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INTERNAL MEDICINE 5TH > diabetes > Flashcards

diabetes Flashcards

1
Q

what type of reaction is type 1

A

delayed as T cells attack

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2
Q

why do people loose 1 in type 1

A

essentially the cells are starving so they resort to other methods

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3
Q

how does diabetes affect the stomach

A

patients have gastroperis, delayed gastric emptying so they complain of getting full early on and feeling nauseas and vommiting

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4
Q

how does diabetes affect the RBCS

A

CBC: increased HTC( why) and also has shown increased viscosity of the blood as the morphology of rbc changes (shape, size)

Hypochromia – An anemia of the RBCs, observed as a paler than normal color, due to a reduction in haemoglobin which reduces oxygen affinity
Anisocytosis – RBCs in diabetics are unequal in size.
Poikilocytosis – Variations in RBC shape, with up to almost a third of red cells being unequal in size, compared to below 2% in non-diabetic patients.

rbc also have an increased diameter

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5
Q

how does diabetes affect the liver

A

Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes.

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6
Q

RF FOR TYPE 2

A 
BMI >25kg/m2,
1
st degree relative with DM,
Arterial hypertension >140/90mmHg, PCOS
HDL <0.9mmol/l and/or TAG >2.2mmol/l
History of CVD
Polycystic ovarian syndrome
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7
Q

VALUE range for random

A

11.1

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8
Q

VALUE range for fasting

A

7

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9
Q

prediabteic values

A

FPG 6.3-7.0 or 2hr oGTT 7.8-11.1

notes say for fating - 5.6-6.9

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10
Q

normal hb a1c values

A

4- 6.2 % - lecture confirmed

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11
Q

what’s important about hba1c

A

B HbA1C should not be used for dx if: Young pt (child) or is suspected of
having DM1, pregnancy, medications which cause hyperglycemia - steroids,
antipsychotic

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12
Q

threshold for glycated

A

6.5%

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13
Q

acute complications

A

hypoglycaemia, ketoacidosis, nonketotic

hyperosmolar coma

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14
Q

what classes as hypoglycaemia for a person with diabetes vs a non diabetic

A

non diabetic - 2.8 mol

diabetic - 4mmol

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15
Q

how does alcohol affect blood sugar levels

A

Alcohol makes your blood sugar levels drop by inhibiting the liver’s ability to release glucose. initially however it can cause a raised spike in levels

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16
Q

factors of hypoglycaemia

A 
too much insulin 
skipped a meal 
gastropareisis 
increases sensitivity  to insulin
clearance of insulin
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17
Q

tx severe hypoglycaemia

A

or intramuscular Glucagon 1mg - wake up slice of bread long release

10% Glucose 200ml/hr if patient is conscious
10% Glucose at 200ml/15 mins if patient is unconscious

18
Q

triad of DKA

A

ketonuria /ketonemia
acidosis
hyperglycaemia

19
Q

definition of ketonemia in DKA

A

> 3 mmol

20
Q

normal osmalitty of blood

A

280-300

21
Q

smality values in DKA

A

> 350

22
Q

when to give bicarb

A

only in < рН6.9, give 100mmol 8.4%

sodium bicarbonate + 20mmol KCl are infused for 45 min.

23
Q

what’s the difference between non ketogenic and dka

A

there is hyperflycmeia >30 mol but no ketones

mortality is higher

PH is >7.3 (but occacionlay a mild acidosis can develop)

MARKED VOLUME DEPLETION

not as acute as DKA

more likely to see in elderly than young unlike in DKA

don’t give insulin unless dingifacnt changes?

24
Q

what sodium electrolyte is more likely in ska

A

hyponatremia is commonly seen ( vommiting, ) Dilutional hyponatremia is common due to water driven into the intravascular space from inside cells.

but hypernatremia can be too

25
Q

tx of HHS

A

LMWH - prevent clots
rehydration with 0.9% saline
correct hypoklameia

only give insulin if ketonemia or

only glucose is not falling by 5mmol/L/h with rehydration or if
ketonemia is present

26
Q

microangiopathy examples

A

eyes and kidneys

27
Q

rubeuosis iridis

A

New vessel formation on iris - can lead to glaucoma cos they block the angle of the eye

28
Q

changes of kidney

A 
glomerular hypertyophy 
mesangial proliferation
hyalinosi s
glomerular sceloris
BM thickening
29
Q

advice for diabetics

A

stop smoking
monitor bP - <130/80 mmHg with proteinuria
fat levels . if you have proteinuria keep it lower
control body weight keep BMI <25

30
Q

proliferative retinopathy

A

comes after non proliferative, more advanced and poorer outcome, associated with neovascurilisation but with fragile vessels, and so associated with vitreous hemroggabe + tractional retinal detachment due to fibrosis of vessels

the vessels can also lead to glaucoma as they block the angle of the eye prevent draining

31
Q

how to manage a patient with macroalbuminera

A
  1. keep blood pressure <125/75
  2. antiaggrgants for thrombosis - peeign out antithrombin
  3. reduce protein intake up to < 0.8g/kg body weight daily
  4. EPO if HB less than 115
32
Q

type of macroangipathy

A

Coronary vascular disease

  1. Cerebrovascular disease
  2. Peripheral vascular disease
33
Q

RF for macroangipathy

A 
Poor glycaemic control - HbA1c >6.5%
Arterial hypertension
Dyslipidaemia (↑LDL and ↓HDL)
Obesity - Overweight BMI >25
Smoking
34
Q

examples of autonomic neuropathy

A

gastropareiss, fixed tachycardia, ED, retrograde ejaculation , urinary retention or incontenice, orthostatic hypotension (drops by more than 30) ,

35
Q

classification of diabetic neuropathy

A

autotomic

peripheral

36
Q

metabolic syndrome

A

when 3 of the 5 is diagnose
d

  1. diabtes
  2. hypertension
  3. low HDL and elevated LDL
  4. elevated TAG
  5. obesity
37
Q

dx of type 1

A

anemia

but also diabetes is often misdiagnosed as a UTI, strep throat or viral infections like infectious mono

38
Q

advice for gasttoprepris

A

avoid fatty foods, can take metoclorprmaide

39
Q

why is there s.o.b in dkah

A

ketones build up faster than the kidneys can remove them from the body. This results in a buildup of ketones, which is toxic. The body may try to use the lungs to expel the excess ketones, which causes shortness of breath

40
Q

diagnostic criteria for hhs

A 
Severe hyperglycaemia >30mmol/L
hyperosmolarty > 320mOsm/Kg –
Normal pH >7.3
No ketonemia < 3mmol/L
High blood sodium and urea aka Hypovolemic Hypernatremia: dehydration -
relative increase in sodium
Hypokalemia

INTERNAL MEDICINE 5TH (12 decks)

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