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Y4 Gen Med > Diabetes > Flashcards

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
Q

Why is there dehydration in DKA?

A

Osmotic diuresis glucose in urine draws water out with it

polydipsia, polyuria

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26
Q

What level are the blood ketones in DKA?

A

> 3

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27
Q

What is the management of DKA?

A

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

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28
Q

When is cardiac monitoring required in fluid resuscitation?

A

If potassium given quicker than 20mmol/hr

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29
Q

What type of foot ulcers are associated with diabetes? Where would they most commonly be?

A

Neuropathic ulcer

Metatarsal head/big toe

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30
Q

Give 4 examples of microvascular complications of diabetes

A 
Gastroparesis
Erectile dysfunction
Retinopathy
Peripheral neuropathy
Nephropathy
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31
Q

What is diabetic nephropathy also known as?

A

Glomerulosclerosis

32
Q

Describe diabetic peripheral neuropathy

A

Distal symmetrical glove + stocking

33
Q

What is the management of diabetic gastroparesis?

A

Metoclopramide

34
Q

20% of T2DM have microvascular complications at diagnosis - true or false

A

True

35
Q

What is the diagnostic criteria for T2DM if someone has symptoms? What if they have no symptoms?

A

Symptoms: random glucose >11.1 OR fasting >7

No symptoms: 2X random glucose >11.1 OR 2X fasting >7 OR 2X HbA1c >48

36
Q

What are the diagnostic criteria for impaired glucose tolerance?

A

Fasting glucose 6.1-6.9 on two occasions

Offer a OGTT

37
Q

What are the diagnostic criteria for pre-diabetes?

A 
HbA1c 42-47
OR 
Fasting glucose 6.1-6.9
OR
OGGT 7.8-11.0
38
Q

What is the first line management of T2DM?

A

Metformin 500mg OD

Can titrate to 1g BD

39
Q

What is the management of T2DM if the patient gets GI SE from metformin?

A

Switch to modified release metformin

40
Q

What is the management of T2DM if the patient can’t tolerate metformin?

A

Switch to 1 of: sulfonylurea OR gliptin OR pioglitazone

41
Q

What is the HbA1c threshold for adding a new drug in T2DM Mx?

A

> 58

42
Q

What is the second line management if on Metformin and HbA1c >58?

A

Add sulfonylurea OR gliptin OR pioglitazone OR SGLT2 inhibitor

43
Q

What is the third line management of T2DM?

A

Metformin + 2 oral drugs OR metformin + insulin

44
Q

Should T2DM patients on insulin continue metformin?

A

Yes

45
Q

What are the clinic / home blood pressure targets in T2DM?

A

Same as HTN targets
If <80yr clinic 140/90, home 135/85
If >80yr clinic 150/90, home 145/85

46
Q

What is the HbA1c target in T2DM if on lifestyle Mx alone?

A

48

47
Q

What is the HbA1c target in T2DM if on metformin alone?

A

48

48
Q

What is the HbA1c target in T2DM if on sulphonylurea alone?

A

53

49
Q

What is the HbA1c target in T2DM if on multiple oral drugs?

A

53

50
Q

What is the 1st line Mx of new HTN in T2DM in caucasian / black skin?

A

ACE/ARB if white

ARB if black skin

51
Q

When should a statin be started in T2DM?

A

Cardiovascular risk score >10%

52
Q

When should diabetics inform the DVLA?

A

If on insulin
OR >1 hypo requiring assistance in past 12mth
OR neuropathy
OR retinopathy

53
Q

Which T2DM drugs are contraindicated in an eGFR <30?

A

Metformin

SGLT2 inhibitors

54
Q

Name a sulfonylurea

A

Gliclazide

55
Q

Name a DDP4 inhibitor

A

Gliptin

56
Q

Name a SGLT2 inhibitor

A

Empagiflozin

57
Q

Name a GLP-1 mimetic

A

Exenatide

58
Q

Which T2DM drug can cause acute pancreatitis as a side effect?

A

GLP-1 mimetic exenatide

59
Q

Which T2DM drug can cause lactic acidosis as a side effect?

A

Metformin

60
Q

Which T2DM drug can cause Fournier’s gangrene as a side effect?

A

SGLT2 inhibitor empaglifozin

61
Q

Which T2DM drug can cause URTI symptoms as a side effect?

A

DDP4 inhibitor gliptin

62
Q

Which T2DM drug can cause UTIs as a side effect?

A

SGLT2 inhibitor empaglifozin

63
Q

Which T2DM drug can cause hypoglycaemia as a side effect?

A

Sulfonylurea

64
Q

Which T2DM drug can cause increased CVD risk when used as monotherapy?

A

Sulfonylurea

65
Q

Which T2DM drug can cause heart failure as a side effect?

A

Pioglitazone

66
Q

Which T2DM drug can cause hip fractures as a side effect?

A

Pioglitazone

67
Q

Which T2DM drug is good in CVD?

A

SGLT2 inhibitor empaglifozin and GLP-1 mimetic exenatide

68
Q

Which T2DM drugs are SUBCUT only?

A

Insulin and GLP-1 mimetic exenatide

69
Q

Which T2DM drug should be avoided in lorry drivers?

A

Sulphonylurea gliclazide

70
Q

Which T2DM drug is safe in pregnancy?

A

Metformin

71
Q

What effect does metformin have on weight?

A

Weight neutral

72
Q

What effect does Pioglitazone have on weight?

A

Weight gain

73
Q

What effect does empaglifozin have on weight?

A

Weight loss

74
Q

Can T2DM patients get DKA?

A

Yes

75
Q

In HHS is the blood volume low or high? Is sodium low or high? Is osmolarity low or high?

A

Low blood volume
High Na
High osmolarity

Y4 Gen Med (9 decks)

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