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Year 3 Medicine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes diagnosis

with symptoms

A

fasting > 7
random > 11.1
HbA1c > 48 mmol/mol

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2
Q

pre-diabetes

A

HbA1c 42-47 mmol/mol

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3
Q

T1 diabetes gene assoc?

A

HLA DR3, DR4

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4
Q

Diabetes management

A
  1. Metformin
  2. DPP-4i - sitagliptin
  3. Pioglitazone (ttd)
  4. Sulfonylurea - gliclazide
  5. SGLT-2i - (glifozin)
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5
Q

sulfonylureas action

A

enhance endogenous insulin secretion (B-cells)

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6
Q

sulfonylureas examples

A

Gliclazide

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7
Q

biguanides action

A
  • increase glucose uptake
  • decrease hepatic gluconeogenesis
  • increase peripheral insulin sensitivity
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8
Q

biguanides example

A

METFORMIN

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9
Q

sulfonylureas side effects

A

weight gain
hypoglycaemia
hyponatraemia

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10
Q

biguanides side effects

A

GI upset: nausea, diarrhoea

lactic acidosis

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11
Q

DPP-4 inhibitors example

A

sitagliptin

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12
Q

DPP-4 inhibitors action

A
  • increase incretin levels
  • prevents peripheral breakdown (longer action)
  • inhibits glucagon secretion
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13
Q

DPP-4 inhibitors side effects

A

well tolerated

pancreatitis risk

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14
Q

thiazolidinediones action

A

Activate PPARG receptor in adipocytes

adipogenesis & FA uptake

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15
Q

thiazolidinediones side effects

A

weight gain
fluid retention
bladder cancer

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16
Q

thiazolidinediones example

A

pioglitazone

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17
Q

SGLT-2 inhibitors

A

selective sodium glucose contransporter 2 inhibitors

inhibits glucose reaborption in kidney

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18
Q

SGLT-2 inhibitors example

A

-gliflozins

empagliflozin

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19
Q

SGLT-2 inhibitors side effects

A

UTI (bacteria love sugar)

weight loss

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20
Q

GLP-1 agonists action

A

mimics incretin

inhibits glucagon secretion

21
Q

GLP-1 agonists example

A

-tide

22
Q

GLP-1 agonists side effects

A

N & V

pancreatitis

23
Q

who do I NOT give metformin to

A

GFR <30

increased chance of lactic acidosis

24
Q

if HbA1c still >58

A

add gliptin first, then another

if 3 not effective add a GLP-1 agonist

25
Q

ACE inhibitors in T2D

A

reno-protective
against nephropathy
afrocarribean (offer + CCB/thiazide)

26
Q

BP target in T1D, albuminuria, metabolic syndrome

A

130/80

140/90 - otherwise

27
Q

what drug do I avoid when already on thiazide

A

beta blockers
impaired insulin secretion
insulin resistance
impaired response to hypoglycaemia

28
Q

basal bolus

A

rapid acting insulin with meals

long acting insulin at bedtime

29
Q

biphasic 30/70 mixed insulin - T2D uncontrolled

A

30% rapid
70% intermediate
increase night dose slowly?

30
Q

acanthosis nigricans

A

associated w T2 diabetes

31
Q

best investigation for dm

A

HbA1c
glycated Hb
reflects exposure over last 6-8wks

32
Q

serum osmolality

A

2x (Na + K) + Urea + Glucose

33
Q

DKA path?

A

infection, missed insulin, MI
uncontrolled lipolysis
FFAs –> ketones

34
Q

DKA features

A 
abdominal pain
polyuria, dipsia
dehydration 
kussmaul resp
acetone breath
35
Q

DKA diagnosis

A

glucose >11
ph <7.3
ketones >3 or ++
bicarb <15

36
Q

DKA mgmt?

A

0.9% saline 1L over 30 minutes (if sbp <90)
when glucose <15mmol/L start 5% dextrose infusion
IV insulin 0.1 units/kg/hr
K replacement (insulin)

37
Q

HHS path?

A

hyperosmolar hyperglycaemia state - T2D

osmotic diuresis w loss of Na/K

  • severe dehydration, high glucose
  • raised serum osmolarity >320
  • hyper-viscous blood
  • clot risk
38
Q

HSS diagnosis

A

hypovolaemia
hyperglycaemia >30mmol/L
without sig ketone/acidosis
serum osmolarity >320

39
Q

HSS management

A

IV 0.9% saline - gradually normalise osmolality
if need to normalise glucose - insulin
LMWH

40
Q

Insulin side effects

A

weight gain

…

41
Q

complications of DM

A

end-stage renal failure

42
Q

autonomic symptoms of hypoglycaemia

A 
Sweating
Hunger
Anxiety
Tremor
Palpitations
43
Q

neuroglycopenic symptoms of hypoglycaemia

A 
Confusion 
Drowsiness 
Seizures
Coma
Personality change
44
Q

causes of hypoglycaemia

A 
exogenous insulin/gliclazide
insulinoma 
liver failure
addisons
alcohol
45
Q

investigating DKA in ED

A

VBG

46
Q

Diabetes insipidus

A
  • nephrogenic = no response to ADH

- cranial = pit dysfunction, no ADH (treat w desmopressin)

47
Q

Water deprivation test

A

low, high = cranial

low, low = nephrogenic

48
Q

T1D antibodies

A

Anti-islet

Anti-GAD

49
Q

diabetes screening for complications

A 
Macro
- Pulses
- BP
- Cardiac auscultation
Micro
- Fundoscopy
- ACR + U+Es
- Sensory testing plus foot inspection

Year 3 Medicine (13 decks)

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