retinopathy, diabetic nephropathy, peripheral neuropathy. Infection related complications such as UTIs, oral / vaginal candidiasis, impaired wound healing, skin and soft tissue infections
  5. > 7
  6. 6-7
  7. < 6
  8. 48 mmol/L
  9. 42 - 47 mmol/L
  10. <41 mmol/L
  11. > 11.1
  12. Fasting glucose <7, and an OGTT between 7.8 and 11.1
  13. Necrobiosis lipoidica
53
Q

MATURITY ONSET DIABETES OF YOUNG

  1. What is it?
  2. What is the inheritance pattern?
  3. What are they PARTICULARLY sensitive to?
A
  1. T2D which develops in patients before 25 years old
  2. Autosomal dominant
  3. Very sensitive to sulfonylureas
54
Q

LATENT AUTOIMMUNE DIABETES IN ADULTS

  1. What is it?
A
  1. A form of diabetes commonly seen in patients with autoimmune conditions
55
Q

TYPE 2 DIABETES

  1. What skin manifestation is associated with T2D?
  2. What is some advice to give patients in managing their T2D?
  3. How may you manage complications of T2D?
  4. What is the initial HbA1c target for a patient with T2D?
  5. What is the HbA1c target for patients who are prescribed more than Metformin?
  6. A patient must go beyond what HbA1c to have a target of 53 mmol/L?
  7. What is the mechanism of action of Metformin? And side-effects?
  8. What is the mechanism of action of Sulfonylureas? Give examples of them? And side-effects?
  9. Which medications cause weight gain?
  10. Which medications cause weight loss?
  11. Which medication causes risk of UTIs?
  12. Which medication should be avoided in heart failure patients?
  13. Which medication increases risk of bladder cancer?
  14. Which medication increases risk of Fournier’s gangrene?
  15. Which medication is WEIGHT NEUTRAL?
  16. What is the mechanism of action of Pioglitazone?
  17. Which two drugs increase insulin sensitivity?
A
  1. Necrobiosis lipoidica
  2. High fibre diet, with low glycaemic index. Low fat dairy products, with oily fish. Initial target weight loss of 5-10%, exercise, stop smoking, optimise HTN and CVD risk
  3. Referral to nephrology for diabetic nephropathy, referral to diabetic foot clinic / podiatry for foot checks / footwear, referral to ophthalmology / optometry for retinopathy
  4. 48 mmol/L
  5. 53 mmol/L
  6. 58 mmol/L
  7. Increases insulin sensitivity, SE: GI upset, lactic acidosis
  8. Increase pancreatic cells to secrete insulin, examples: Gliclazide, Glimepiride. SE: Weight gain, hyponatraemia (due to SIADH)
  9. Sulfonylureas and Pioglitazone
  10. SGLT-2 Inhibitors i.e. -Flozins
  11. SGLT-2 Inhibitors i.e. -Flozins
  12. Pioglitazone
  13. Pioglitazone
  14. SGLT-2 Inhibitors i.e. -Flozins
  15. DPP4 inhibitors i.e. GLIPTINS
  16. PRARy agonists, increasing insulin sensitivity
  17. Metformin and Pioglitazone (PPARy agonist)

Medicine, Year 3, Metabolic Medicine (9 decks)

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