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Diabetes Flashcards

1
Q

Insulin

  • anabolic or catabolic
  • produced by what cells
  • when is it produced
A

Anabolic
Beta cells in Islets of Langerhans in pancreas
Produced when high blood sugars

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2
Q

What is the function of insulin?

A

Causes cells to absorb glucose from blood + muscle / liver cells to store glucose as glycogen

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3
Q

Glucagon

  • anabolic or catabolic
  • produced by what cells
  • when is it produced
A

Catabolic
Alpha cells in Islets of Langerhans in pancreas
In low blood sugars or in stress to rise blood sugar

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4
Q

In ketosis, the acidosis is usually buffered by _____. DKA occurs when used up all _____.

A

Bicarbonate

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5
Q

Glucagon, cortisol, GH and adrenaline are all what

A

Counter regulatory hormones AKA stress hormones

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6
Q

25-50% of T1DM patients first present in DKA. How do the others present?

A

Polyuria, polydipsia, weight loss, recurrent infections, blurred vision, lethargy

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7
Q

What is normally capillary glucose?

What is hypoglycemia?

A

4.4 - 6.1

Hypoglycaemia <4

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8
Q

Is c-peptide low or high in T1DM?

A

Low

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9
Q

What autoantibody is associated with T1DM?

A

Anti-GAD

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10
Q

What is glycated haemoglobin?

A

HbA1c - reflects average BG over last 3mth (since RBC lifespan 3mth)

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11
Q

What is a complication of injecting insulin in the same spot?

A

Lipodystrophy

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12
Q

When investigating T1DM, are antibodies and c-peptide checked in primary care?

A

Nope by endocrinologists

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13
Q

How are diabetes complications classified?

A

Macrovascular or microvascular

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14
Q

How frequently are diabetes patients reviewed?

A

Annually

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15
Q

In IDDM, if BG is high before lunch/dinner - when should insulin dose be changed?

A

Increase breakfast dose by 10%

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16
Q

In IDDM, if BG is high before bed/breakfast - when should insulin dose be changed?

A

Increase dinner dose by 10%

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17
Q

What are the diagnostic criteria for T1DM?

A

Fasting glucose >7 + random glucose >11.1 + symptoms
OR
if no symptoms:
fasting >7 on 2 occasions + random glucose >11.1 on 2 occasions

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18
Q

Is HbA1c a reliable test in a new diagnosis of T1DM?

A

No since could’ve happened less than 3mth ago

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19
Q

What is the management of hypoglycaemia if conscious but not confused?

A

Rapid acting glucose eg lucozade + slow acting carb eg toast

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20
Q

What is the management of hypoglycaemia if confused?

A

1-2 tubes glucogel

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21
Q

What is the management of hypoglycaemia if unconscious?

A

IV 10% dextrose or IM glucagon

Then 20g PO complex carb

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22
Q

Is potassium low or high in DKA?

A

High blood potassium, total-body potassium low

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23
Q

What is seen on ABG in DKA?

A

Raised anion gap metabolic acidosis

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24
Q

Why can DKA cause arrhythmias?

A

Hypokalaemia

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25
Why is there dehydration in DKA?
Osmotic diuresis glucose in urine draws water out with it | polydipsia, polyuria
26
What level are the blood ketones in DKA?
>3
27
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
28
When is cardiac monitoring required in fluid resuscitation?
If potassium given quicker than 20mmol/hr
29
What type of foot ulcers are associated with diabetes? Where would they most commonly be?
Neuropathic ulcer | Metatarsal head/big toe
30
Give 4 examples of microvascular complications of diabetes
``` Gastroparesis Erectile dysfunction Retinopathy Peripheral neuropathy Nephropathy ```
31
What is diabetic nephropathy also known as?
Glomerulosclerosis
32
Describe diabetic peripheral neuropathy
Distal symmetrical glove + stocking
33
What is the management of diabetic gastroparesis?
Metoclopramide
34
20% of T2DM have microvascular complications at diagnosis - true or false
True
35
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
36
What are the diagnostic criteria for impaired glucose tolerance?
Fasting glucose 6.1-6.9 on two occasions | Offer a OGTT
37
What are the diagnostic criteria for pre-diabetes?
``` HbA1c 42-47 OR Fasting glucose 6.1-6.9 OR OGGT 7.8-11.0 ```
38
What is the first line management of T2DM?
Metformin 500mg OD | Can titrate to 1g BD
39
What is the management of T2DM if the patient gets GI SE from metformin?
Switch to modified release metformin
40
What is the management of T2DM if the patient can't tolerate metformin?
Switch to 1 of: sulfonylurea OR gliptin OR pioglitazone
41
What is the HbA1c threshold for adding a new drug in T2DM Mx?
>58
42
What is the second line management if on Metformin and HbA1c >58?
Add sulfonylurea OR gliptin OR pioglitazone OR SGLT2 inhibitor
43
What is the third line management of T2DM?
Metformin + 2 oral drugs OR metformin + insulin
44
Should T2DM patients on insulin continue metformin?
Yes
45
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
46
What is the HbA1c target in T2DM if on lifestyle Mx alone?
48
47
What is the HbA1c target in T2DM if on metformin alone?
48
48
What is the HbA1c target in T2DM if on sulphonylurea alone?
53
49
What is the HbA1c target in T2DM if on multiple oral drugs?
53
50
What is the 1st line Mx of new HTN in T2DM in caucasian / black skin?
ACE/ARB if white | ARB if black skin
51
When should a statin be started in T2DM?
Cardiovascular risk score >10%
52
When should diabetics inform the DVLA?
If on insulin OR >1 hypo requiring assistance in past 12mth OR neuropathy OR retinopathy
53
Which T2DM drugs are contraindicated in an eGFR <30?
Metformin | SGLT2 inhibitors
54
Name a sulfonylurea
Gliclazide
55
Name a DDP4 inhibitor
Gliptin
56
Name a SGLT2 inhibitor
Empagiflozin
57
Name a GLP-1 mimetic
Exenatide
58
Which T2DM drug can cause acute pancreatitis as a side effect?
GLP-1 mimetic exenatide
59
Which T2DM drug can cause lactic acidosis as a side effect?
Metformin
60
Which T2DM drug can cause Fournier's gangrene as a side effect?
SGLT2 inhibitor empaglifozin
61
Which T2DM drug can cause URTI symptoms as a side effect?
DDP4 inhibitor gliptin
62
Which T2DM drug can cause UTIs as a side effect?
SGLT2 inhibitor empaglifozin
63
Which T2DM drug can cause hypoglycaemia as a side effect?
Sulfonylurea
64
Which T2DM drug can cause increased CVD risk when used as monotherapy?
Sulfonylurea
65
Which T2DM drug can cause heart failure as a side effect?
Pioglitazone
66
Which T2DM drug can cause hip fractures as a side effect?
Pioglitazone
67
Which T2DM drug is good in CVD?
SGLT2 inhibitor empaglifozin and GLP-1 mimetic exenatide
68
Which T2DM drugs are SUBCUT only?
Insulin and GLP-1 mimetic exenatide
69
Which T2DM drug should be avoided in lorry drivers?
Sulphonylurea gliclazide
70
Which T2DM drug is safe in pregnancy?
Metformin
71
What effect does metformin have on weight?
Weight neutral
72
What effect does Pioglitazone have on weight?
Weight gain
73
What effect does empaglifozin have on weight?
Weight loss
74
Can T2DM patients get DKA?
Yes
75
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

Y4 Gen Med (9 decks)

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