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Endo finals > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Describe the classic patient with Type 2 DM

A

Middle-aged/older adult, metabolic syndrome

  • Overweight/obese
  • Hypertension
  • Hyperlipidaemia
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2
Q

Describe the presentation of Type 2 DM

A

Usually insidious onset

  • Polyuria, nocturia
  • Polydipsia
  • Fatigue
  • Blurry vision
  • Frequent bacterial/fungal infections eg Candida
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3
Q

Describe the investigations for suspected Type 2 DM

A
  • After history and examination
  • Urine dip
  • Bloods: fasting plasma glucose, random plasma glucose, HbA1c, lipids, FBC, U+Es
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4
Q

Describe the criteria for diagnosing Type 2 DM

A

Symptoms:

  • Fasting plasma glucose >7.0
  • HbA1c >48
  • Random plasma glucose >11.1

OR 2x positive test

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5
Q

Describe the investigations to do in confirmed Type 2 DM

A
  • Fundoscopy and foot exam
  • BP
  • Urine ACR
  • Bloods: lipids, U+Es + monitoring HbA1c
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6
Q

Describe the monitoring of Type 2 DM

A 
6 monthly HbA1c
Yearly:
-Fundoscopy and foot exam
-BP
-Urine ACR
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7
Q

Describe the management of Type 2 DM

A

Conservative:

  • Diet and exercise, weight loss
  • Dietician support
  • Stop smoking

Medical:
-1st line: metformin
-2nd line: any eg. DPP4i, sulphonylureas, SGLT2i
-3rd line: add further
-Insulin
Also: optimise RFs eg antihypertensives, statins

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8
Q

What HbA1c target should you aim for in T2DM?

A

48 mmol/L if no meds/metformin

53 mmol/L if on hypoglycaemic agent

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9
Q

When should you increase medications in T2DM?

A

If HbA1c rises to 58 or above

+ reinforce diet/lifestyle

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10
Q

When is pioglitazone contraindicated?

A
  • Bladder cancer
  • Heart failure
  • Liver failure
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11
Q

Which diabetic drug is best for heart failure? Obesity? Renal failure?

A

Heart failure: SGLT2i
Obesity: GLP-1 agonists
Renal failure: DPP4i

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12
Q

What are the complications of DM?

A

Microvascular:

  • Eyes: diabetic retinopathy
  • Kidneys: nephropathy
  • Nerves: neuropathy

Macrovascular:

  • CAD
  • PVD
  • CVD
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13
Q

Describe the stages of diabetic retinopathy

A

Background: microaneurysms, hard exudates
Pre-proliferative: soft exudates (cotton wool spots)
Proliferative: new vessels

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14
Q

Describe the management of diabetic retinopathy

A

BG + pre-prolif: education, lower HbA1c

Proliferative: photocoagulation

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15
Q

Describe the presentation of T1DM

A

Typically younger patients, but can be any age

  • Weight loss, polydipsia, polyuria, fatigue
  • DKA
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16
Q

Describe the actions of insulin

A

Released after meal (senses glucose)

  • Glucose uptake by adipocytes, myocytes, liver
  • Fat and glycogen synthesis
  • Inhibits proteolysis
17
Q

Describe the diabetes MDT

A 
Endocrinologist
GP 
Dietician
Specialist diabetic nurse
Psychologist 
Podiatrists 
Ophthalmologist
18
Q

Describe the management of T1DM

A

Conservative:

  • Education
  • Diet: dietician support
  • Exercise, smoking cessation, reduce alcohol
  • Psychologist

Medical:

  • Insulin + blood glucose monitoring
  • RF management as needed: statin, ACEi

Surgical:
-Pancreas transplant

19
Q

Describe the different insulin regimes. When are they used?

A

3 main types:

  • Basal bolus: common
  • Once/twice daily : common for T2DM
  • Continuous

Usually start on basal-bolus
Switch to continuous if:
-Disabling hypos
-HbA1c remains high with intense treatment

20
Q

Describe blood glucose monitoring for T1DM

A 
Should monitor daily at least 4 times:
-Before meals
-Before bed 
More frequently if: 
-Frequent hypos
-Driving
-Intercurrent illness

Aim for:

  • Waking: 5-7
  • Before meals: 4-7
21
Q

Who is eligible for continuous glucose monitoring?

A

Patients who are able/willing to commit to use AND:

  • > 1 severe hypo /year
  • Loss of hypo awareness
  • > 2 hypos /week
22
Q

Describe the different types of insulin available

A

Rapid-acting: (before meals)

  • Actrapid
  • Humalog

Medium-acting

Long-acting: (once/twice daily basal)

  • Detemir (Levemir)
  • Glargine (Lantus)
23
Q

Describe the management of hypoglycaemia

A

Conscious: glucose tablets
Slightly impaired consciousness: glucose gel
Unconscious: IM glucagon or IV glucose

24
Q

Describe the annual review for T1DM

A

Ask about:

  • Hypos, DKA
  • Hospitalisations
  • Psych

Examine:

  • Feet
  • Eyes
  • Injection sites

Measure:

  • BP
  • Urine ACR
  • Bloods: HbA1c (3-6 monthly), U+Es, lipids, TFTs
25
Q

What are sick day rules for T1DM?

A
  • Measure BMs more frequently
  • Measure fingerprick ketones
  • Drink lots of fluids
  • Keep taking insulin, may need to ^^
26
Q

What is hyperosmolar hyperglycaemic state? What are the criteria for diagnosis?

A 
HHS- a hyperglycaemic complication of T2DM where there is severe dehydration -> hyperosmolarity
No strict criteria but usually: 
-Plasma glucose >30 mmol/L
-Plasma osmolality >320mmol/L
-pH >7.3
27
Q

What is the management of HHS?

A

A to E assessment

  • Ensure adequate airway
  • IV access and bloods
  1. IV fluids: 0.9% NS. Start 1L over 1 hour. Add KCl
  2. Consider insulin fixed rate- 0.05u/kg/hour
  3. Investigate and treat cause: MI, infection
28
Q

Describe the investigations in suspected DKA

A
  • History and examination/ A to E
  • Observations
  • Urine dip + MCS
  • Bloods: FBC, CRP, U+Es, VBG, glucose, ketones, culture
  • ECG
  • CXR
29
Q

Describe the management of DKA in adults

A

A to E + investigations
Ensure adequate airway
IV access
Neuro obs

  1. IV fluids: 0.9% NS. 1L over 60 mins if normotensive OR 500ml over 15 mins if BP <90
  2. Add KCl to 2nd litre (if K <5.5)
  3. IV fixed rate insulin infusion (0.1u/kg/hr)
  4. Commence monitoring: hourly cap glucose + ketones, 4 hourly U+Es, VBG at 1/2/4 hours, continuous cardiac monitor + pulse ox
  5. Treat cause
  6. Extras: consider NGT, urinary catheter, LMWH
-> when glucose falls to <14 give 10% glucose 125ml/hr (1L/8hours)
Switch to SC insulin regimen when
1) pH >7.3
2) Ketones <0.6
3) Eating and drinking
Stop insulin infusion after 30 mins
30
Q

Define DKA

A

1) Plasma glucose >11
2) Ketones >3
3) pH <7.3

31
Q

Describe the side effects of metformin

A

Common: GI upset (nausea, diarrhoea), abdo pain
Rare: lactic acidosis, hepatitis

32
Q

Describe the contraindications for metformin

A

Severe renal impairment (GFR <30)
Acute metabolic acidosis
Morning before GA

33
Q

Describe the presentation of DKA

A
  • Abdo pain
  • Vomiting
  • Confusion, drowsiness
  • Kussmaul respiration
34
Q

What are the complications of DKA?

A

Cerebral oedema: rapid fluid replacement
Hypokalaemia
Aspiration
VTE

35
Q

Describe the presentation of hypoglycaemia

A

Autonomic:

  • Sweating
  • Nausea + vomiting
  • Tremor, palpitations

Neuroglycopenic:

  • Confusion
  • Drowsiness
  • Seizures, coma

Endo finals (6 decks)

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