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Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Define the bascis of diabetes.

A

A group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both

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2
Q

What are the 4 criteria of which any can be used to diagnose diabetes?

A

HbA1c 48mmol/mol +
Fasting glucose - 7mmol/L+ 2hr glucose in OGTT 11.1mmol/L+
Random glucose 11.1mmol/L+

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3
Q

What are the 4 main types of Diabetes?

A

Type 1
Type 2
Other specific types
Gestational Diabetes

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4
Q

What are the 2 cardinal symptoms of diabetes?

A

Polydipsia (excessive thirst)

Polyuria

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5
Q

Give a list of other syptoms that can occur with any diabetes in general?

A

Thrush (candidal or other infection)
Blurred vision
Weakness fatigue

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6
Q

What are the 3 main microvascular complications in diabetes?

A

Nephropathy
Retinopathy
Neuropathy

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7
Q

Define gestational diabetes.

A

any degree of glucose intolerance arising or diagnosed during pregnancy

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8
Q

Which autoantibodies are normally present in T1DM?

A

anti-GAD and /or anti-islet cell antibodies

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9
Q

What is type 2 DM?

A

A diagnosis of exclusion - not type 1 and not some other specific type

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10
Q

Does autoimmune destruction to the beta-cells occur in type 2 DM?

A

No

It is not an AI disease

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11
Q

Give 5 specific types of diabetes? Not incding T1, T2 or gestational diabetes

A 
LADA 
MODY 
Drug induced 
NND 
Endocrine disease 
Wolfram syndrome
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12
Q

How does type 1 DM usually present?

A 
Pre-school or peri-puberty 
Usually lean 
Acute onset of severe symptoms 
Often severe weight loss 
ketonuria with/wo metabolic acidosis 
No evidence of complications
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13
Q

What is the basis pathogenesis of T1DM?

A

Interaction between genes imparting susceptibility and resistance –> Variable insulinitis and beta-cell sensitivity to injury –>
Pre-diabetes –> Overt diabetes

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14
Q

What is your risk of havin T1DM if both of your parents have it?

A

~30%

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15
Q

Briefly describe the management of type 1 DM.

A 
BG and ketone monitoring 
Insulin 
CHO estimation 
Dieticia and DSN contact 
Annual review assessment 
Record severe hypoglycaemia episodes and DKA
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16
Q

What is the typical presentation of T2DM?

A 
Middle aged/ elderly 
Usually obese 
Pre-diagnosis duration of ~6-10 years 
Insidious onset 
Ketonuria – minimal or absent 
Evidence of microvascular disease/complications at diagnosis in 20-50 %
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17
Q

Give the risk factors for the development of T2DM.

A 
Obesity 
FH 
Age 
Ethnicity (Asian, African, Afro-Carribean)
PMH - MI or CVA 
Antipsychotics
IGT/IFG
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18
Q

What is a diagnosis of the “metabolic syndrome” made on?

A

Need insulin resistance and T2DM plus 2 of the following to have the metabolic syndrome:
Micralbuminuria
Obesity (BMI >30 or WHR 1.7, HD <1.0

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19
Q

What are the basic steps of treatment for T2DM?

A 
Therapeutic lifestyle change 
Monotherapy 
Combination therapy (w/o insulin)
Combination therapy (with insulin)
20
Q

What does LADA stand for?

A

Latent autoimmune diabetes of adults

21
Q

When should you suspect LADA?

A 
AGe 25-40 
Usually non-bese 
Associated AI conditions 
Male preponderance
Auto-antibody positive
22
Q

What does MODY stand for?

A

Maturity onset diabetes of the young

23
Q

What kind of inheritance does MODY express?

A

Autosomal dominant inheritance - rare

24
Q

What are the 2 main types of MODY?

A

Glucokinase and transcripton factors

25
Q

Which class of diabetic drugs works really well in MODY?

A

Sulphonylureas

26
Q

When is neonatal diabetes diagnosed and what is required?

A

Within the first 3 months of life and insulin treatment is required

27
Q

What are the 3 macrovascular complications of diabetes?

A

CVA
MI
PVD

28
Q

The microvascular diabetic complication of retinopathy can present with what?

A

Retinopathy
Cataract
Glaucoma

29
Q

What is the scale used to measure diabetic retinopathy?

A 
Mid non-proliferative 
Moderate non-proliferative 
severe non-proliferative 
Proliferative 
Maculopathy
30
Q

What are some further complications caused by the diabetic complication of nephropathy?

A

Development of HTN
Relentless decline in renal functtio
reduction in GFR
accelerated vascular disease

31
Q

Which anti-hypertensive drug is particularly good at treating diabetic nephropathy?

A

ACE Inhibitors

32
Q

What are the symptoms of peripheral neuropathy?

A 
Numbness
tingling
burning 
sharp pain or cramps 
sensitivity to touch 
loss of balance and coordination
33
Q

What can diabetic neuropathy lead to?

A

infections
ulcers
deformities (charcot foot, rocker bottom foot)
amputations

34
Q

What is the treatment for diabetic peripheral neuropathy?

A 
Simple analgesia 
tricyclic antidepressanes 
gabapentin 
Duloxetin (SSRI)
Stronger opiods (Tramadol)
topical capsaicin cream
35
Q

What other complications can diabetes lead to?

A

Erectile dysfunction or vaginal dryness

Psychiatric – depression, eating disorder, bi-polar, schizophrenia

36
Q

What is the target blood pressure for diabetics?

A

130/80

37
Q

What other measures besides diabetic drugs can help in controlling diabetes?

A

simvastatin 40 mg or atorvastatin 10 mg for T2DM regardless of baseline cholesterol

38
Q

Is low dose aspirin recommended for primary prevention of CV disease in diabetics?

A

No but can be used for 2y prevention

39
Q

Why is diabetes monitored?

A 
Guide treatment decisions 
reduce risk of compications 
Avoid hypo/hyper/DKA 
Safe in society 
Empower patients
40
Q

What is HbA1c?

A

Glycated haemoglobin formed by non-enzymatic glycation of haemoglobin on exposure to glucose

41
Q

What does HbA1c measure?

A

Average blood glucose over a period of time

42
Q

What HbA1c needs to be reached before diabetes can be diagnosed?

A

> 48mmol/mol (6.5%)

43
Q

What is the targert HbA1c for diabetics?

A

53mmol/mol

44
Q

For T1 and T2 DM how many times a day should they be monitoring their blood glucse via home BG monitoring machine?

A

T1 - 4-8 times a day

T2 - 1-4 times a day

45
Q

What are the targets for home blood glucose monitoring before and after meals?

A

before - 4-7mmol/mol

1-2 hours after beginning of meal <10mmol/mol

46
Q

What is the main purpose of bllod ketone monitoring at home?

A

Identifies early stages of ketone body formation when the patient often has no symptoms allowing preventative action to be carried out

47
Q

Patients in DKA are at high risk of what?

A

Thromboembolism

Endocrine (18 decks)

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