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DIABESITY Flashcards

1
Q

What is the equation for calculating BMI?

A

BMI = kg/m2

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2
Q

BMI is accurate for elderly populations, pregnant women and those with a high muscle mass. TRUE or FALSE

A

FALSE because muscle is heavier than fat so can give a misleading reading

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3
Q

A BMI of 25 is classed as what?

A

Overweight (25-29.9)

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4
Q

A BMI of 35 is classed as Obesity I, II or III?

A

Obesity II (35-39.9)

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5
Q

A BMI of what or over is classed as obese?

A

30+

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6
Q

To reduce risk of co-morbidities such as insulin resistance, a target waist circumference in men and women is what?

A

Below 88 women

Below 102 men

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7
Q

Orlistat can be given to those with a BMI of…

A

28kg/m2 + with risk

30kg/m2 + no risk

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8
Q

Orlistat therapy can only be continued beyond 3 months if lost at least ____% of initial body weight since stat of treatment

A

5%

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9
Q

What is the dose of Orlistat than can be purchased OTC if over 18 and criteria is met?

A

60mg capsule

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10
Q

Bariatric surgery can be considered in those with BMI of…

A

35 or more with co-morbidities (T2DM or High blood pressure)

40 or more

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11
Q

What are the 4 T’s of diabetes identification?

A

Tiredness, Thinner, Toilet, Thirst

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12
Q

Diagnosis = random venous plasma glucose conc of what?

A

> 11.1 mmol/l

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13
Q

Diagnosis = fasting venous plasma glucose conc of what?

A

> 7.0 mmol/l

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14
Q

Blood pressure targets in those with T2DM are…

A

below 130/80

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15
Q

What is first line treatment in Type 2 diabetes?

A

Oral Metformin (biguanide)

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16
Q

If Metformin contraindicated/not tolerated consider…

A
  • DPP-4 inhibitor
  • pioglitazone (thiazolidinedione)
  • sulphonylurea
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17
Q

If blood pressure not adequately controlled then introduce…

A

ACEI if tolerated/recommended

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18
Q

What should be calculated in those with Type 2 diabetes to check cardiovascular risk?

A

Q risk score - assess need for statin etc…

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19
Q

Trembling, sweating, tachycardia, faintness, loss of concentration, drowsiness and confusion are symptoms of…

A

Hypoglycaemia - risk associated with sulphonylureas

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20
Q

Sulfonylureas can cause weight gain TRUE or FALSE

A

TRUE - they can cause weight gain

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21
Q

Sulfonylureas should be used with caution in the elderly due to risk of what?

A

Hypos - they are frail and may have a low food intake

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22
Q

Sulfonylureas pose a risk of hypernatraemia due to effects on increasing renal sensitivity to ADH. TRUE OR FALSE

A

FALSE - Sulfonylureas pose a risk of hyPOnatraemia due to effects on increasing renal sensitivity to ADH.

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23
Q

Give an example of two Meglitinides and when their use is licensed…

A

Repaglinide and Nateglinide (comb therapy when metformin alone inadequate)

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24
Q

What is the main use for non adherence to alpha glycosides inhibitors and give an example of one.

A

Acarbose - flatulence

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25
List two side effects of Thiazolidinediones (Pioglitazone) | When should you not use them?
Weight gain and oedema - DONT use in congestive heart failure - DONT use if hepatic function impairment
26
DPP-4 inhibitors are also knows as the...
Gliptins (Sitagliptin, Bildagliptin, Saxagliptin)
27
Name two Incretin Mimetics (GLP-1 agonists)
Liraglutide and exenatide
28
Incretin mimetics (GLP-1 agonists) can aid weight loss TRUE or FALSE
TRUE
29
Name the 4 different types of insulin
Short/Rapid acting Intermediate (1st line) Long acting analogues Biphasic combinations
30
What is the lifespan of a RBC? THEREFORE over what time period do HbA1c (glycosylated haemoglobin) levels show us average diabetes control for?
2-3 months
31
What is the optimal HbA1c target (% and mmol/mol) for those with type 2 diabetes and not at risk of hypo?
6.5% (48mmol/mol)
32
Q risk calculator calculates what?
Risk of having stroke over next 10 years
33
What is the HbA1c target for those at risk of hypos?
7% (53mmol/mol)
34
What should we be aware of that can possibly cause low HbA1c/hypos?
Deteriorating renal function
35
Why is the dose of Metformin gradually increased over a period of several weeks rather than starting at the higher dose?
- To reduce the risk of GI side effects
36
What is the second line treatment of type 2 diabetes?
- Metformin and... - DPP-4 Inhib (gliptin) - Pioglitazone - Sulfonylurea - SGLT-2 Inhib
37
In adults with type 2 diabetes, review the dose of metformin if the estimated glomerular filtration rate (eGFR) is below __ ml/minute/1.73m2: Stop metformin if the eGFR is below __ ml/minute/1.73m2.
1) 45 (3a) moderately reduced | 2) 30 (3b) moderately reduced
38
What type of insulin is NPH insulin?
Intermediate
39
Name an SGLT-2i...
- Canagliflozin
40
List some implications of poor control of bloody glucose levels...
- Microvascular damage e.g neuropathy, retinopathy, nephropathy - Hyperglycaemia - Hypoglycaemia
41
List the common symptoms of hyperglycaemia (4)
- Passing more urine than normal, especially at night - Being very thirsty - Headaches - Tiredness and lethargy.
42
Oral anti-diabetic drugs should only be initiated if the patient has failed to respond to __ months restriction of energy and carb intake with increased exercise.
3 months
43
NICE has recommended that treatment with pioglitazone and sita and vildagliptin is continued only if HbA1c concentration is reduced by at least 0.5 percentage points within _ months of starting treatment.
6
44
What do you need to fill in a Q-RISK assessment form? | 4 things...
- Details about the person — age, sex, ethnicity, postcode, smoking status, and selected medical and family history. - Values of current blood pressure - Body mass index (BMI). - The total cholesterol/high-density lipoprotein (HDL)-cholesterol ratio from a non-fasting blood sample.
45
What are the drinking guidelines for men and women?
MEN = 21 units per week (maximum of 4 units on any one day) WOMEN = 14 units per week (maximum of 3 units on any one day)
46
In what circumstance might it be appropriate to use waist circumference as a measurement instead of BMI? - How do you take a waist measurement?
- In an athlete | - Tape measure just above hip bone, measure circumference
47
How does Orlistat work?
- Inhibits breakdown of fat causing it to be excreted rather than digested
48
What are some side effects of Orlistat?
- Steatorrhea (fatty stools) | - Impaired abs of fat soluble vitamins
49
Give two examples of GLP-1 agonists (incretins)... | - What is an advantage of these?
- Liraglutide - Exenatide - Cause weight loss
50
What plasma glucose level qualifies as a diagnosis for diabetes 2 hours after administration of 75g anhydrous glucose in an oral glucose tolerance test?
Greater than 11mmol/l (should be around 5)
51
Which three drugs cause insulin secretion from pancreas?
- Sulfonylureas (glicazide, glipazide) - Meglitinides - Incretins (GLP-1 agonists and DPP-4 antagonists)
52
Which two drugs reduce hepatic glucose output (gluconeogenesis)?
- Metformin | - Thiazolidinediones (pioglitazone)
53
Which two drugs increase glucose uptake and utilisation?
- Metformin | - Thiazolidinediones (pioglitazone)
54
Which group of drugs reduce glucose reabsorption?
- SGLT2 inhibitors (Canagiflozin, Dapagliflozin)
55
Which drug controls appetite?
- Incretin
56
Can metformin be used in those with renal impairment?
- Do not use in those with eGFR less than 60ml/min/1.72m2 | - Because may cause lactic acidosis due to reduce uptake of lactate by liver
57
What must be taken with a sulfonylurea? | Why?
- Must take it with food to prevent hypoglycaemia
58
If Metformin alone is not controlling blood sugar levels adequately then what should be done?
ADD... - DPP-4 inhibitor - Pioglitazone (Thiozoladinedione) - Sulfonylurea (Gliclazide, Glipizide) TO METFORMIN
59
What do DPP-4 inhibitors do?
- Reduce breakdown of GLP-1 by DPP-4 - Means more GLP-1 - GLP-1 released after food, tells body full and causes insulin secretion from pancreas - GLP-1 reduces hepatic glucose output
60
What is an advantage of DPP-4 inhibitors? | When are they used?
- Weight neutral USED if Metformin not tolerated or if treatment with Metformin alone is inadequate (Step up)
61
If Metformin with... - Pioglitazone - Sulfonylurea - DPP-4 inhibitor Is inadequate, what happens next?
- Use... - metformin, a DPP‑4 inhibitor and a sulfonylurea - metformin, pioglitazone and a sulfonylurea OR start insulin based therapy
62
When can you use Metformin with a sulfonylurea and a GLP-1 analogue (incretin mimetic)?
- BMI of 35 kg/m2 or higher AND - Specific psychological or other medical problems associated with obesity -BMI lower than 35 kg/m2 AND -insulin therapy would have significant occupational implications or -weight loss would benefit other significant obesity‑related comorbidities.
63
What are the conditions for continuing a GLP-1 analogue (incretin mimetic)?
- Beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c AND - Weight loss of at least 3% of initial body weight in 6 months)
64
What are the effects of insulin?
- Promotes peripheral utilisation of glucose - Suppresses hepatic glucose production - Limits postprandial glucose elevation
65
What is the first line recommendation for insulin therapy?
- OD or BD NPH insulin e.g Humulin - intermediate - Keep on metformin unless contraindicated - Monitor for hypos
66
A waist circumference of less than ___ is considered low risk for comorbidities in women A waist circumference of less than ___ is considered low risk for comorbidities in men
80 women 94 men
67
What are some risk factors for type 2 diabetes? (9)
- Being overweight or obese (especially around the waistline) - Poor diet - Lack of physical activity - Family history of type 2 diabetes - Increasing age - Hypertension or cardiovascular disease - South Asian, African or African-Caribbean ethnicity - High socioeconomic deprivation - Impaired glucose regulation and/or raised HbA1c
68
Each patient should receive the ___ healthcare essentials set out by the NHS.
15
69
What are the 15 healthcare essentials?
1- HBA1c monitoring 2-3months unstable 6 months stable 2- Annual blood pressure monitoring 3- Annual retinopathy 4- Annual foot checks (doctor, podiatrist) 5- Weight monitoring 6- Annual kidney function tests (urine test protein, blood test) 7- Annual cholesterol monitoring 8- Input into own care 9- Opportunity to attend a Diabetes course 10- Smoking cessation support 11- Care from specialist paediatric team if young person 12- Specialist care if admitted to hosp 13- Specialist care if planning to have a baby 14- Care from specialist diabetes healthcare professionals 15- Psychological support
70
How often should Adults exercise a week?
- Aim to be active daily. | - Week = 2 1⁄2 hours of moderate intensity e.g 30 minutes on at least 5 days a week.
71
What takes place at an NHS health check?
- Questions e. g Alcohol, Smoking status, Family history, Exercise - Blood pressure taken - Height and weight to calc BMI - Cholesterol levels - If at risk of type 2 then blood sugar level test
72
What is a disadvantage of Liraglutide (GLP-1 agonist)?
- Administration by subcut injection
73
Waist measurements can be useful in those with a BMI of under...
35kg/m2
74
If you are an overweight women with a waist circumference of less than 80 are you at... No increased risk Increased risk Significantly increased risk Of health risks associated with being overweight?
No increased risk
75
If you are an overweight man with a waist circumference of 94-102 are you at... No increased risk Increased risk Significantly increased risk Of health risks associated with being overweight?
Increased risk
76
If you are an obese woman with a waist circumference of 80-88 are you at... No increased risk Increased risk High risk Very high risk Of health risks associated with being overweight?
High risk
77
When should you consider adding a biphasic insulin? (NPH and short acting)
- If HbA1C is above 78mmol/L (9%)

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