[diabetes] Flashcards
[diabetes][Dx]: What is HBa1c
Glycated haemoglobin
[diabetes][Dx]: HbA1c is a marker of average glucose levels over what prior time period
8 weeks (RBC t1/2)
[diabetes][Dx]: What symptoms are signs of DM according to WHO criteria for Dx. (6)
Polyuria Polydipsia Visual blurring Genital thrush lethargy Unexplained wt loss
[diabetes][Dx]: Symptoms of DM + raised venous glucose once of …. (fasting)
> = 7mmol/L
[diabetes][Dx]: Symptoms of DM + raised venous glucose once of …. (random)
> =11.1 mmol/L
[diabetes][Dx]: Raised venous glucose on 2 occasions of … (fasting)
> = 7 mmol/L
[diabetes][Dx]: Raised venous glucose on 2 occasions of … (random)
> = 11.1 mmol/L
[diabetes][Dx]: On 2 occasions a raised OGTT after 2hrs of …. is Dx
> = 11.1 mmol/L
[diabetes][Dx]: an HbA1c of … mmol/L is Dx of DM
> =48 mmol/L
[diabetes][Dx]: an HbA1c of …. % is Dx of DM
6.5%
[diabetes][Dx]: An HbA1c of lower than the cut off for DM does exclude DM: T/F
F
[diabetes][Dx]: HbA1c measurements are avoided in (3)
Children
Pregnancy
DM 1
[diabetes][Dx]: pathophysiology behind DM1
Autoimmune destruction Beta cells
[diabetes][Dx]: What does LADA stand for
Latent autoimmune diabetes of adults
[diabetes][Dx]: What is LADA?
Late onset DM 1
[diabetes][Dx]: Cause of DM2 (2)
decreased insulin secretion
increased insulin resistance
[diabetes][Dx]: Impaired fasting or glucose tolerance in a marker for progression in to which DM ?
2
[diabetes][Dx]: When would lifestyle intervention be most crucially indicated?
DM 2
during impaired fasting glucose/tolerance
[diabetes][Dx]: What does MODY stand for
Maturity onset DM of the young
[diabetes][Dx]: MODY genetic inheritance pattern?
Autosomal Dominant
[diabetes][Dx]: Explain MODY
Autosomal dominant DM2 affecting the young with a family Hx
[diabetes][Dx]: Genetic concordance in DM1?
30% - strong environmental factors
[diabetes][Dx]: Genetic concordance in DM2?
80% - F Hx!
[diabetes][Dx]: what are the criteria to have impaired glucose tolerance?
a fasting glucose of < 7 mmol/L
OGTT of 7.8 mmol/L
[diabetes][Dx]: what are the criteria to have a raised fasting glucose?
6.1 mmol/L
[diabetes][Dx]: what Ix is indicated if pt has impaired fasting glucose
OGTT
[diabetes][Dx]: pancreatic destruction can cause DM. Name 2 diseases apart from surgery?
haemochromatosis
Cystic fibrosis
[diabetes][Dx]: Name 4 categories of drugs known to cause DM
Steroids
Anti HIV
Thiazides
New anti-psychotics
[diabetes][Dx]: 5 endocrinological diseases that can cause DM ?
Phaechromocytoma Hyperthyroidism Pregnancy Acromegaly Cushings
[diabetes][pregnancy]: what % of pregnant women develop new-onset gestational DM
3.5%
[diabetes][pregnancy]: what advice can you offer the pt
control weight
[diabetes][pregnancy]: what supplement can you offer?
folic acid 5mg/day
[diabetes][pregnancy]: when should the pt take supplements until
12 weeks into the pregnancy
[diabetes][pregnancy]: All oral hypoglycaemics should be stopped apart from
metformin
[diabetes][pregnancy]: 6 weeks post partum?
Fasting glucose
[diabetes][pregnancy]: what % of GDM pts go on to develop DM
50% (regardless of post partum glucose)
[diabetes][pregnancy]: metformin can be used in conjunction (or alone) with what Tx for GDM
insulin
HLA D3 D4
DM 1
T
[diabetes][syndromeX]: what is metabolic syndrome aka
syndrome X
[diabetes][syndromeX]: defined as BMI …. or ^ waist circumference
> 30 (central obesity)
[diabetes][syndromeX]: cut off for BP in Dx?
> 130/85
[diabetes][syndromeX]: Cut off for TAGs in Dx?
=>1.7 mmol/L
[diabetes][syndromeX]: cut off for HDL in men?
1.03 mmol/L
[diabetes][syndromeX]: cut off for HDL in Females?
1.29 mmol/L
[diabetes][syndromeX]: cut off for fasting glucose?
> =5.6 mmol/L
[diabetes][syndromeX]: Presence of .. is Dx if increased BMI?
DM
[diabetes][syndromeX]: what 5 criteria do you need 2 of with an increased BMI to be Dx
BP TAGs HDL Fasting glucose DM
[diabetes][syndromeX]: which cancer are you at risk from
pancreas (+other)
[diabetes][syndromeX]: decreased fertility affects which gender
M and F
[diabetes][syndromeX]: you are at increased risk of vascular event t/F?
T
[diabetes][syndromeX]: What very broad neurological disorder are you at risk of
neurodegeneration
[diabetes][syndromeX]: Lifestyle advice Tx? (2)
Exercise
Mediterranean diet
[diabetes][syndromeX]: Drug Tx same as DM?
Yes - metformin
[diabetes][syndromeX]: microalbuminuria risk in increased? T/F
T
[diabetes][syndromeX]: How might the bile duct be at risk?
Gallstone risk increased
asians
SSRIs
anti TB drugs
[diabetes][Tx]: what lifestyle advice should be given (3)
exercise
diet
smoking
[diabetes][Tx]: How would yo lower triglycerides
Statin
[diabetes][Tx]: 1st line tx for triglycerides
Simvastatin 40mg nocte
[diabetes][Tx]: how does simvastatin work
Inhibits HMG-CoA reductase
[diabetes][Tx]: What is HMG-CoA redutase
rate limiting step in endogenous production of cholesterol
[diabetes][Tx]: When is Simvastatin not used in lowering triglycerides
if triglycerides are >4.5 mmol/L
[diabetes][Tx]: what is used if there is a triglyceride level of cut off for simvastatin?
Bezalip 200mg/8hr
[diabetes][Tx]: what is the target BP for DM management
<140/80 mmHg
[diabetes][Tx]: what advice should be given about driving
do not drive if hypoglycaemic spells
[diabetes][Tx]: DM1: mainstay of Tx?
Insulin
[diabetes][Tx]: DM1: what is the danger with binge drinking
delayed hypoglycaemia
[diabetes][Tx]: DM1: name 2 ultra fast acting insulins
Humalog
Novarapid
[diabetes][Tx]: DM1: what is the usual dose of insulin in 1 injection regardless of speed of action?
100u/mL
[diabetes][Tx]: DM1: when is ultra fast acting used
before or after a meal
[diabetes][Tx]: DM1: medium acting insulin?
Isophane insuling
[diabetes][Tx]: DM1: What is Novomix?
30% ultrafast
70% long acting
[diabetes][Tx]: DM1: what are the 2 long acting insulins
Insulin glargine
Insulin Detemir
[diabetes][Tx]: DM1: when is insulin glargine used
night time
[diabetes][Tx]: DM1: why is insulin glargine used before bed
prevent nocturnal hypoglycaemia
[diabetes][Tx]: DM1: there are 3 main regimens. name them
BD biphasic
QDS regimens
Once before bed
[diabetes][Tx]: DM1: describe BD biphasic
2x daily Novamix
[diabetes][Tx]: DM1: describe QDS
long acting before bed
ultra rapid before meal
[diabetes][Tx]: DM1: Describe once before bed
Long acting before bed
[diabetes][Tx]: DM1: if switching from metformin in type 2 DM to injections of insuling. Which regimens is most appropriate.
once before bed
[diabetes][Tx]: DM1: what advice about autonomy in insulin regimens should you give
Promote autonomy i.e react to meals/exercise/illness
[diabetes][Tx]: DM1: what effect does illness have on insulin requirements
increases insulin requirements (despite reduced food)
[diabetes][Tx]: DM1: if ill how frequently should you check blood glucose
4 times a day
[diabetes][Tx]: DM1: in illness what may be a sign of rising glucose levels other than blood glucose
ketouria
[diabetes][Tx]: DM2: what class of drug is metformin
biguanide
[diabetes][Tx]: DM2: what SE does metformincrucially not have
hypoglycaemia
[diabetes][Tx]: DM2: what SE does metformin have (3)
Nausea
diarrhoea
abdominal pain
[diabetes][Tx]: DM2: metformin CI is an eGFR of …
<36mL/min
[diabetes][Tx]: DM2: what is the worry with using metformin if the is reduced eGFR?
lactic acidosis
[diabetes][Tx]: DM2: what and when is the dose with metformin (2)
500mg
after food
[diabetes][Tx]: DM2: what indications are the which make you stop metformin (3)
Tissue hypoxia (MI/sepsis for e.g.)
morning of GA
iodine contrast
[diabetes][Tx]: DM2: for how long is metformin alone given before you give another drug
16 weeks
[diabetes][Tx]: DM2: after 16 weeks on metformin what is measured to learn if another drug is required
HbA1c
[diabetes][Tx]: DM2: after 16 weeks what is the HbA1c cut off for adding another drug on top of metformin
=>53mmol/L
[diabetes][Tx]: DM2: what drug is added is after 16 weeks HbA1c is too high
Gliclazide 40mg/d
[diabetes][Tx]: DM2: what class is gliclazide
sulfonylurea
[diabetes][Tx]: DM2: how does gliclazide work
Binds to sulfonylurea-r on beta cells
closes K+ channels = depolarisation
Ca++ open, exocytosis of insulin
[diabetes][Tx]: DM2: how does metformin work
supresses hepatic gluconeogenesis
[diabetes][Tx]: DM2: what is a SE of gliclazide (2)
hypoglycaemia
increased weight
[diabetes][Tx]: DM2: After metformin and sulfonylurea when next do you measure HbA1c?
6 months
[diabetes][Tx]: DM2: what is the HbA1c cut off for addition of a 3rd anti-diabetic drug (post metformin+gliclazide)?
=>57 mmol/L
[diabetes][Tx]: DM2: if HbA1c after 2 drugs reaches the cut off for a 3rd drug, what 2 drugs might you try?
Insulin
Pio-Glitazone 15-45 mg/24hrs
[diabetes][Tx]: DM2:how does glitazone work?
increase insulin sensitivity
[diabetes][Tx]: DM2: does using glitazone for DM2 after 6 months mean you stop metformin and sulfonylurea?
YES
[diabetes][Tx]: DM2: if after 6 months you do not use a glitazone but insulin, in what case can you keep metformin
if unable to use BD regimens
[diabetes][complications]: what effect does exercise have on cells with regard to insulin?
increase their sensitivity
[diabetes][complications]: what is the target BP
<140/80
[diabetes][complications]: what is the target BP if renal disease (microalbuminuria)
<75
ensure ACEi
[diabetes][complications]: what effect may insulin have at the injection site (apart from ^risk of infection)
lipohypertrophy
[diabetes][complications]: chief cause of death is
Vascular event
[diabetes][complications]: what should ALL DM patients be put on regardless of blood levels of triglycerides
Statin (simvastatin unless > 4.5 mmol/L: bezalip)
[diabetes][complications]: … mg aspirin is prescribed to reduce vascular event
75mg
[diabetes][complications]: define microalbuminuria
urine dipstick -ve for protein
urineACR is =>3 mmol
[diabetes][complications]: what does microalbuminaemurea indicate
early renal damage/disease
[diabetes][complications]: when is an ACEi indicated even if BP is normal
if urine ACR is >3 mmol
[diabetes][complications]: why is an ACEi indicated even if BP is normal?
Renal protective
[diabetes][complications]: Diabetic retinopathy: how frequent is mandatory screening?
annual
[diabetes][complications]: retinopathy: if pre-symptomatic and cotton wool spot/haemorrhages/aneurysms seen what intervention is used to prevent retinopathy?
laser photocoagulation
[diabetes][complications]: Diabetic retinopathy: what does laser photocoagulation do?
stops angiogenic factor production from ischaemic retina
[diabetes][complications]: what happens in retinopathy
angiogenic proliferation
[diabetes][complications]: diabetic retinopathy: what are the hard exudates seen early on?
lipid deposits
[diabetes][complications]: diabetic retinopathy: what would a retinal infarct look like/be described as?
cotton wool spot
[diabetes][complications]: diabetic retinopathy: if new vessel formation is seen what should you do?
urgent referral to ophthalmologist - blindness.
[diabetes][complications]: diabetic retinopathy: what is responsible for new vessel formation
ischaemia
[diabetes][complications]: diabetic retinopathy: hyperglycaemia causes high blood flow and capillary pericyte damage leading to aneurysms and occlusion T/F?
t
[diabetes][complications]: diabetic retinopathy: new vessel formation proliferate, bleed and fibrose and can cause the retina to ….
detach
[diabetes][complications]: diabetic retinopathy: is aspirin safe to take?
yes
[diabetes][complications]: diabetic retinopathy: what is new vessel formation on iris called
rubeosis iridis
[diabetes][complications]: diabetic retinopathy: what may rubeosis iridis lead to
glaucoma
[diabetes][complications]: diabetic retinopathy: Class of drug for Tx for maculopathy if surgery not an option?
intra-vitreal steroids
[diabetes][complications]: diabetic retinopathy: cataracts can be reversed with normoglycaemia? T/F
T
[diabetes][complications]: if the pt has reached the target BP of <140/80 and no microalbuminurea how frequently should BP check be
every 6 months
[diabetes][neuropathy]: how would you identify peripheral foot neuropathy cf. ischaemia
infection or injury over pressure points = neuropathy
[diabetes][neuropathy]: how would ischaemia present cf. neuropathy
absent dorsalis pedis
[diabetes][neuropathy]: what is the classical distribution of peripheral neuropathy
glove and stocking
[diabetes][neuropathy]: how would you measure sensation in the foot
10g monofilament
[diabetes][neuropathy]: decreased sensation and absent jerks indicates neuropathy or ischaemia
peripheral neuropathy
[diabetes][neuropathy]: if there is an absent dorsalis pedis what is the ext step?
doppler to measure flow
[diabetes][neuropathy]: is foot ulceration painful or painless
painless
[diabetes][neuropathy]: what investigation is specific to ulcers
depth probe (osteomyelitis/cellulits risk)
[diabetes][neuropathy]: Mx of foot non-pharm? (2)
regular chiropody (remove calluses) comfortable shoes
[diabetes][neuropathy]: 1st line empirical drug Mx of cellulitis
benzylpenicillin 1.2g/6hr IV \+ Flucloxacillin 1g/6hrs IV \+- metronidazole 500mg/8hrs IV
[diabetes][neuropathy]: what are the 4 indications for amputation/surgery?
abscess/deep infection
gangrene (pain at rest)
suppurative arthritis
spreading anaerobic infection
[diabetes][neuropathy]: diabetic neuropathy symptoms (2)
pain
numbness
[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 1st line Tx?
paracetamol
[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 2nd line Tx?
amitriptyline 10-25mg at night (TCA)
[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 3rd line Tx? (2)
Duloxetine (SNRI)
Gabapentin
[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 4th line Tx?
opiates
[diabetes][neuropathy]: Mononeuritis multiplex Tx (3 and 6 CNs can be affected)
corticosteroids
[diabetes][neuropathy]: what is amyotrophy?
painful wasting
of quadriceps
[diabetes][neuropathy]: autonomic neuropathy may present with? (5)
Postural BP drop urine retention erectile dysfunction diarrhoea gastroparesis
[diabetes][neuropathy]: 1st line drug Tx for autonomic induced postural BP drop?
fludrocortisone
[diabetes][neuropathy]: 1st line drug Tx for autonomic induced diarrhoea?
Codeine phosphate 15mg/8hrs
[diabetes][neuropathy]: what is charcots joint
neuropathy –> loss of pain sensation.
repeated unimpeded mechanical stress –> deformity.
[diabetes][neuropathy]: 1st line Tx for charcots ?
total rest of joint
