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year 2 - endocrine > diabetes > Flashcards

diabetes Flashcards

1
Q

what do alpha cells produce

A

glucagon

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2
Q

what do beta cells produce

A

insulin

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3
Q

what do delta cells produce

A

somatostain

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4
Q

what time frame does HbA1c measure from

A

2-3 months

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5
Q

normal HbA1c level

A

< 4.1

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6
Q

prediabetes HbA1c level

A

4.2-4.7

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7
Q

diabetes HbA1c level

A

> 4.8

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8
Q

normal fasting glucose level

A

< 6

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9
Q

prediabetes fasting glucose level

A

6.1-6.9

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10
Q

diabetic fasting glucose level

A

> 7

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11
Q

normal 2 hour GTT level

A

< 7.7

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12
Q

prediabetes 2 hour GTT level

A

7.8-11

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13
Q

diabetic 2 hour GTT level

A

> 11.1

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14
Q

diabetic random glucose level

A

> 11.1

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15
Q

what is LADA

A
  • latent onset diabetes of adulthood
  • slow onset vesion of type 1 diabetes
  • normally presents 25-40
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16
Q

what is type 1 diabetes

A

state of absolute insulin deficiency due to autoimmune destruction of the beta cells in the islets of Langerhans

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17
Q

type 1 diabetes auto-immune antibodies

A
  • anti-GAD
  • anti-IA2
  • anti-ZnT8
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18
Q

type 1 diabetes presentation

A
  • fatigue
  • weight loss
  • polyuria and polydipsia
  • diabetic ketoacidosis
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19
Q

diabetic ketoacidosis

A

presents with abdominal pain, vomiting and signs of systemic shock)

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20
Q

type 1 diabetes diagnosis

A
  • glucose testing
  • urine (ketones to rule out diabetic ketoacidosis)
  • bloods (auto-antibodies)
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21
Q

type 1 diabetes management

A
  • insulin therapy
  • target HbA1c 48-59
  • need to check blood sugar at least twice a day
  • diet advice (control sugar intake)
  • even if sick, don’t stop insulin as illness can cause hyperglycaemia
  • try to eat/drink as much as possible when sick
  • increase blood sugar monitoring to minimum of four times a day when sick
  • seek medical advice if ketones found on urine dip
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22
Q

give 3 examples of short acting insulins

A
  • Humulin
  • Humalog
  • Novarapid
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23
Q

give 2 examples of long acting insulins

A
  • Lantus
  • Lenevinir
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24
Q

type 1 diabetes complications

A
  • hypoglycaemia
  • lipohypertrophy
  • diabetic ketoacidosis
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25
Q

what is lipohypertrophy

A

fatty lumps that develop due to continual use of the same injection site

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26
Q

type 2 diabetes pathophysiology

A
  • associated with varying levels of insulin resistance and insulin deficiency
  • obesity and high sugar intake is thought to contribute to insulin resistance
  • insulin deficiency occurs due to the genetic susceptibility of individuals resulting in them failing to produce more insulin to overcome degree of resistance
  • progression is associated with a static level of resistance but a progressive failure of insulin secretion, eventually resulting in production becoming non-existent
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27
Q

what is metabolic syndrome

A

type 2 diabetes with at least two of
* hypertension
* central obesity
* dyslipidaemia
* micro-albuminuria

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28
Q

type 2 diabetes presentation

A
  • often asymptomatic
  • fatigue, thirst, polyuria, weight loss
  • symptoms of complications (blurred vision, peripheral neuropathy, ulcers, genital thrush, claudication, acute coronary syndrome)
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29
Q

type 2 diabetes symptomatic diagnosis

A

one raised fasting or OGTT result

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30
Q

type 2 diabetes asymptomatic diagnosis

A

two raised fasting or OGTT results

31
Q

type 2 diabetes HbA1c aim

A

48-53

32
Q

type 2 diabetes first line management

A
  • diet
  • exercise
  • smoking cessation
33
Q

type 2 diabetes second line management

A

medication
- 1st line medication is always metformin
- next drug chosen is tailored to individual
- when all other drug therapy is exhausted, insulin is commenced
- GLP-analogues and gliptins can be used as insulin delaying drugs

34
Q

blood pressure target for uncomplicated type 1 diabetics

A

< 135/80

35
Q

blood pressure target for uncomplicated diabetics

A

< 140/80

36
Q

blood pressure target for coomplicated diabetics

A

< 130/75

37
Q

first line blood pressure management for type 2 diabetics

A

ACE inhibitor with possible calcium channel blocker or diuretic if African American

38
Q

what is type 3 diabetes

A

any form of diabetes that has an underlying cause

39
Q

type 3 diabetes causes

A
  • genetics: MODY
  • drug side effects: steroids, anti-psychotics
  • endocrine disorders: cushing’s acromegaly, pheochromocytoma
40
Q

what is MODY

A
  • maturity onset diabetes of the young
  • monogenic, autosomal dominant form of diabetes that can present in neonates, teenagers and young adults
41
Q

MODY presentation

A
  • young onset
  • strong family history
  • normal body weight
  • no auto-antibodies
  • mild onset of symptoms over several months
  • associated with renal cysts
  • increased sensitivity and response to sulphonylureas
42
Q

what is type 4 diabetes

A

gestational diabetes

43
Q

insulin mechanism of action

A

direct replacement for endogenous insulin

44
Q

metformin mechanism of action

A

increases insulin sensitivity and decreases hepatic gluconeogensis

45
Q

sulphonylureas mechanism of action

A

stimulate pancreatic beta cells to secrete insulin

46
Q

thiazolidinediones mechanism of action

A

activate PPAR gamma receptor in adipocytes to promote adipogenesis and fatty acid uptake

47
Q

DPP4 inhibitors (gliptins) mechanism of action

A

increases incretin levels which inhibit glucagon secretion

48
Q

SGLT-2 inhibitors (gliflozins) mechanism of action

A

inhibitrs reabsorption of glucose in the proximal renal tubule

49
Q

GLP-1 agonists (tides) mechanism of action

A

incretin mimetic which inhibits glucagon secretion

50
Q

which diabetic drugs cause weight loss

A
  • SGLT-2
  • GLP-1
51
Q

what is hypoglycaemia

A

blood sugar < 4 mmol

52
Q

hypoglycaemia causes

A
  • alcohol excess
  • excess institution or oral hypoglycaemic
  • acute illness (sepsis, liver failure)
  • endocrine (adrenal failure, pituitary insufficiency, insulinoma)
  • dumping syndrome (complication of bypass surgery)
53
Q

hypoglycaemia sympathetic symptoms

A
  • sweating
  • anxiety
  • hunger
  • tremor
  • nausea
  • palpitations
  • dizziness
54
Q

hypoglycaemia neurological symptoms

A
  • sweating
  • anxiety
  • hunger
  • tremor
  • nausea
  • palpitations
  • dizziness
55
Q

hypoglycaemia diagnosis

A
  • ABCDE
  • finger prick glucose
  • bloods (FBC, UE, LFT, glucose)
56
Q

hypoglycaemia management if conscious, orientated and able to swallow

A
  • 15-20g rapid acting glucose (4-5 glucose tablets, 90-120 ml Lucozade)
  • recheck blood sugar after 10-15 minutes
  • repeat up to 3 times
  • if blood sugar is still under 4 call for help and consider IV glucose and 1 mg IM glucagon
57
Q

hypoglycaemia management if conscious and able to swallow, but confused, disoriented or aggressive

A
  • if capable and co-operative treat as per mild

if not capable/co-operative, then:
- 1.5-2 tubes glucogel
- recheck blood sugar after 10-15 minutes
- repeat up to 3 times
- if ineffective: 1 mg IM glucagon
- if deteriorating or blood sugar still under 4, consider IV therapy

58
Q

hypoglycaemia management if unconscious, fitting or nil by mouth

A
  • ABCDE
  • stop any IV insulin
  • start IV glucose over 10 minutes
  • 75 ml 20% glucose
    • 150 ml 10% glucose
  • recheck blood sugar after 10 minutes
  • check for ketones if insulin stopped
  • once blood sugar > 4, give 10% glucose infusion at 100 ml/hour and restart infusion
59
Q

what is diabetic ketoacidosis

A
  • state of insulin deficiency resulting in hyperglycaemia and dehydration
  • associated with hyperglycaemia due to insulin deficiency and release of stress hormones such as adrenaline and cortisol trapping glucose within the blood
60
Q

diabetic ketoacidosis biochemical markers

A
  • hyperglycaemia
  • ketonemia
  • high anion gap acidosis
61
Q

diabetic ketoacidosis causes

A
  • drugs and alcohol
  • undiagnosed type 1 diabetes
  • non-compliance with insulin therapy
  • acute illness (sepsis, MI, trauma, surgery)
62
Q

diabetic ketoacidosis presentation

A
  • symptoms take hours to develop
  • increasing lethargy
  • confusion
  • abdominal pain and vomiting
  • polyuria and polydipsia
  • reduced GCS
  • deep, sighing breathing
  • sweet smelling breath
  • dehydration (due to polydipsia and vomiting)
63
Q

diabetic ketoacidosis diagnostic criteria

A
  • glucose > 11 or bicarb < 15
  • ketones > 3
  • pH: acidosis (under 7.35)
  • anion gap > 12
64
Q

diabetic ketoacidosis management

A
  • fluid resuscitation
  • IV insulin (monitor potassium and replace as necessary if infusion rate of potassium > 20 mmol/hour)
  • cardiac monitoring may be required
  • monitor bicarbonate and pH
  • continue infusion until stable (add in 10% dextrose once blood sugar under 14)
  • assess for ICU based on severity of metabolic disturbance and shock
  • long-acting insulin should be continued. short acting insulin should be stopped
65
Q

what is lactic acidosis

A

reduction in pH due to build up of lactate in blood

66
Q

lactic acidosis causes

A
  • sepsis
  • complication of diabetic ketoacidosis
  • use of metformin in acute kidney injury
67
Q

lactic acidosis presentation

A
  • hyperventilation
  • confusion
  • stupor
  • coma
68
Q

lactic acidosis diagnosis

A
  • bloods (lactate > 5, reduced phosphate)
  • pH < 7.35
  • reduced bicarb
  • high anion gap
69
Q

what is hyperglycaemia hyperosmolar syndrome (HONK)

A
  • hyperglycaemia emergency seen in those with type 2 diabetes caused by a severe uncorrected hyperglycaemia that results in dehydration
  • not associated with ketoacidosis due to there being some residual production of insulin, which prevents ketosis
70
Q

HONK causes

A
  • undiagnosed type 2 diabetes or poor compliance with medications
  • acute illness (sepsis, pancreatitis, MI)
  • drugs (steroids)
71
Q

HONK presentation

A
  • symptoms take days to weeks to develop
  • increasing lethargy
  • confusion
  • abdominal pain and vomiting
  • polyuria and polydipsia
  • reduced GCS
  • deep, sighing breathing
  • sweet smelling breath
  • dehydration (due to polydipsia and vomiting)
  • more elderly patients
72
Q

HONK diagnosis

A
  • finger prick glucose
  • bloods (FBC, UE, glucose, osmolality)
  • blood sugar is usually sky high (> 35)
  • osmolality > 340
73
Q

HONK management

A
  • start on insulin sliding scale
  • monitor UE, glucose
  • monitor for occlusive events such as stroke
74
Q

lactic acidosis management

A
  • fluid resuscitation
  • bicarbonate infusion
  • treat underlying cause

year 2 - endocrine (6 decks)

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