Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PR3152 Revision > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the 7 differences between type 1 and type 2 DM

A
  1. autoimmume mediated vs insulin resistance
  2. positive Ab vs negative Ab
  3. C-peptide absent vs present
  4. Age of onset below 30 vs above 40
  5. Onset abrupt vs gradual
  6. Physical appearance thin vs overweight
  7. DKA risk frequent vs uncommon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for screening in asymptomatic adults? (screen if there are ≥ 1 risk factor for diabetes) (9)

A
  1. Obesity
  2. Ethnicity
  3. First degree relative with DM
  4. Women who have delivered babies ≥4kg or previously diagnosed w gestational DM
  5. HTN ≥ 140/90 or on medication
  6. High HDL-C or TG levels
  7. PCOS
  8. Impaired glucose tolerance or impaired fasting glucose on previous testing
  9. History of CVD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When should screening be started for in the general population in the absence of DM risk factors? (and subsequently how often)

A

40 years old, then every 3 years
or every year if IFG or IGT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the s/sx of hyperglycemia?

A

Extreme thirst, frequent urination, dry skin, hunger, blurred vision, drowsiness, decreased healing

3 “P”s - polyuria, polydypsia, polyphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the s/sx of hypoglycemia?

A

Shaking, tachycardia, sweating, dizziness, anxiety, hunger, impaired vision, weakness, fatigue, headache, irritability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 3 key parameters to measure DM?

A
  1. Fasting plasma glucose (no calorie intake for ≥ 8h)
  2. Postprandial plasma glucose (2h after a meal) (or 2hOGTT using 75-0g oral glucose)
  3. HbA1c (3 month average of FPG + PPG)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How often should BG be monitored for T1DM, pregnant women or insulin pump users?

A

≥4 times daily
before meals/snacks, at bedtime at 3am

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How often should BG be monitored for T2DM patients on multiple insulin injections?

A

≥3 times daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How should T2DM be diagnosed with HbA1c alone?

A

For HbA1c 6.0% and below → no diabetes, no further tests needed
For HbA1c 6.1-6.9% → proceed to FPG or OGTT
For HbA1c 7.0% and above → diabetes no further tests needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the FPG guidelines for when HbA1c 6.1-6.9% ?

A

FPG ≤ 6.0 mmol/L no diabetes
FPG 6.1-6.9 mmol/L prediabetes
FPG ≥ 7.0 mmol/L diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 2hOGTT guidelines for when HbA1c 6.1-6.9% ?

A

2hOGTT ≤ 7.7 mmol.L no diabetes
2hOGTT 7.8-11.0 mmol/L prediabetes
2hOGTT ≥ 11.1 mmol/L diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the microvascular complications of DM? (3)

A

retinopathy, nephropathy, neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are local MOH goals for HbA1c, FBG and PPG?

A
  • HbA1c → ≤ 7%
  • Fasting blood glucose → 4.0 - 7.0 mmol/L
  • Postprandial glucose → < 10 mmol/L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In what patient groups can a more stringent goal of 6.0 to 6.5% be aimed for? (3)

A

patients with short disease duration, long life expectancy and no significant CV diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In what patient groups can a more lenient goal of 7.5 to 8.0% be aimed for? (5)

A

history of hypoglycemia
limited life expectancy
advanced complications
extensive comorbid conditions
lower target is difficult to attain despite intensive SMBG, repeated counselling and effective pharmacotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How often should HbA1C be monitored?

A

3 months, 6 if stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How often should lipid panel be monitored?

A

3-6 months, 12 if stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How often should BP be monitored?

A

at every visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How often should an eye exam be conducted?

A

6 months, 12 if stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How often should renal function be monitored?

A

6 months, 12 if stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How often should foot exam be conducted?

A

daily by patient, yearly by podiatrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 4 main NPM for diabetes

A
  1. quit smoking
  2. weight reduction (7% body weight)
  3. Exercise (150min/week moderate intensity)
  4. Diet modification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is metformin’s MOA

A

Decreases hepatic glucose production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the maximum dose of metformin?

A

1g TDS (3g/day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the main side effects of metformin (4)

A
  1. Diarrhea (take after food)
  2. anorexia
  3. metallic taste
  4. lactic acidosis (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In which 2 patient groups is metformin contraindicated?

A

Patients in hypoxic state and severe renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the eGFR guidelines for metformin use

A
  • eGFR < 30 → stop metformin
  • eGFR 30-45 → titrate to half of the maximal dose (FDA says don’t start new patients, KDIGO says can)
  • eGFR 45-60 → can continue max dose, monitor every 3-6 months
  • eGFR ≥ 60 → can continue max dose, monitor annually
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the DDIs for metformin? (3)

A
  1. alcohol consumotion
  2. iodinated contrast media (withhold for ≥ 48h after contrast administration)
  3. cationic drugs (compete for excretion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are SU’s (glipizide) effect?

A

Stimulates insulin secretion by b-cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When should SUs be taken

A

15-30 mins before meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the 3 main adverse effects of SUs?

A
  1. hypoglycemia (mainly in elderly)
  2. weight gain
  3. blood dyscrasias (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the DDIs with SUs? (2)

A
  1. alcohol (disulfram-like rxn)
  2. Beta blockers (mask hypoglycemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are TZD effects?

A

Promotes glucose uptake into cells

34
Q

What are the contraindications for TZDs (pioglitazone)? (2)

A

Black box warning for increased rish of CHF (CI in NYHA class III or IV HF) (stop if pt shows s/sx of HF)
CI in patients with active liver disease

35
Q

What are the adverse effects of TZDs? (6)

A
  1. Hepatotoxicity (don’t start or stop if ALT > 3x ULN)
  2. Edema
  3. Fractures
  4. Weight gain
  5. Bladder cancer
  6. Elevated LDLs
36
Q

How does acarbose work and which type of BG does it target?

A

delays glucose absorption and lowers postprandial glucose by competitively inhibiting brush border α-glucosidase enzymes required for the breakdown of complex carbohydrates

works on postprandial glucose

37
Q

What is the MAIN adverse effects of acarbose?

A

GI SE (flatulence, abdominal pain, diarrhea), until patients discontinue

38
Q

What are the DDIs with acarbose?

A

Intestinal adsorbants and digestive enzyme preparations like charcoal and yakult

39
Q

When should acarbose be taken?

A

With largest meal (or meal with the most carbs)

40
Q

What are adverse effects of GLP1-agonists (Liraglutide)?

A

nvd, acute pancreatitis
black box warning for thyroid C-cell tumour in animals (avoid in pts with thyroid disorders)

41
Q

What are the side effects of DPP4is?

A

Mild, some joint pain

42
Q

Which DPP4i is associated with acute pancreatitis?

A

Sitagliptin

43
Q

What are the side effects of SGLT2is? (7)

A
  1. hypotension
  2. hypoglycemia
  3. renal impairment
  4. increased LDL
  5. urinary urgency
  6. increased risk of GMI
  7. increased risk of euglycemic DKA
44
Q

Where is SGLT2i contraindicated in? (2)

A

ESRD
Pts on dialysis

45
Q

What are the KDIGO guidelines for SGLT2i?

A

Start in all patients with eGFR of ≥ 30 ml/min/1.73m2
Even if it falls below 30 after starting can continue because its an efficacy and not a safety issue

46
Q

What are the 3 main drugs for FBG?

A

Metformin
others (not so strong): GLP1-Agonists, TZD

47
Q

What are the 3 main drugs for PPG

A

SU, GLP-1 agonist, TZD

48
Q

How long can insulin vials be kept for?

A

If refrigerated, until expiry (if not, 28 days)
Once opened, 28 days

49
Q

Name the rapid-acting insulins

A

Glulisine
Aspart
Lispro

50
Q

Name the short-acting insulin

51
Q

Name the intermediate acting insulin

52
Q

Name the long acting insulins

A

Detemir
Glargine

53
Q

When should rapid and short acting insulins be taken?

A

Rapid - 15 mins before meals
Short - 30 mins before meals

54
Q

What are the 2 ultra fast acting insulins?

A

Insulin Aspart (vitamin B12 and L-arginine)
Insulin Lispro-aabc (treprostinil and citrate)

55
Q

When can ultra-fast acting insulins be given?

A

At the first bite or during the meal (within 20 minutes)

56
Q

What are the 2 ultra-long acting insulins?

A

Insulin degludec and glargine (U-300)

57
Q

What are the benefits of ultra-long acting insulins?

A

Peakless, so lesser instances of hypoglycemia

58
Q

How are degludec and glargine (U-300) given

A

Degludec SC OD any time
Glargine (U-300) SC OD at the same time everyday

59
Q

What drugs can be continued when injectables are started?

A

Metformin, SGLT2i

60
Q

What drugs should be discontinued (or reduced by 50%) when injectables are started?

A

TZD - insulin sensitiser, high hypoG risk
SU - high risk of hypoG

DPP4i discontinue if patient is also on GLP1-agonist due to similar MOA

61
Q

What are the 4 main counselling points for SGLT2i?

A
  1. Increased risk of UTI/GMI
  2. Increased DKA risk (hold off 2-3d before surgery)
  3. Diuresis and natriuresis (vol depletion, stop taking in acute illness until 24-48h after)
  4. AKI (mild decrease in kidney function but recovers)
62
Q

What are the 3 target LDL levels?

A

super high risk < 1.4 mmol/L
very high risk < 2.1 mmol/L
high risk < 2.6 mmol/L

63
Q

When should dose be decreased when converting from different forms of insulin?

A

Decrease by 20% when switching from BD NPH to OD glargine/detemir

64
Q

What are the side effects of insulin? (4 main, 2 rare)

A
  1. Hypoglycemia (≤ 4.0 mmol/L, use 15-15-15 rule)
  2. Weight gain (usually w patients on SUs, counsel to exercise)
  3. Lipodystrophy
  4. Local allergic rxn
  5. Systemic allergic rxn
  6. Insulin resistance
65
Q

What are the first 2 drugs that can be started for course of treatment?

A

Metformin
SGLT2i for comorbidities (ASCVD, HF, CKD) independent of A1c

66
Q

Which drugs are good for ASCVD and CKD risk? (2)

A

GLP1A, SGLT2i

67
Q

Which drugs should be avoided in hypoglycemia risk? (2)

A

SU, insulin

68
Q

Which drugs have good weight loss benefits? (2)

A

GLP1A, SGLT2i

69
Q

When is insulin indicated? (3)

A
  1. ongoing catabolism (weight loss)
  2. sx of hyperglycemia
  3. A1c > 10% or BG > 16.7 mmol/L
70
Q

How should insulin be started?

A

Less than 10units before bedtime (glargine, detemir, degludec)

71
Q

How should insulin be uptitrated in inadequate response?

A

Increase by 2units every 3 days until at FPG goal
Increase by 4 units every 3 days if FPG consistently above 10mmol/L

72
Q

When should prandial cover be added?

A

When FPG still not at goal despite basal > 0.5IU/kg or FPG at goal

73
Q

How should prandial cover be added (dose and when to give)

What about when the patient is on bedtime NPH?

A

1 dose with largest meal (4IU or 10% of basal)

If patient on bedtime NPH, split to 2/3 in morning then 1/3 in evening

74
Q

What are the 4 characteristics of DKA?

A

Fruity breath
Ketones in blood and urine
Patient alert
BG > 14mmol/L

75
Q

What are the 4 characteristics of HHS?

A

no ketones
patient dehydrated
near unconscious
BG > 33mmol/L

76
Q

What is the somogyi effect caused by

A

Sharp decrease in BG (missing bedtime snack or too much insulin), causing body to overcompensate by releasing glucagon

77
Q

What is the Dawn phenomenon caused by

A

Release of cortisol (stress hormone) in the morning

78
Q

How to prevent complications in DM? (6)

A
  1. Smoking cessation
  2. Aspirin or clopidogrel administration
  3. BP control
  4. Lipid control
  5. Metabolic syndrome control
  6. Immunity (vaccinations)
79
Q

What are ASCVD risk factors for starting aspirin? (5)

A
  1. LDL ≥ 2.6 mmol/L
  2. High blood pressure
  3. Smoking
  4. CKD, albuminuria
  5. family history of premature ASCVD
80
Q

Who should not be started on aspirin therapy for CVD risk in DM?

A

elderly above 70yo, risk of falls

81
Q

How can medications be adjusted for Muslims fasting during Ramadan? (3)

A
  1. TDS meds change to BD
  2. Reduce medications w high hypoG risk (eg. SU, insulin)
  3. Evening dose potency higher than morning (bc break fast meal heavier)

PR3152 Revision (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions