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Week 23 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Male presents with painful itchy penis with thick white discharge/exudate on retracted foreskin. Diagnosis, cause and investigations?

A

Candidal balanitis

Differentials:
* STD
* Poor hygiene
* Balanitis circinata- skin conditon associated with reactive arthritis= ring shaped dermatitis on glans of penis

Risk factors:
* Diabetes
* Oral antibiotics
* Poor hygiene
* Immunosuprresion

Investigations:
* Urine dip
* Swab
* Blood sugar

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2
Q

Diagnostic criteria for diabetes?

A

In symptomatic patients:
* Fasting glucose test greater than or equal to 7
* Random glucose test greater than or equal to 11.1

If patient is asymptomatic then the above needs to be met on 2 seperate occasions

HbA1C- equal or greater than 48= T2D diabetes
* If asymptomatic a second one should be done

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3
Q

Modifiable/non modifiable risk factors for T2D?

A

Non-modifiable:
* Older age
* Ethnicity
* Fam history

Modifiable:
* Obesity
* Sedentary lifestyle
* High carb diet

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4
Q

Presentation of diabetes?

A
  • Tiredness
  • Polyuria and polydipsia
  • Unintentional weightloss
  • Oral thrush
  • Slow wound healing
  • Glucose in urine
  • Acanthosis nigircans- thickening and darkening of skin- associated with insulin resistance
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5
Q

HbA1c reading for pre diabetes?

A

HbA1c- 42-47 mmol/mol

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6
Q

HbA1c reading that indicates T2D?

A

Above 48 mmol/mol

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7
Q

HbA1c treatment targets for new type 2 diabetics?

A

48 mmol/mol

Measured every 3-6 months until under control and stable

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8
Q

HbA1c treatment target for patients requiring more than 1 antidiabetic medication?

A

53 mmol/mol

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9
Q

Medical management of Type 2 diabetes?

A

1st line:
* Metformin
* Then add an SGLT-2 inhibito e.g. dapagliflozin if the patient has existing cardio disease or HF

2nd line- add sulfonylurea, pioglitazone, DPP-4 inhibitor or SGLT2 inhibitor

3rd line:
* Triple therapy with metformin and 2 of the 2nd line drugs
* Insulin therapy

Significant potential side effect= ketoacidosis

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10
Q

Action of metformin and side effects?

A

Increases insulin sensitivity and decreases glucose production by the liver
Does not cause weight gain but may cause weight loss

Side effects:
* Gasto symptoms- pain, nausea, diarrhoea- can try modified release to help these
* Lactic acidosis- secondary to acute kidney injury

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11
Q

SGLT-2 inhibitors action and side effects?

A

SGLT-2 inhibitors end with the suffix- gliflozin

SGLT is found in proximal tubules of the kidneys- acts to reabsorb glucose from the urine back into the blood- SGLT-2 inhibitors stop this causing more glucose to be excreted in the urine
= lower HbA1c, lower BP, weight loss and improves heart failure

Side effects:
* Hypoglycaemia
* Glycosuria
* Increased urine output and frequency
* UTI and thrush- key
* Weight loss
* Diabetic ketoacidosis- key

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12
Q

Action of pioglitazone and side effects?

A

Thiazolidinedione- increases insulin sensitivity and decreases liver production of glucose

Side effects:
* Weight gain
* Heart failure
* Increased risk of bone fractures
* A small increase risk of bladder cancer

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13
Q

Action of Gliclazide and side effects?

A

Sulfonylureas stimulate insulin release from the pancreas

Side effects:
* Weight gain
* Hypoglycaemia

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14
Q

Types of insulin (5)

A

Rapid acting insulins e.g. Novorapid-start working after 10 mins and last 4 hours

Short-acting insulins e.g. Actrapid start working around 30 mins and last about 8 hours

Intermediate acting insulins e.g. Humulin 1 start working around 1 hour and last about 16 hours

Long acting insulins e.g. Levemir/Lantus- start working in around 1 hour and last 24 hours or longer

Humalogs- contain rapid and intermediate

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15
Q

1st line treatment to manage hypertension in patients with type 2 diabetes?

A

ACE inhibitors

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16
Q

What is type 1 diabetes?

A

Autoimmune disorder where the insulin producing beta cells of the islets of langerhanns in the pancreas are destroyed by the immune system= reduction in insulin production

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17
Q

What is type 2 diabetes?

A

Reduced sensitivity to insulin due to increased adipose tissue

18
Q

What is maturity onset diabetes of the young? MODY

A

A group of inherited genetic disorders affecting the productino of insulin

19
Q

Management of T1D? Side effects?

A

Insulin

Side effects:
Hypoglycaemia
Weight gain
Lipodystrophy

20
Q

Features of diabetic ketoacidosis?

A
  • Abdo pain
  • Polyuria, polydipsia and dehydration
  • Kussmaul respiration (deep hyperventilation)
  • Acetone smelling breath (pear drops smell)

= signs in a new diagnosis of T1D

21
Q

Investigations for T1D?

A
  • Urine dip- glucose and ketones
  • Fasting glucose and random glucose
  • HbA1c- NOT recomended
  • Low C-peptide levels (by product of insulin production)
    *
22
Q

The antibodies present in T1D?

A

anti-GAD, ICA and IAA

23
Q

Typical presentation of T1D?

A
  • Ketosis
  • Rapid weight loss
  • Age of onset below 50 years old
  • BMI below 25kg
  • Family history of autoimmune disease
24
Q

Sick day rules for patients with T1D?

A

Do not stop insulin but check blood glucose more frequently
Drink enough fluid

25
Q

Sick day rules for T2D?

A
  • stop some oral hypoglycaemics during acute illness
  • Do not stop insulin
  • Monitor blood glucose more frequently
26
Q

Blood results in DKA?

A
  • Glucose- >11 mmol/l
  • PH- <7.3
  • Bicarbonate <15 mmol/l
  • Ketones >3mmol/l or urine ketones ++ on dip
27
Q

Management of DKA?

A
  • Fluid replacement- isotonic saline
  • Insulin- IV 0.1 unit/kg/hour and then one blood glucose is <14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in additon to saline
  • Electrolyte disturbance correction
  • Long acting insulin should be continued and short acting insulin stopped
28
Q

Blood results for when DKA is resolved?

A
  • PH >7.3
  • Blood ketones- <0.6 mmol/L
  • Bicarbonate >15 mmol/L

Should be resolved within 24 hours

29
Q

An important complication in the brain of fluid ressusitation in DKA?

A

Cerebral oedema

30
Q

How does diabetic neuropathy present?

A

Sensory loss- glove and stocking distribution- with the lower legs affected first due to the lenght of the sensory neurones in this area

31
Q

Management of diabetic neuropathy?

A
  • 1st line- amitriptyline, duloxetine, gabapentin or pregabalin
  • Tramadol may be used as rescue therapy for pain
  • Pain management clinics
32
Q

Patient has erratic blood glucose control, bloating and vomiting- Diagnosis? Management?

A

Think gastroparesis- due to gastrointestinal autonomic neuropathy

Management- metoclopramide, domperidone or erythromycin

Also causes chronic diarrhoea usually at night

33
Q

Screening and management of diabetic nephropathy?

A

Screening:
* Annually using ACR- early morn specimen

Management:
* Diet
* Good glycemic control
* ACE inhibitor or ARB- all diabetic patients with a urinary ACR of 3 or more should be started on one of these

34
Q

Non-proliferative diabetic retinopathy?- management?

A

Mild- 1 microaneurysm

Moderate:
* Microaneurysms
* Blot haemorrhages
* Hard exudates
* Cotton wool spots- represent areas of retinal infarction

Severe:
* Everything in 4 quadrants

Management:
* Regular observation
* Optimise glucose control, BP and hyperlipidemia

35
Q

Proliferative diabetic retinopathy?- features and management

A

Features:
* Retinal neovascularisation
* Fibrous tissue forming
* More common in T1D- 50% blind in 5 years

Management:
* Optimise glycaemic control, BP and hyperlipdidemia
* Panretinal laser photocoagulation- can cause up to 50% reduction in visual fields and decrease in night vision
* Intravitreal VEGF inhibitors

36
Q

BP target for patient with diabetes?

A

140/80

37
Q

Which electrolyte is essnetial to monitor during DKA therapy?

A

Potassium- ensure its not too low as giving insulin will drop potassium leevls

38
Q

When should a patient with DKA be excelated to crit care?

A

PH <7.1
GCS <12
Pregant
Sats- <92% on air
Potassium <3.5 on admission

39
Q

Hallmark symptoms of T1D?

A

Polyuria
Polydipsia
Fatigue

40
Q

How many times should a diabetic check their glucose levels?

A

At least 4 times a day
Check before each meal and before you go to bed

41
Q

Blood glucose targets for diabetics are?

A

5-7 mmol/L on waking
4-7 mmol/L before meals and at other time in the day

42
Q

A condition that is a complication in T2D?

A

Hyperosmolar hyperglycaemic state
Patients have glucose levels over 40mmol/l and profound dehydration
Mortality- 10-20%

Week 23 (2 decks)

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