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Met3b > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What symptoms would make you consider nocturnal hypoglycemia?

A
  • high blood glucose levels (reboud hypoglycemia

- headache (feeling hangover with no alcohol)

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2
Q

How do you confirm diagnosis of nocturnal hypoglycemia?

A

testing glucose at 3am
or
continuous glucose moniotirng sensor whic monitors glucose over 5 days subcutaneously.

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3
Q

Management of nocturnal hypoglycemia?

A
  • analogue insulins
    prebed snack
    change timing of insulin
    insulin pump therapy
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4
Q

level of RPG hyperglycemia in DKA?

A

14 mmol/L

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5
Q

bicarbonate value in DKA

A

<15 mmol

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6
Q

pH value in DKA

A

<7.3

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7
Q

what are the three things you need to measure to confirm DKA

A
  • pH (acidotic)
  • low bicarbonate
  • high plasma glucose
  • ketones in serum or urine
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8
Q

In DKA, what physiological change leads to trygliceride breakdwon to free FA and gycerol?

A

unopposed catecholamine excess

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9
Q

DKA clinical features

A

kussmaul breathing (deep sighting inspiration due to acidosis)
ketones on breath
drowisness
dehydration adn tachy

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10
Q

precipitating factors of DKA

A
  • insulin omission
  • pregnancy
  • infection
  • MI
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11
Q

Diagnosis of DKA

A

venous blood gas shows acidosis
capillary blood glucose over 14UNLESS euglycemic ketosis or alcoholic ketosis
raised urea and creatining
raised urine or plasma ketone

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12
Q

what things define a SEVERE DKA

A 
Blood ketones > 6 mmol/L  
Bicarbonate < 5 mmol/L  
pH < 7.1 
 Potassium < 3.5 mmol/L 
 GCS <12 
 O2 sats < 92% 
 Systolic BP < 90 mmHg 
 Pulse >100 or < 60 bpm
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13
Q

do people in severe DKA need thromboprophylactic?

A

Yes. give them LMWH

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14
Q

Fluid therapy in DKA?

A

1- start wtih 0.9% naCl
2- 1 L potassium chloride- if patient K is above 5.5, do NOT give more potassium
3. when CBG is less than 12, give 5% glucose at 125 mL/hr
4. Insulin infusion by intravenous syringe (50 units Actrapid up to 50mL in NaCL 0.9%) - FIXED RATE IV insulin infusion (0.1 u /kg – around 6-8 u / hr for most patients)
5. aim for bicarb rise of 3 mmol/hr and glucose fall bu 3 mmol/hr
if not achieved you increase by 1unit per hour

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15
Q

when do you convert to subcutaneous insulin?

A

once eating and drinking reliably?

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16
Q

what is the commonest cause of death from DKA in children? how do you treat it

A

cerebral edema

Treated with dexamethasone or mannitol

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17
Q

with what type of diabetes doy ou get hyperosmolar hyperglycemia syndrome

A

type 2

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18
Q

what glycemia level is diagnostic of HHS

A

over 40

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19
Q

what osmolality level is diagnostic of HHS

A

over 340

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20
Q

how can you estimate osmolality in patient with HHS

A

2x[Na+K]+Ur+Glu

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21
Q

in HSS are patients hyper or hyponatremic

A

hypernatremic

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22
Q

HHS treatment

A

IV as for DKA
no insulin bolus to start
correct BG at maximum of 2 mmol/L/hr
give LMWH

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23
Q

does HSS require thromboprophylaxis

A

yes give LMWH

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24
Q

why should a rapid shift of glucose be avoided in HSS

A

can cause central pontine myelinolysis.

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25
Q

what should a sick pateint do if they are on insulin

A
  • drink lots of fluid
  • if they dont eat, drink
  • DO NOT stop insulin
  • if unable to keep fluids down, come to hospital
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26
Q

how often should patients with diabetes be reviewed=

A

twice a year.

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27
Q

BP aim in patients with diabetes

A

Aim for 140/80 mmHg (130/80 mmHg if CVD or Renal d)

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28
Q

BP drugs for diabetes

A

First line –ACEI, calcium channel blockers (often need >2 BP treatments)

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29
Q

should all diabetic patients get statins?

A

Diabetic > 40 years, or diabetic < 40years + 1 risk factor = statin

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30
Q

cholesterol and LDL aim in diabetes

A

< 4.0 mmol/L, LDL < 2.0 mmol/L

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31
Q

what three organs are screened for in diabetic pateints

A

1- eyes - digital retinal photography yearly

  1. feet - pulses and nerves
  2. kidneys )yearly ACR and estimated GFR ie. serum creatinie
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32
Q

well controlled HbA1c

A

53 mmol

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33
Q

what do you use to monitor diaebtes in people with hemoglobinopathies or no speen OR PREGNANCY

A

fructosamine

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34
Q

what patients need daily monitoring of BG

A

insulin therspy
Preprandial aim for around 4-7 mmol/L

Post parandial 2 hour glucose aim for around 5-9 mmol/L

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35
Q

exercise recommendation for people with diabetes

A

10 min vigorous exercise 3x a week

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36
Q

weight reduction for people with diabetes

A

3-5%

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37
Q

Insulin secretagogues (sulfonylureas/PGR) MOA

A

stimulate insulin release from B cells.

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38
Q

biguanides (metformin) MOA

A

improve insulin sensitivity in liver and muscle AND reduce haptic glucose output

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39
Q

Alpha-glucosidase inhibitors: MOA

A

reduce intestinal absoprtion of glucose

40
Q

Thiazolidinediones (glitazone): MOA

A

improve insulin sensitivity

41
Q

GLP1 receptor AGONISTS like EXENATIDE MOA

A

stimulates insulin secretion adn decreases glucagon secretion
delays gastric emotying
decreases food intake and induces satiety
ONLY FOR BMI OVER 35 and poor glucose control

42
Q

DPP-IV inhibitiors (AKA GLIPTINS) MOa

A 
inhibiit breakdwon of GLP1 hence increase endogenous GLP1
oral
once daily
well tolerated. 
INCRETIN RELEASE
43
Q

first line med for diabetes

A

metformin

44
Q

if metformin contraindicated, whts first line

A

sufonylurea

45
Q

when to take metformin

A

after meals

46
Q

at what level of egfr should you stop metformin

A

belwo 30

47
Q

second line med

A

sulfonykrea (gliclazide). consider PGR if erratic lifestul

48
Q

third line med if above 58 Hba1c

A

add a glitazone or gliptin or insulin. or glp1 analogue if obese.

49
Q

fourth line if above 58 hba1c

A

insulin plus metformin plus sulfonylurea

50
Q

fifth line

A

intensify insulin ro add glitazoe –> risk of edema

51
Q

side effect of biguanides (metformin)

A

Nausea, diarrhoea, lactic acidosis in pts with renal failure

52
Q

side effect of sulfonylureas (gliclazide) and PGR (repaglinide)

A

Hypoglycaemia, weight gain

53
Q

Glitazone (prioglitazone)

A

Weight gain, oedema, heart failure, post menopausal fractures, ?? Bladder cancer

54
Q

alpha glucosidase inhibitors (acarbose) SE

A

faltulance diarrhoea

55
Q

DPP4 inhibiotrs (sitagliptin) SE

A

nasopharyngitis, pancreatitis

56
Q

GLP 1 agonits (exenatide) SE

A

nauseam diarrhoea, pancreatitis, pancreatic cancer

57
Q

what are incretins and what is their role in glucose metabolism

A

protein hormones

stimulates the release of insulin by the β cells and inhubits the release of glucagon by pancreatic α cells.

58
Q

what are some indications of insulin therapy

A
  • tpe 1 diabetes
  • pregnancy
    symptomatic hyperglycemia
    nfecitn/foot ulcer…
    contraindication to tablets. (nil by outh etc)
59
Q

types of insuline

A

Human insulin

Short acting – eg Humulin S
Intermediate acting – eg Humulin I
Biphasic - mixture of short and intermediate – eg Humulin M3

Analogue insulin
Rapid acting – eg Novorapid, Lispro
Long acting (basal insulin) – eg Lantus, Levmir
Biphasic - mixture of rapid and intermediate eg Novomix 30

60
Q

when should insulin be given

A

before bed or first thing in the morning

61
Q

to mimic normal insulin physiology waht shoudl you given and when

A

3 injection of rapid acting and 2 injection of long acting.

62
Q

how to prescribe insulin

A

write just the number not the units

63
Q

most common complication of diabetes

A

retinopathy

64
Q

microvascular complication of diabetes

A

Reitnopahty

Nephropahty

Neuropathy

65
Q

macrovascular complication of diabetes

A

MI

Coronary heart disease

Peripheral vacular disease

66
Q

commonest cause of blindness in people of working age

A

diabetic retinopaty

67
Q

types of diabetic retinopathy

A
  • non proliferative retinopathy (AKA background retinpaty)

- proliferative retinopathy

68
Q

cahracteritics of non proliferative retinopahy

A
  • microaneurysms

Dot hemorrhages

Hard exudates (lipid deposits)

Mild, moderate, severe (COTTON WOOL SPOTTS, aka soft exudates) –> areas of retinal ischemia

69
Q

characteritics of proliferative retinpathy

A

Ischemic retina leads to production of growth factors and to new vessel formation (neovascularisation)

New vessels on disc

New vessels elsewhere

70
Q

diabetic maculopathy

A

Presence of any retinopathy within 1 disc diameter around macula

Can be:

Focal or exudative maculopathy – hard exudates around macula which leads to macular oedema and visual loss

Diffuse

Ischemic – due to retinal vessel closure

71
Q

what can be sight preserving for proliferative retinoapthy or maculopathy

A

laser photocoagulation

72
Q

Types of diabetic neuropathy

A

Peripheral sensory neuropathy

Autonomic neuropathy

Proximal motor neuropathy (amyotrophy)

Mononeuropathy

Cranial nerve palsies

Median nerve (carpal tunnel syndrome)

73
Q

commonest cause of non truamatic amputation

A

daiebtic neruopathic ulceration

74
Q

diabetic autonomic neuroapthy sx

A

postural hypotension

erectile dysfns, atonic blader, gastroparesis, constipation, diarrhoea

75
Q

diabetic nephorpathy sx

A

hypertensino, albumineria, declinc renal function

on renal biospy “kimmelstein wilson lesion”

76
Q

Screening for microalbumineria . how?

A

Measure albumin: creatinine ration (ACR)
Normal is < 2.5 mg/mmol in men or < 3.5 mg/mmol in women
If elevated, repeat x2

If 2 out of 3 positive – microalbuminuria present

77
Q

treatment for nephropathy

A

keep BP low 130/80

- ACEi even if BP is normal

78
Q

Acute MI in diabetes

A

Aspirin, primary angioplasty, or thormbolysis

Glucose insulin infusion

Secondary prevention (ACEi, B blockers, statins, aspirin, improve glycemic control, cardiac rehabilitation)

79
Q

peripheral vascular disease Tx

A

vasodilatorss, reconstrcutuve surgery, angioplast

80
Q

granuloma nnulare

A

many

81
Q

necrobiosis lipoidica diabeticorum

A

1

82
Q

bullosis siabteicorum

A

bulle

83
Q

diabetic dermoapthy

A

pathy lesin

84
Q

rhumatological manifestation of diabtes

A

Charcots neuroarthopathy – a neuropathic joint leads to sever deformity and high risk of ulcers

Diabetic cheriroarthorpahty due to limited joint mobility

Adhesive capsulitis (froxen shoulder)

Diffuse idiopathic skeletal hyperostosis

Flexor tendinopathy

Diabetic osteoarthroapthy

85
Q

liver problem related to diabetes

A

non alcoholic fatty lvier disease

rasied ALT and AST >2x the ipper limit of norma.

86
Q

drug used to reduce progression to cirrhosis

A

pioglitazone.

87
Q

does alcholo cause hypo or hyper

A

hypoglycemia

88
Q

dibaetic cheriorarthrypahy

A

hands thigns

89
Q

charcot neuroarthropathy

A

feet thing

90
Q

test fir someone with acanthosis nigricans

A

hba1c

91
Q

early sign of diabetic renal disease

A

albumin in urine.

92
Q

what diabetes drugs are contraindicated in pregnancy

A

Both gliclazide and liraglutide are contraindicated in pregnancy.

93
Q

Pioglitazone contraindications

A

hx of bladder cancer

94
Q

gestational diabetes diagnosis

A

fasting glucose is >= 5.6 mmol/L, or
2-hour glucose level of >= 7.8 mmol/L
‘5678

95
Q

how does lithium lead to diabetes inspidus

A

lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts

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