Diabetes Flashcards
Insulin
- anabolic or catabolic
- produced by what cells
- when is it produced
Anabolic
Beta cells in Islets of Langerhans in pancreas
Produced when high blood sugars
What is the function of insulin?
Causes cells to absorb glucose from blood + muscle / liver cells to store glucose as glycogen
Glucagon
- anabolic or catabolic
- produced by what cells
- when is it produced
Catabolic
Alpha cells in Islets of Langerhans in pancreas
In low blood sugars or in stress to rise blood sugar
In ketosis, the acidosis is usually buffered by _____. DKA occurs when used up all _____.
Bicarbonate
Glucagon, cortisol, GH and adrenaline are all what
Counter regulatory hormones AKA stress hormones
25-50% of T1DM patients first present in DKA. How do the others present?
Polyuria, polydipsia, weight loss, recurrent infections, blurred vision, lethargy
What is normally capillary glucose?
What is hypoglycemia?
4.4 - 6.1
Hypoglycaemia <4
Is c-peptide low or high in T1DM?
Low
What autoantibody is associated with T1DM?
Anti-GAD
What is glycated haemoglobin?
HbA1c - reflects average BG over last 3mth (since RBC lifespan 3mth)
What is a complication of injecting insulin in the same spot?
Lipodystrophy
When investigating T1DM, are antibodies and c-peptide checked in primary care?
Nope by endocrinologists
How are diabetes complications classified?
Macrovascular or microvascular
How frequently are diabetes patients reviewed?
Annually
In IDDM, if BG is high before lunch/dinner - when should insulin dose be changed?
Increase breakfast dose by 10%
In IDDM, if BG is high before bed/breakfast - when should insulin dose be changed?
Increase dinner dose by 10%
What are the diagnostic criteria for T1DM?
Fasting glucose >7 + random glucose >11.1 + symptoms
OR
if no symptoms:
fasting >7 on 2 occasions + random glucose >11.1 on 2 occasions
Is HbA1c a reliable test in a new diagnosis of T1DM?
No since could’ve happened less than 3mth ago
What is the management of hypoglycaemia if conscious but not confused?
Rapid acting glucose eg lucozade + slow acting carb eg toast
What is the management of hypoglycaemia if confused?
1-2 tubes glucogel
What is the management of hypoglycaemia if unconscious?
IV 10% dextrose or IM glucagon
Then 20g PO complex carb
Is potassium low or high in DKA?
High blood potassium, total-body potassium low
What is seen on ABG in DKA?
Raised anion gap metabolic acidosis
Why can DKA cause arrhythmias?
Hypokalaemia
Why is there dehydration in DKA?
Osmotic diuresis glucose in urine draws water out with it
polydipsia, polyuria
What level are the blood ketones in DKA?
> 3
What is the management of DKA?
IV fluid 1st bag NaCl over 1hr, 2nd bag NaCl over 2hr with 40mmol potassium
Insulin Actrapid 0.11unit/kg/hr
Glucose: monitor BG, add dextrose infusion if below 4
+-LMWH
Treat trigger
When is cardiac monitoring required in fluid resuscitation?
If potassium given quicker than 20mmol/hr
What type of foot ulcers are associated with diabetes? Where would they most commonly be?
Neuropathic ulcer
Metatarsal head/big toe
Give 4 examples of microvascular complications of diabetes
Gastroparesis Erectile dysfunction Retinopathy Peripheral neuropathy Nephropathy
What is diabetic nephropathy also known as?
Glomerulosclerosis
Describe diabetic peripheral neuropathy
Distal symmetrical glove + stocking
What is the management of diabetic gastroparesis?
Metoclopramide
20% of T2DM have microvascular complications at diagnosis - true or false
True
What is the diagnostic criteria for T2DM if someone has symptoms? What if they have no symptoms?
Symptoms: random glucose >11.1 OR fasting >7
No symptoms: 2X random glucose >11.1 OR 2X fasting >7 OR 2X HbA1c >48
What are the diagnostic criteria for impaired glucose tolerance?
Fasting glucose 6.1-6.9 on two occasions
Offer a OGTT
What are the diagnostic criteria for pre-diabetes?
HbA1c 42-47 OR Fasting glucose 6.1-6.9 OR OGGT 7.8-11.0
What is the first line management of T2DM?
Metformin 500mg OD
Can titrate to 1g BD
What is the management of T2DM if the patient gets GI SE from metformin?
Switch to modified release metformin
What is the management of T2DM if the patient can’t tolerate metformin?
Switch to 1 of: sulfonylurea OR gliptin OR pioglitazone
What is the HbA1c threshold for adding a new drug in T2DM Mx?
> 58
What is the second line management if on Metformin and HbA1c >58?
Add sulfonylurea OR gliptin OR pioglitazone OR SGLT2 inhibitor
What is the third line management of T2DM?
Metformin + 2 oral drugs OR metformin + insulin
Should T2DM patients on insulin continue metformin?
Yes
What are the clinic / home blood pressure targets in T2DM?
Same as HTN targets
If <80yr clinic 140/90, home 135/85
If >80yr clinic 150/90, home 145/85
What is the HbA1c target in T2DM if on lifestyle Mx alone?
48
What is the HbA1c target in T2DM if on metformin alone?
48
What is the HbA1c target in T2DM if on sulphonylurea alone?
53
What is the HbA1c target in T2DM if on multiple oral drugs?
53
What is the 1st line Mx of new HTN in T2DM in caucasian / black skin?
ACE/ARB if white
ARB if black skin
When should a statin be started in T2DM?
Cardiovascular risk score >10%
When should diabetics inform the DVLA?
If on insulin
OR >1 hypo requiring assistance in past 12mth
OR neuropathy
OR retinopathy
Which T2DM drugs are contraindicated in an eGFR <30?
Metformin
SGLT2 inhibitors
Name a sulfonylurea
Gliclazide
Name a DDP4 inhibitor
Gliptin
Name a SGLT2 inhibitor
Empagiflozin
Name a GLP-1 mimetic
Exenatide
Which T2DM drug can cause acute pancreatitis as a side effect?
GLP-1 mimetic exenatide
Which T2DM drug can cause lactic acidosis as a side effect?
Metformin
Which T2DM drug can cause Fournier’s gangrene as a side effect?
SGLT2 inhibitor empaglifozin
Which T2DM drug can cause URTI symptoms as a side effect?
DDP4 inhibitor gliptin
Which T2DM drug can cause UTIs as a side effect?
SGLT2 inhibitor empaglifozin
Which T2DM drug can cause hypoglycaemia as a side effect?
Sulfonylurea
Which T2DM drug can cause increased CVD risk when used as monotherapy?
Sulfonylurea
Which T2DM drug can cause heart failure as a side effect?
Pioglitazone
Which T2DM drug can cause hip fractures as a side effect?
Pioglitazone
Which T2DM drug is good in CVD?
SGLT2 inhibitor empaglifozin and GLP-1 mimetic exenatide
Which T2DM drugs are SUBCUT only?
Insulin and GLP-1 mimetic exenatide
Which T2DM drug should be avoided in lorry drivers?
Sulphonylurea gliclazide
Which T2DM drug is safe in pregnancy?
Metformin
What effect does metformin have on weight?
Weight neutral
What effect does Pioglitazone have on weight?
Weight gain
What effect does empaglifozin have on weight?
Weight loss
Can T2DM patients get DKA?
Yes
In HHS is the blood volume low or high? Is sodium low or high? Is osmolarity low or high?
Low blood volume
High Na
High osmolarity