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Exam 2- Endocrinology and cancer > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is secondary diabetes?

A

Diabetes with a known cause (1-2 of cases):
e.g.
- Liver disease- cirrhosis
- pancreatic disease- cystic fibrosis
- Endocrine disease- cushings syndrome, thyrotoxicosis
- Drug induced- thiazide diuretics, corticosteroids

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2
Q

What is gestational diabetes?

A
  • Diabetes that develops during pregnancy- occurs in 3-4% of pregnancies
  • caused by insulin resistance that returns to normal after delivery
  • can cause large babies
  • usually controlled by diet
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3
Q

Discuss the epidemiology of type 1 diabetes

A
  • 8% of all diabetic cases
  • Prominent in childhood, peaking at puberty- 50-60% of cases present by 20 years old
  • highest in Caucasians
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4
Q

Discuss the epidemiology of type 2 diabetes

A
  • 90% of all diabetic cases
  • Increases with age- most c cases are over 40 years and obesity
  • most common in hispanic American (4-7 x more likely) and African/carribean (3-4 x more likely)
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5
Q

Causes of type 1 diabetes (Aetiology)?

A
  • It is an auto-immune disease associated with the ‘Human leukocyte antigen (HLA)’
  • greater than 90% of cases carry the HLA-DR3 and/or HLA-DR4 marker
  • Autoantibodies (antibodies produced by the immune system that target the bodies own proteins) cause the body to destroy its own pancreatic cells- greater than 70% of patients have ‘islet cell antibodies (ICA)’ at time of diagnosis
  • It isn’t genetically pre-determined but individuals with family history are more at risk
  • Has yet to be proven but could be impacted by the Coxsackie B4 virus
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6
Q

Causes of type 2 diabetes (Aetiology)?

A
  • Obesity accounts for 80% of cases of type 2 DM- causes increased resistance to insulin
  • Seems to be blink between those with low births weight-12 months
  • not proven but could be linked to poor nutrition in early life causing impaired beta cell development
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7
Q

What is metabolic syndrome?

A

A group of medical conditions that when occurring together, increase an individuals risk of developing type 2 diabetes or cardiovascular disease.
These include:
- Hypertension
- High blood glucose
- High cholesterol
- Central abdominal obesity ( men= >102 cm and women > 88cm)

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8
Q

What factors influence development of metabolic syndrome?

A
  • Being overweight ( Central abdominal obesity of men= >102 cm and women > 88cm)
  • High blood glucose- insulin resistance
  • hIgh blood pressure
  • High cholesterol
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9
Q

What are the estimated beta cell mass for an individual with type 1 and type 2 diabetes?

A
  • Type 1: Have less than 5-10% of a healthy beta cell mass
  • Type 2: Have about 50 mass remaining
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10
Q

What are the ‘ four Ts’?

A

Thirst
Tired
Toilet
Thin

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11
Q

What are the clinical manifestations of type 1 diabetes?

A
  • Polyuria- excess urination
  • Polydipsia- Excessive thirst
  • Weight loss
  • Fatigue
  • Blurred vision
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12
Q

What causes the clinical manifestation of polyuria?

A

Is caused by osmotic diuresis when blood glucose exceeds the renal threshold= glucose passes into the urine (rather than being directed back into the bloodstream by the kidneys)= as glucose concentration is high it pulls in more water and therefore increased production of urine.

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13
Q

What causes the clinical manifestation of polydipsia?

A

As lots of fluid and electrolytes are lost through increased urination (polyuria), the body needs more fluids to replace what has been lost.

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14
Q

What causes the clinical manifestation of weight loss?

A

Weight loss is caused by fluid depletion- when sodium and water loss exceeds intake and also because of increased breakdown of fat and muscle- the increased glucose concentration in the blood is NOT actually reaching the body cells to provide energy so they have to breakdown fat and muscle for fuel.

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15
Q

What is DKA?

A

Diabetes ketoacidosis

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16
Q

What are the symptoms of DKA?

A
  • Hyperventilating
  • Nausea and vomiting
  • Dehydration
  • Weakness
  • Ketone breath- sweet, pear drop smell
  • Reduced consciousness

Can be fatal

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17
Q

What causes DKA?

A
  • An increase in blood glucose levels- due to osmotic diuresis and dehydration
  • An increase in ketone bodies- Metabolic acidosis- Due to the increase loss of H+ ions, the body tries to compensate by increasing rate of respiration. This is known as “ Air hunger”. The smell is caused by ketones as they are the byproduct of fat breakdown in the liver and cause the blood to become acidic.
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18
Q

What may trigger DKA in an already diagnosed type 1 diabetic?

A
  • Becoming unwell e.g UTI, chest infection, flu
  • Not taking insulin doses properly or at all
  • when menstruating
  • High blood sugar levels caused by a growth spurt/puberty
  • Surgery/injury
  • Pregnancy
  • Binge drinking, use of illegal drugs
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19
Q

What should ketone levels be/ when do they become a problem?

A
  • lower than 0.6mmol/L is a normal reading
  • 0.6 to 1.5mmol/L means you’re at a slightly increased risk of DKA and you should test again in 2 hours
  • 1.6 to 2.9mmol/L means you’re at an increased risk of DKA and should contact your diabetes team or GP as soon as possible
  • 3mmol/L or above means you have a very high risk of DKA and should get medical help immediately
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20
Q

What are the clinical manifestations of type 2 diabetes?

A
  • Often a very gradual onset with few/no symptoms- often just detected as part of routine investigations
  • may present symptoms like type 1 e.g. polyuria, polydipsia, blurred vision etc
  • May see chronic skin infections due to impaired phagocyte function by high glucose levels
  • Pruritis- Itchiness
  • recurrent thrush and UTIs
  • Can be picked up because of the presence of a diabetes complication- retinopathy, neuropathy, nephropathy, foot ulcers
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21
Q

What does HONK stand for?

A

Hyperosmolar non-ketotic syndrome

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22
Q

What is HONK?

A
  • HONK is a medical emergency like that of DKA
  • there is no significant ketosis or acidosis like in DKA as the patient does still have some endogenous insulin that can inhibit ketogenesis but gluconeogenesis and glycogenolysis is occurring hence the high blood glucose.
  • it has the same clinical manifestations as DKA:
  • Hyperventilating
  • Nausea and vomiting
  • Dehydration
  • Weakness
  • Ketone breath- sweet, pear drop smell
  • Reduced consciousness
    except ketone breath as air hunger is not occurring
23
Q

What is the normal blood glucose levels for a non-diabetic?

A

3.4-.8 mmol/L

24
Q

What blood glucose reading is indicative of diabetes in a non-fasting blood test?

A

Greater than 11.1 mmol/L

25
Q

What blood glucose reading is indicative of diabetes in a fasting blood glucose test?

A

Greater than 7.1 mmol/L

26
Q

What is the oral glucose tolerant test (GTT)?

A

Patient has to consume 75g of anhydrous glucose and then waits 2 hours for a blood glucose reading. If the result is greater than 11.1 mmol/l, it is indicative of diabetes.
- Usually is only used in borderline and gestational diabetes

27
Q

What is the diagnosis for diabetes should the patient have no symptoms?

A

To diagnose a patient with no symptoms, they must have TWO blood glucose measurements that exceed the thresholds
- if random or fasting is not diagnostic, can use GTT

28
Q

Aside from blood glucose tests, what other tests may be done when diagnosing a diabetic patient?

A
  • Near-bed: Looking at patients symptoms
  • Testing renal factors: glucose, urea, creatinine, eGFR, electrolytes
  • arterial pH
  • blood pressure
  • urine analysis
  • renal and liver function
  • lipids- cholesterol levels
29
Q

What factors can lead to hypoglycaemia?

A
  • Issues with insulin therapy
  • Problems at injection site
  • Weight gain
30
Q

What is lipohypertrophy?

A
  • Production of fatty lumps under the surface of the skin because of repetitive injections in the same site. This can effect rate of absorption of insulin.
31
Q

What may be causing bruising/redness/swelling at injection sites?

A
  • If having inappropriate injection technique e.g. into the intradermal layer rather than the subcutaneous layer
32
Q

What blood glucose levels are deemed hypoglycaemic?

A
  • Levels below 4 mmol/l
33
Q

What are the symptoms of mild hypoglycaemia?

A

Palpitations
tremor
hunger
sweating
numbness
tingling
blurred vision
fatigue
headaches

34
Q

What are the symptoms of moderate hypoglycaemia?

A

behavioural changes- restlessness, agitated, irritable
drowsy
confused
slurred speech

35
Q

What are the symptoms of severe hypoglycaemia?

A

Very agitated
aggressive
unconscious
unresponsive
seizures
coma

36
Q

What is the treatment for mild hypoglycaemia?

A

15-20g of rapidly absorbed sugar
e.g. 120ml lucozade
90ml coke
1.5-2 tubes of glucogel

if necessary repeat after 10-15 minutes
After blood glucose has increased, take a snack or meal containing sustained carbohydrates

37
Q

What is the treatment for moderate hypoglycaemia?

A
  • Patient is rousable but cant treat themselves
    Can give 1.5-2 tubes of glucogel
    if nil by mouth, can be given an injection of intramuscular glucagon (1mg)
38
Q

What is the treatment of severe hypoglycaemia?

A

Give IM glucagon (1mg)
OR iv glucose- 150 mL of 10% glucose over 10-15 minutes

39
Q

What can cause hypoglycaemia?

A
  • Incorrect insulin doses
  • Delayed or missed meals
  • Excess alcohol- inhibits gluconeogenesis
  • Increased exercise
  • Heat
  • Stress
40
Q

What are the target blood glucose levels?

A

Before meals: 4-7 mmol/L
90 minutes after meal: 5-9 mmol/L
At waking: 4-7 mmol/L

41
Q

How often should type 1 and 2 diabetics measure their blood glucose levels?

A

Type 1: 4 times a day usually- at meals and bed time or on waking
type 2 : not required to self monitor. Will be checked at reviews by healthcare workers

42
Q

What items are needed for a finger prick test and where can they be obtained?

A
  • Meter: not on prescription- given free on diagnosis and can be purchased from a community pharmacy
  • Lancets
  • test strips (both available on FP10)
43
Q

What do continuous glucose/flash monitors measure the glucose levels of?

A
  • The glucose levels in the interstitial fluid- fluid that surrounds cells and contains leakages from the capillaries
44
Q

What is flash glucose monitoring?

A

Involves wearing a sensor on the body that measures the glucose levels in the interstitial fluid.
It only shows readings when scanned by phone and can have alarms set
e.g. Freestyle libre

45
Q

What is continuous glucose monitoring?

A

Wearing a sensor that measures glucose in the interstitial fluid. Acts via bluetooth so sends levels to device continuously without scanning- good for pumps as can have a closed loop system
- can calibrate with finger prick
e.g. Dexcom

46
Q

What does Hba1c measure?

A
  • Levels of glycosylated/glycated haemoglobin- when glucose has formed covalent bonds with haemoglobin in the presence of high glucose levels. Hba1c measures the level of this glycated haemoglobin
  • expressed as % or mmol/mol
    gives the average blood glucose concentration over life of haemoglobin molecule- 4-12 weeks
    Normal levels: 20-42 mmol/mol (4-6%)
    Targets for diabetics: 48 mmol/mol (6.5%)
47
Q

What is the target Hba1c level?

A

48mmol/mol (6.5%)

48
Q

When is Hba1c used in diagnosis?

A
  • Used for diagnosis of type 2 diabetes

NOT in:
- type 1 dm
- children
- pregnancy

49
Q

When would you perform a control test on your blood glucose monitor?

A
  • if using a new pot of test strips
  • I f readings appear inaccurate- don’t match symptoms
  • if the meter has been dropped/damaged
50
Q

Why/when would a QRISK2 score be used in diabetes?

A

A QRISK2 assessment is used in type 2 diabetics to assess the risk of a patient developing cardiovascular diseases/ having a stroke or heart attack

51
Q

What are the results of a QRISK2 score?

A

LOW- Less than 10%- less than 1 in 10 chance
MODERATE- 10-20%- 1-2 in 10 chance
HIGH- 20%+ - At least a 2 in 10 chance

52
Q

What score in a QRISK2 test would require additional therapies in type 2 DM?

A

In patients with a QRISK2 of 10% or higher

53
Q

What should cholesterol levels be?

A

Total cholesterol levels should be less than 5 mmol/L

Exam 2- Endocrinology and cancer (28 decks)

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