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Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the different types of diabetes?

A
  • Diabetes mellitus
  • Gestational diabetes
  • Diabetes insipidus
  • Secondary diabetes
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2
Q

What can cause secondary diabetes>

A
  • Pancreatic damage
  • Endocrine disease
  • Hepatic cirrhosis
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3
Q

What is diabetes insipidus?

A

When Kidneys cannot hold enough water.
Decreased amount or lack of action of ADH - anti-diuretic hormone (this hormone stops you from losing water).

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4
Q

What are the different types of diabetes inspidius?

A

Cranial & Nephrogenic

Cranial - brain produces less ADH

Nephrogenic - Kidneys resist effects of ADH, so does not hold water

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5
Q

How do you treat cranial diabetes insipidus?

A

Give Vasopressin & Desmopressin (which is ADH)

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6
Q

How do you treat nephrogenic diabetes insipidus?

A

Give:
- Carbamazepine
- Thiazide
- Oxytocin

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7
Q

What are the side effects of desmopressin?

A
  • Can lead hyponatraemic convulsions
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8
Q

What DVLA advice is given for diabetic patients?

A
  • ALL drivers treated with insulin must inform DVLA (and also let them know any history of diabetic complications like episodes of hypoglycaemia)
  • Patients should know warning signs of hypoglycaemia.
  • Patients must carry a capillary blood-glucose meter and test strips when driving.
  • Blood glucose concentration must be checked no more than 2 hours before driving and every 2 hours while driving.
  • Blood glucose conc should be at least 5mmol/l while driving.
    Take snack if below.
    Stop driving if less than 4mmol/l or warning signs develop.
    Wait 45 minutes after blood glucose is normal, before continuing journey.
  • Always ensure fasting acting carbohydrate in the car
  • Resume driving when medical reports show hypo awareness has been regained.
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9
Q

Which drugs are must likely to cause hypoglycaemia?

A
  • Insulin
  • Sulphonylurea
  • Meglitinides
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10
Q

What are the signs of hypoglycaemia?

A
  • Hunger
  • Anxiety
  • Sweating
  • Tingling lips
  • Tremor
  • Palpations

As levels fall lower:
- Confusion
- Weakness
- Incoordination
- Impaired vision

Severe
- Convulsions
- Inability to swallow
- Unconscious
- Coma

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11
Q

Can diabetic patients take alcohol?

A
  • Drink in moderation and with food

because alcohol can mask the symptoms of hypoglycaemia

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12
Q

What is the OGT test? What is it for?

A

Oral glucose tolerance test.

To see how well you can tolerate glucose.

So diagnose impaired glucose tolerance - diagnoses gestational diabetes.

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13
Q

What does this OGT test involve?

A

Measuring blood glucose conc after fasting for 8 hours.

Then measuring conc 2 hours after driving a standard anhydrous glucose drink (polycal, OGTT oral)

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14
Q

What is HbA1c?

A

Glycated haemoglobin - red blood cells exposed to glucose

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15
Q

What does the HbA1c test show? And when must it be performed?

A

The average plasma glucose over the last 2-3 months.
Indicates body’s glycaemic control in type 2.
Expressed as mmol/mol

Performed at any time of the day.

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16
Q

When must HbA1c not be used?

A
  • To diagnose type 1 diabetes
  • In children
  • During pregnancy
  • Women up to 2 months postpartum
  • Pt with symptoms of diabetes for less than 2 months
  • Pt is ill
  • Takes meds that can cause hyperglycaemia, pancreatic damage, kidney disease or HIV
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17
Q

What can HbA1c be used to predict?

A
  • Microvascular complications
  • Macrovascular complications
  • Morality

Lower values represents lower risk of long term vascular complications

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18
Q

How often must type 1 n type 2 diabetic patients be monitored?

A

Type 1 - every 3-6 months (more frequently if blood glucose changes rapidly)

Type 2 - every 3-6 months until medication and hba1c are stable, then every 6 months

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19
Q

Which test diagnose type 2 diabetes?

A

Hba1c & fasting blood glucose test

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20
Q

Which test diagnose type 1 diabetes?

A

random blood glucose test

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21
Q

What is type 1 diabetes?

A

Absolute insulin deficiency due to little to no insulin secretion caused by the destruction of beta cells in the pancreatic islets of langerhans.

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22
Q

What are the complications of diabetes?

A
  • Retinopathy
  • Nephropathy
  • Neuropathy
  • Premature CVD
  • Peripheral arterial disease
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23
Q

What are the signs n symptoms of type 1 diabetes?

A
  • Increased thirst
  • Frequent urination esp at night
  • Extreme hunger
  • Unintended weight loss
  • Irritability and mood changes
  • Fatigue & weakness
  • Blurred vision
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24
Q

How often must type 1 diabetic patient monitor their blood glucose levels?

A

At least 4 times a day (including before each meal & before bed)

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25
Q

What are the common target ranges for type 1 diabetes?

A
  • HbA1c = below or equal to 48mmol/mol
  • Fasting plasma glucose level upon waking = 5-7mmol/L
  • Plasma glucose level before meals = 4-7mmol/L
  • Plasma glucose after meals = 5-9mmol/L
  • Plasma glucose when driving, at least = 5mmol/L
  • Random plasma glucose conc = below 11mmol/L
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26
Q

Which type 1 diabetic patient may benefit from metformin being added to insulin?

A

Patient overweight.

With BMI of over or equal to 25kg/m2 (or 23kg/m2 if Asian ethnicity).

And those who which to improve glucose control but reduce insulin use.

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27
Q

What are the different drug classes of antidiabetic drugs?

A
  1. Alpha Glucosidase inhibitors = Acarbose
  2. Dipeptidylpeptidase-4-inhibitors (gliptins) = alogliptin, linagliptin
  3. Glucagon-like peptide-1-receptor agonists = albiglutide, liraglutide, exenatide
  4. Meglitinides = nateglinide
  5. Sodium glucose co-transporter 2 inhibitors = canagliflozin, dapagliflozin
  6. Sulphonylureas - Gliclazide, tolbutamide, glipizide, glimepiride
  7. Thiazolidinediones - Pioglitazone
  8. Biguanides - metformin
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28
Q

What is the first choice antidiabetic drugs? What happens to the dose?

A

Biguanide - Metformin.
Because it does not cause hypoglycaemia as does not stimulate insulin secretion.

The dose must be increased (if necessary) slowly, to prevent G.I side effects (OD-BD-TDS).
Offer modified release if standard is not tolerated.

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29
Q

What are the side effects of metformin?

A
  • G.I side effects
  • Lactic acidosis (discontinue if occurs)
30
Q

When should metformin be taken?

A
  • Taken with or after food
31
Q

What are the contraindications for metformin?

A
  • Acute metabolic acidosis (including lactic acidosis & DKA)
  • Ketoacidosis
  • Renal failure (cause cause renal failure which increases risk of lactic acidosis)
  • General anaesthesia (stop on morning of surgery)
  • If eGFR is less than 30ml/min
32
Q

Can metformin be given at pregnancy and breastfeeding?

A

Yes, for pre-existing and gestational diabetes.

Women with gestational diabetes should discontinue after birth.

33
Q

What monitoring must be done for metformin?

A

Before treatment, monitor renal function; and annually.

34
Q

What patient n carer advice must be given for metformin?

A

Inform of risk of lactic acidosis & how to recognise signs.

35
Q

What are the signs of lactic acidosis?

A
  • Dyspnoea (difficult/laboured breathing)
  • Muscle cramps
  • Abdominal pain
  • Hypothermia (low temp)
  • Asthenia (weakness/lack of energy)
36
Q

Examples of sulphonylureas?

A

Short acting - Gliclazide, tolbutamide, glipizide

Long acting - glimepiride, chlorpropamide, glibenclamide

37
Q

What can sulphonylureas cause?

A

Hypoglycaemia (especially with long acting ones) and weight gain

38
Q

What are the cautions and contraindications for sulphonylureas?

A

Caution:
- Elderly (avoid; if necessary give short acting

  • Patients with G6PD deficiency
  • Pregnancy and breastfeeding
  • Surgery (avoid before surgery, change to insulin)

Contraindications:
- Acute porphyria especially for gliclazide and tolbutamide)
- Ketoacidosis
- Overweight
- Real & hepatic impairment (or reduce the dose)

39
Q

What are the side effects of sulphonylureas?

A
  • G.I reactions (nausea, vomiting, diarrhoea, constipation)
  • Hepatic impairment (Jaundice, hepatic failure, hepatitis)
  • Allergic skin reactions in first 6-8 weeks (frequency unknown)
40
Q

Which antidiabetic drug is an alpha glucosidase inhibitors?

A

Acarbose

41
Q

What are the side effects of Acarbose?

A
  • G.I side effects
  • Interferes with sucrose absorption (therefore give glucose and not sucrose for hypoglycaemia, for patients on acarbose)
42
Q

What MHRA advice is given with Thiazolidinediones?

A

It is associated with heart failure - increased risk when given with insulin.

And increased risk of bladder cancer

43
Q

When should Thiazolidinediones treatment be continued?

A

Only continue if HbA1c decreases by at least 0.5% within 6 months of starting treatment.

44
Q

What are the side effects of Thazolidinediones?

A
  • Bone fracture
  • Weight gain
  • Visual impairment
  • Increased risk of infections & numbness
45
Q

What monitoring needs to be done for Thiazolidinediones?

A

Monitor live function and tell patients to report signs of liver toxicity

46
Q

What are examples of Dipeptidylpeptidase-4-inhibitors?

A

Gliptins:
- Alogliptin
- Linagliptin
- Sitagliptin
- Saxagliptin
- Vidagliptin

47
Q

What are the contraindications of gliptins?

A

Diabetic ketoacidosis

(not for linagliptin and saxagliptin)

48
Q

What are the side effects of gliptins?

A
  • G.I & skin reactions
  • Acute pancreatitis (persistent severe abdominal pain)
49
Q

When should gliptins be discontinued?

A

If symptoms of acute pancreatitis occurs (persistent severe abdominal pain)

50
Q

Examples of Sodium glucose co-transporter 2 inhibitors (SGLT2)?

A

Flozins:
- Canagliflozin
- Dapagliflozin
- Empagliflozin

51
Q

What MHRA advice is given with SGLT2?

A

Associated with risk of diabetic ketoacidosis.

Canagliflozin - increased risk of lower limb amputation (mainly toes)

52
Q

What are the cautions and contraindications of SGLT2?

A

Caution - if taken with insulin or sulphonylureas, these doses may need to be reduced when given with flozins.

Contraindication - With Dapagliflozin avoid if eGFR is less than 15ml/min

53
Q

What are the side effects of SGLT2?

A
  • Urinary disorders
  • Weight loss
  • DKA
  • Increased infection risk,
54
Q

Examples of Glucagon-like peptide 1 receptor agonists? (GLP-1 agonist)

A
  • Semaglutide
  • Exenatide
  • Delaglutide
  • Liraglutide
  • Lixisenatide
  • Albiglutide
55
Q

When is GLP-1 agonists used?

A

Used as combination therapy, when other treatment options have failed

56
Q

When should GLP-1 agonists be discontinued?

A

When acute pancreatitis occurs

57
Q

What advice should be given GLP-1 agonists?

A

Women of child bearing age, should be recommended to use effective contraception

58
Q

Which antidiabetic drugs causes weight gain?

A
  • Sulphonylurea
  • Pioglitazone
59
Q

Which antidiabetic drugs causes weight loss?

A
  • SGLT2i - Flozins
  • GLP1
60
Q

Which antidiabetic drugs has no effect on weight?

A
  • Metformin
  • Gliptins
61
Q

What is the mechanism of action for alpha glucosidase inhibitors (acarbose)?

A
  • Inhibits intestinal alpha glucosidases.
  • Delays digestion & absorption of starch & sucrose.
  • Has a small but significant effect on lowering glucose
62
Q

What is the mechanism of action for Biguanides - metformin?

A
  • Decreases gluconeogenesis & increases peripheral utilisation of glucose.
  • Acts only in the presence of insulin, so only effect when there is some functioning of pancreas cells
63
Q

What is the mechanism of action for Dipeptidylpeptidase-4 -inhibitors (Gliptins)?

A

Inhibitors dipeptidylpeptidase-4, to increase insulin secretion & lower glucagon secretion.

64
Q

What is the mechanism of action for Thiazolidinediones (pioglitazone)?

A

Pioglitazone reduces peripheral insulin resistance, leading to reduction of blood glucose concentration.

65
Q

What is the mechanism of action for glucagon-like peptide-1 receptor agonists?

A

Increases glucose dependent insulin secretion, slows gastric emptying

66
Q

What is the mechanism of action for meglitinides?

A

Stimulates insulin secretion

67
Q

What is type 2 diabetes associated with?

A
  • Obesity
  • Physical activity
  • Raised bp
  • Dyslipidaemia
  • Has a tendency to develop thrombosis and therefore increases CV risk
  • Can have long term microvascular & macrovascular complications
68
Q

What is the treatment steps for type 2 diabetes?

A

Step 1 - lifestyle advice for 3 months

Steps 2 - Antidiabetic drugs if lifestyle control isn’t adequate

69
Q

What are the contraindications of Pioglitazone?

A
  • History of heart failure
  • Previous or active bladder cancer
  • Investigated macroscopic haematuria
70
Q
A

Endocrine (7 decks)

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