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Endocrine > Diabetes 3 > Flashcards

Diabetes 3 Flashcards

1
Q

What should be taken into account when prescribing insulin?

A

Patient usual regimen and dose, BGM, ketone monitoring, sepsis/acute illness, steroid therapy, age/lifestyle. For new initiation- age, lifestyle, current health status, unit/kg

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2
Q

When is IV insulin used?

A

In DKA, role in hyperosmolar hyperglycaemic state (HHS), acute illness, fasting patients unable to tolerate oral intake

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3
Q

What monitoring is required for IV insulin management?

A

Hourly BGM, aim for BG 5-12, free of hypo, check ketones if BG >12, check U&E’s at least daily. Eventually safe transition from IV to SC insulin

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4
Q

What are some symptoms of hypoglycaemia?

A

Shaking, sweating, anxious, dizziness, hunger, fast heartbeat, impaired vision, weakness, fatigue, headache, irritable

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5
Q

What is severe hypoglycaemia?

A

Hypoglycaemia that leads to seizures, unconsciousness, or the need for external assistance

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6
Q

What is the immediate treatment of hypoglycaemia?

A

Eat 15-20g glucose/simple sugar. Recheck BG after 15mins, if continuing repeat. Once normal, eat small snack if next meal is more than 1/2hrs away

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7
Q

What are examples of 15g of simple carbs commonly used in hypo treatment?

A

Glucose tabs, gel tube, 2 tbsp raisins, 4 ounces juice or coke, 1 tbsp sugar, honey or corn syrup, 8 ounces nonfat/1% milk, hard sweets, jellybeans, or gumdrops

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8
Q

What is the treatment of severe hypo?

A

Glucagon 1mg injection-buttock, arm or thigh. When consciousness occurs (usually 5-15/60), nausea/vomiting may occur

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9
Q

At what BG level does hypoglycaemia occur?

A

Less than 4 mmol/l

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10
Q

What is DKA?

A

A disordered metabolic state that usually occurs in the context of an absolute or relative insulin deficiency accompanied by an increase in the counter-regulatory hormones ie. glucagon, adrenaline, cortisol and growth hormone

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11
Q

How is DKA diagnosed biochemically?

A

Ketonaemia >3mmol/l, or significant ketonuria (>2+ on dipstick). BG >11.0mmol/l, or known DM. Bicarb less than 15mmol or venous pH less than 7.3

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12
Q

What are some common contributors to DKA?

A

Infection, illicit drugs and alcohol, non-adherence with treatment, newly diagnosed diabetes

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13
Q

What are some typical symptons and signs of DKA?

A

Osmotic related-thirst and polyuria, dehydration

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14
Q

What effect does fat ingestion have on glycaemic control?

A

Little effect on BG, delays gastric emptying and peak glycaemic response

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15
Q

What effect does protein ingestion have on glycaemic control?

A

Little effect on BG, stimulates insulin secretion which increases glucose clearance from blood

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16
Q

How would you roughly work out a basal bolus regimen for a T1DM patient?

A

0.3 units/kg- Half pre bed (2200hrs), other half split across pre meals

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17
Q

What are some prandial insulin analogues?

A

Insulin aspart (Novorapid), lispro (Humalog)

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18
Q

What are some prandial soluble insulins?

A

Actrapid, Humulin S

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19
Q

What is the onset of action, peak action and duration of insulin analogues?

A

10-15mins, 60-90mins, 4-5hrs

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20
Q

What is the onset of action, peak action and duration of soluble insulins?

A

30-60mins, 2-4hrs, 5-8hrs

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21
Q

What are some basal isophane insulins?

A

Insulatard, humulin

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22
Q

What are some basal analogue insulins?

A

Lantus (glargine), levemir (determir)

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23
Q

What is the ratio of insulin:CHO in insulin dose calculations?

A

1 unit of insulin per 10g CHO

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24
Q

What are some macrovascular complications of diabetes?

A

IHD, Stroke

25
Q

What are some chronic complications of diabetes, other than macro/microvascular ones?

A

ED, Psychiatric

26
Q

How does neuropathy occur?

A

Blood vessels providing oxygen and nutrients to nerves are damaged when blood flows through them with high levels of glucose. Therefore there is no longer a sufficient supply of nutrients to nerves, which in turn damages them and causes nerve death, leading to neuropathy

27
Q

What is peripheral neuropathy?

A

Pain/loss of feeling in feet/hands

28
Q

What is autonomic neuropathy?

A

Changes in bowel, bladder function, sexual response, sweating, heart rate, blood pressure, hypoglycaemic unawareness

29
Q

What is proximal neuropathy?

A

Pain in thighs, hips or buttocks leading to weakness in legs (amyotrophy)

30
Q

What is focal neuropathy?

A

Sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel, bells palsy etc

31
Q

What are some neuropathy diagnostic tools?

A

NCS/electromyography, HR variability, US, gastric emptying studies

32
Q

What levels of microalbumin indicate microalbuminaria?

A

30-300mg/ml

33
Q

What levels of microalbumin indicate macroalbuminaria?

A

> 300mg/ml

34
Q

What can cause a false positive in an UACR test?

A

Menstruation, vaginal discharge, UTI, pregnancy, other illness, non-diabetic renal disease

35
Q

What number of results must you have to diagnose microalbuminuria?

A

Repeat test, at least 2/3 positive

36
Q

What are some eye pathologies diabetes can get?

A

Retinopathy, cataracts, glaucoma, visual blurring (in acute hyperglycaemia)

37
Q

Why does diabetes increase the risk of various vascular diseases?

A

Dyslipidaemia-increased Triglycerides/LDL, endothelial dysfunction, platelet aggregation, thrombogenesis, inflammation/increased oxidative stress

38
Q

What are some signs of the metabolic syndrome?

A

Central obesity (apple), high BP, high triglycerides, low HDL, insulin resistance

39
Q

What psychiatric complications can occur in diabetes?

A

Depression, eating disorders, bi-polar, schizophrenia

40
Q

What obstetric problems are associated with diabetes?

A

Cardiac and skeletal development, such as caudal regression syndrome. Stillbirth, mechanical problems in birth canal due to fetal macrosomia, hydramnios and pre-eclampsia. Genital and GI abnormalities- ureteric duplication

41
Q

What neonatal problems may occur in diabetes?

A

Fetal macrosomia. Infant of diabetic mother more susceptible to hyaline membrane disease, neonatal hypoglycaemia may occur.

42
Q

Why does neonatal hypoglycaemia occur?

A

Maternal glucose crosses placenta, but insulin does not, fetal islets hypersecrete to combat maternal hyperglycaemia, and a rebound to hypoglycaemic levels occurs when the umbilical cord is severed. This is due to hyperglycaemia in the third trimester

43
Q

What is the management of a DM patient who is pregant?

A

Good sugar control prior to conception, folic acid 5mg, consider change to insulin if not on, regular eye checks, avoid ACEI/statin, for BP use labetalol, nifedipine, methyl dopa

44
Q

What is gestational diabetes?

A

Glucose intolerance that develops or is first recognised during pregnancy, typically asymptomatic and remits following delivery

45
Q

When is a GTT performed to ensure resolution of GDM?

A

6 weeks post delivery

46
Q

What problems associated with GDM?

A

All obstetric and neonatal problems as with pregnant diabetic, but no increased risk of congenital abnormality

47
Q

What does pregnancy cause of the thyroid?

A

Increased demand-increase in size and increased T4 production to maintain normal concentrations

48
Q

What are normal thyroid function tests in pregnancy?

A

Low TSH in 9% pregnancies, fT4 increased in 14%

49
Q

How should pre-existing hypothyroidism in pregnancy be managed?

A

Increase thyroxine by 25mg soon as pregnancy suspected. Regular TFTS.

50
Q

What are the risks of untreated hypothyroidism in pregnancy?

A

Increased abortion, pre-eclampsia, abruption, post partum haemorrhage, preterm labour. Risk to foetal neuropsychological developlement

51
Q

What may the high level of HCG in pregancy cause?

A

Suppressed TSH with slightly elevated fT4/T3 which may be associated with hyperemesis gravidarum

52
Q

What can hyperthyroidism cause regarding fertility and pregnancy?

A

Infertility, spontaneous miscarriage, stillbirth, thyroid crisis in labour, transient neonatal thyrotoxicosis (due to TRAbs)

53
Q

How is hyperthyroid managed in pregnancy?

A

B-blockers if needed. Low dose anti-thyroid drugs - propylthiouracil 1st trimester, carbimazole 2/3rd. Check TRAbs during pregnancy

54
Q

What are the side effects of carbimazole in pregnancy?

A

Can cause embryopathy in 1st trimester, scalp abnormalities, GI abnormalities, choanal and oesophageal atresia, others

55
Q

What are the side effects of propyl thiouracil in pregnancy?

A

Risk of liver toxicity, best avoided except in 1st trimester

56
Q

What kind of goitre can postpartum thyroiditis cause?

A

Small diffuse

57
Q

What is the expected cause of postpartum thyroiditis?

A

Results from modifications to the immune system necessary in pregnancy

58
Q

What can postpartum thyroiditis cause?

A

Hypo/hyperthyroidism or both sequentially

Endocrine (14 decks)

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