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Endocrinology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what is type 1 diabetes

A

pancreas stops being able to produce adequate insulin. so cells cannot absorb glucose from blood. cells think there is no glucose but really blood sugars rise- hyperglycaemia

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2
Q

viruses that can trigger type 1 diabetes

A

coxsackie B and enterovirus

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3
Q

symptoms of type 1 diabetes

A

polyuria
polydipsia
weight loss
diabetic ketoacidosis

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4
Q

blood glucose concentration normal

A

4.4- 6.1mmol/L

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5
Q

where is insulin produced and by what

A

beta cells in islets of langerhans in the pancreas

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6
Q

how does insulin reduce blood sugars

A

causes cells to absorb glucose and use it as fuel
causes muscle and liver cells to absorb glucose from blood and store it as glycogen

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7
Q

what is produced by alpha cells

A

glucagon (from islets of langerhans)

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8
Q

what does glucagon do

A

breaks down glycogen and releases it as glucose (glycogenolysis)
tells liver to convert proteins and fats into glucose

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9
Q

what is ketogenesis

A

occurs when there is insufficient glucose supply and glycogen stores are exhausted

liver takes fatty acids and converts them to ketones

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10
Q

what are ketones

A

water soluble fatty acids that can be used for energy
can cross blood brain barrier and be used by brain

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11
Q

how can you check ketone levels

A

dipstick test
ketone meter for blood

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12
Q

presentation of diabetic ketoacidosis

A

dehydration
ketoacidosis
potassium imbalance
hyperglycaemia
metabolic acidosis
polyuria
polydipsia
nausea and vomiting
weight loss
hypotension
altered consciousness
acetone smell

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13
Q

diagnosis of DKA

A

hyperglycaemia (above 11mmol/L)
ketosis (blood ketones above 3mmol/L)
acidosis (pH below 7.3)

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14
Q

treatment of DKA

A

FIG PICK

fluids IV
insulin IV
glucose IV and monitor

potassium IV
Infection - treat
chart fluid balance
ketones - monitor

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15
Q

management of diabetes T1

A

subcutaneous insulin
monitor diet
monitor blood sugars at each meal, on waking and before bed
monitoring for complications
use of insulin pump or basal bolus regime
pancreas transplant

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16
Q

what to do to monitor

A

HbA1C every 3-6 months
blood glucose monitor finger prick instant
flash glucose monitors with sensor, change every 2 weeks
continuous glucose monitor CGM

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17
Q

management of acute severe hypoglycaemia

A

IV 10% dextrose and IM glucagon

18
Q

complications of type 1 diabetes

A

infection- UTI, pneumonia, skin and soft tissue infections, fungal infections

macrovascular- coronary artery disease, peripheral ischaemia, diabetic foot ulcers, stroke, hypertension

microvascular- peripheral neuropathy, retinopathy, kidney disease

19
Q

type 2 diabetes

A

metabolic disorder that causes high blood sugar levels. It occurs when the body either doesn’t produce enough insulin or becomes resistant to the insulin it does produce.

repeated exposure to glucose and insulin makes cells in body resistant to effects of insulin

20
Q

risk factors for type 2 diabetes

A

obesity
lack of physical activity
a family history of diabetes
age
black african, caribbean or south asian
high blood pressure
and high cholesterol

21
Q

symptoms T2 diabetes

A

increased thirst
frequent urination
blurred vision
unintentional weight loss
infections
fatigue
acanthosis nigricans
slow healing of cuts and wounds
tingling or numbness in the hands or feet

22
Q

pre diabetes value range

A

HbA1C 42-47mmol/mol (predicts average over 3 months)

23
Q

HbA1C value indicates type 2 diabetes

A

48 or over
repeat 1 month later to confirm diagnosis

24
Q

drugs that improve insulin action

A

biguanides- metformin
thiazolidinediones- glitazones, pioglitazone

25
Q

drugs that increase insulin release

A

sulphonhylurea- gliclazide
incretin mimetics- …gliptins (DPPIV inhibitors)
GLP-1 analogues- …tide (exenatide, liraglutide)

26
Q

drugs that increase insulin excretion

A

SGLT2 inhibitors- …glifozins

27
Q

metformin pros and cons

A

improves insulin sensitivity
decreases fatty acid synthesis
inhibits gluconeogenic pathways
improves receptor function
can be used in pregnancy
GI side effects (usually wear off)
very safe

28
Q

thiazoidinediones- proglitazone pros and cons

A

decrease insulin resistance in liver
increase expense of insulin dependent glucose
decrease quantity of glucose, insulin and HbA1C in bloodstream

CV safe
but fluid retention, weight gain, fractures in females due to decreased bone density

29
Q

sulphonylureas- gli..ides- pros and cons

A

pros- well tolerated, rapid symptomatic
cons- risk of hypos, weight gain, caution in renal and hepatic disease

30
Q

DPPIV inhibitors- gliptins

A

well tolerated
2nd/3rd line
can be used in renal impairment
weight interval

only small effect on glycaemic control
nausea
expensive
not in pregnancy

31
Q

GLP-1 analogues …tide pros and cons

A

weight loss
3rd line
benefit for CV disease

nausea
expensive
only use for last resort
CI in pregnancy

32
Q

SGLT2 inhibitors …glifozins

A

get rid of water
get rid of calories
get rid of sodium
increase risk of urogenital infection
reduces CV and kidney problems
weight loss
2nd/3rd line
can add to insulin

risk of diabetic ketoacidosis
expensive
CI in pregnancy
cannot use in renal impairment

33
Q

what can you use in pregnancy

A

pioglitazone
metformin

34
Q

what can you use in Cv risk

A

SGLT2 inhibitors- glifozins
metformin
GLp-1 analogues …tide

35
Q

what can you use in renal impairment

A

DPPIV inhibitors- … gliptins
metformin
SGLT2 inhibitors- …glifozins

36
Q

biguanides side effects- metformin

A

lactic acidosis
GI distrubanve

37
Q

sulfonylureas side effects- glimepiride, glipizide

A

hypoglycaemia and weight gain

38
Q

thiazolidinediones side effects

A

fluid retention, weight gain, worsening heart failure

39
Q

SGLT2 inhibitors side effects- canaglifozins, dapoglifozins

A

diabetic ketoacidosis when used with insulin, urinary tract infections

40
Q

DPP4 inhibitors side effects - saxagliptins, sitagliptin

A

hypoglycaemia and gi upset

41
Q

GLP1 analogues- exenatide, liraglutide

A

hypoglycaemia, GI upset and increased risk of pancreatitis when used with DPP4 inhibitors

Endocrinology (9 decks)

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