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Medical Complexities > Diabetes > Flashcards

Diabetes Flashcards

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USMLE® Step 1 flashcards
1
Q

Define diabetes

A

A condition that occurs when the body can’t use glucose normally

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2
Q

What is type 1 diabetes?

A

Autoimmune disease that causes the insulin producing beta cells in the pancreas to be destroyed preventing the body from being able to produce enough insulin to adequately regulate blood glucose levels

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3
Q

Causes of type 1 diabetes

A

A fault in the body immune response in which the immune system kills beta cells

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4
Q

2 tests to diagnose type 1 diabetes

A
  1. Keytone testing

2. C peptide test

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5
Q

What are keytones?

A

They are made when the body breaks down proteins. Short term it is a way that the body has of dealing with a situations where it has no other way to gain energy. Long term they can build up which is damaging

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6
Q

Symptoms of keytoacidosis

A 
Nausea
Vomiting
Abdo pain
Shortness of breath
Thirst
Polyuria
Fatigue
Dramatic weight loss
Blurred vision
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7
Q

Keytone test results

A 
0-0.6mmols = normal
0.6-1.5mmols = developing a problem
1.5-3mmols = moderately high and in need of correction dose of insulin
3-5mmols = significantly high and ketotic. This person can become critically ill very quickly
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8
Q

What is a C Peptide test?

A

Blood test carried out to find out how much insulin the body is producing. Useful for determining type 1 or 2 diabetes or insulin resistance

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9
Q

How is a C Peptide test carried out?

A
  1. Fast for 8-12 hours before test

2. Sample of blood is taken

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10
Q

What is a simulated C Peptide test?

A

If the test is to diagnose type 1 or 2 diabetes an injection of insulin may be given between two blood samples to stimulate insulin production

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11
Q

C Peptide normal test results

A

0.51-2.72 ng/ml or 0.17-0.90 nmol/L

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12
Q

Low C Peptide levels and high blood glucose indicates…

A

Type 1 diabetes

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13
Q

High C Peptide levels and low blood glucose indicates…

A

Insulin resistance or type 2 diabetes

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14
Q

Symptoms of type 1 diabetes

A 
Thirst
Tiredness
Urinating regularly
Unexpected weight loss
Genital itchiness
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15
Q

Treatment of type 1 diabetes

A
  1. Insulin treatment with insulin pen or pump

2. Education on how to balance insulin with diet and activity and how to use blood glucose testing to control diabetes

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16
Q

Short term complications of type 1 diabetes

A
  1. Keytoacidosis

2. Hypoglycaemia

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17
Q

What is hypoglycaemia?

A

Occurs when blood sugar levels fall below 4mmol/L

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18
Q

Symptoms of hypoglycaemia

A 
Sweating
Fatigue
Dizziness
Pale
Weak 
Increased HR
Blurred vision
Loss of consciousness
Confusion
Convulsions
Coma
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19
Q

Causes of hypoglycaemia

A

Alcohol

Too much insulin

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20
Q

Diagnosis of hypoglycaemia

A

Measuring blood sugar levels using glucose meter

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21
Q

Treatment of hypoglycaemia

A 
Mild = give quick acting carbs, repeat 10-15 mins later, if less than 4mmol/L
Severe= glucagon IV or IM
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22
Q

Long term complications of type 1 diabetes

A 
Heart disease
Stroke
Retinopathy
Kidney disease
Neuropathy
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23
Q

What is type 2 diabetes?

A

Metabolic disorder that results in hyperglycaemia

24
Q

Causes of type 2 diabetes

A
  1. Insulin not effectively used by the cells in the body

2. Ineffective use of insulin = insulin resistance causing hyperglycaemia

25
Q

What is insulin resistance?

A

Body becomes resistant to norma levels of insulin

26
Q

Symptoms of type 2 diabetes

A 
Excessive thirst
Frequent urination
Increased hunger
Tiredness
Sudden loss of muscle mass
27
Q

Risk factors for type 2 diabetes

A

Overweight
Unhealthy diet and inactivity
Strong genetic factor
>35 years

28
Q

Diagnosis of type 2 diabetes

A

Fasting plasma glucose test

Oral glucose tolerance test

29
Q

Treatment of type 2 diabetes

A

Diet modification and exercise

Medication

30
Q

Complications of type 2 diabetes

A 
Heart disease
Stroke
Neuropathy
Retinopathy
Nephropathy
31
Q

What is hyperglycaemia?

A

High blood glucose levels:

  1. levels > 7mmol/L when fasting
  2. levels > 11mmol/L 2 hours after meal
32
Q

Causes of hyperglycaemia

A
  1. Underlying cause = loss of insulin producing cells in pancreas or insulin resistance
  2. Immediate cause:
    • Missing dose of medication or insulin
    • Too many carbs
    • Stress
    • Infection
33
Q

Symptoms of hyperglycaemia

A 
Increased urination
Tiredness
Weight loss
Increased thirst
Blurred vision
34
Q

Complications on hyperglycaemia

A
  1. Keytoacidosis

2. Hyperosmolar hyperglycemic nonketotic syndrome

35
Q

What is hyperosmolar hyperglycaemic state?

A

Blood sugar levels rise to >50mmol/L and ketones ++

36
Q

Warning signs of HHS

A 
BG >50mmol/L
Increased thirst
Dry skin
High fever
Sleepiness or confusion
Loss of vision
Hallucinations
Weakness
Coma 
Dark urine
37
Q

Treatment of HHS

A
  1. Correct dehydration to improve BP, urine output and circulation
  2. IV fluids and potassium
  3. Insulin
38
Q

What are the effects of pregnancy on diabetes?

A
  • Fall in glucose tolerance as gestation advances
  • Nausea + vomiting make glycemic control difficult
  • More frequent hypoglycaemia
  • Deterioration on neuropathy and hypertension
39
Q

What are the effects of diabetes on pregnancy?

A
  • Increased risk of poor outcome
  • Increased risk of miscarriage
  • Increased risk on preeclampsia
  • Increased risk of infection
  • Increased risk of LCSC
40
Q

What are the effects of diabetes on the fetus?

A
  • Increased risk of congenital abnormalities
  • Increased mortality rates
  • Increased risk of IUD
  • Increased morbidity
  • Maternal hyperglycaemia leads to feta hyperglycaemia = pancreatic hyperplasia = metal hyperinsulinanaemia
41
Q

What makes a woman at high risk of GDM?

A
  • Previous GDM
  • Family history
  • Previous large for dates baby
  • High BMI
  • Ethnicity
42
Q

What is the screening test for diabetes in pregnancy?

A

Times sampling oral glucose tolerance test

  • 16-18 weeks if previous GDM + repeat at 28 weeks if result normal
  • 24-28 weeks for other high risk women
43
Q

What is the antenatal obstetric care for pre existing diabetes during pregnancy?

A
  • Early scan
  • 11-13 week nuchal translucency screening
  • 18-20 week metal cardiology scan
  • Anomaly scan
  • Regular growth scans 28, 32, 36 weeks
44
Q

What is the antenatal midwifery care for pre existing diabetes during pregnancy?

A 
Full hospital care: 
- 6 - 10 week booking
- 1 - 2 week diabetic reviews
- 2-4 weeks antenatal reviews
Monitor for signs of:
- Preeclampsia
- UTI
- IUGR
Plan timing/ mode of delivery
Anaesthetic assessment in 3rd trimester
45
Q

What is the intrapartum care for preexisting diabetes during pregnancy?

A
  • Neonatal resus equipment and skills available
  • Inform obstetric and diabetic teams
  • Iv access and bloods
  • Continuous sliding scale
  • Check glucose level
  • Test all urine passed
  • Consider antacids
  • Normal labour obs
  • Reduce rate of insulin IVI in 3rd stage
46
Q

IOL for pre-existing diabetes during pregnancy

A
  • Usual insulin dose evening before
  • Breakfast and morning dose of rapid acting insulin
  • Prostaglandin get and continuous CTG
  • Commence sliding scale once in established labour
  • Hourly BG monitoring
47
Q

Elective LSCS for pre-existing diabetes during pregnancy

A
  • Usual insulin evening before
  • Check instructions for diabetic team
  • Omit morning insulin
  • Check BG early morning
  • If BG
48
Q

What is gestational diabetes?

A

Carbohydrate intolerance of variable severity with onset during present pregnancy

  • Usually symptomless
  • Develops in 2nd or 3rd trimester
49
Q

What is the cause of GDM?

A

Changes in carb metabolism and insulin resistance

50
Q

How is GDM diagnosed?

A
  • On routine screening

- When investigation large for dates baby, polyhydramnios, glycosuria

51
Q

What are the complications of GDM?

A
  • Perinatal morbidity and mortality
  • Increased risk of metal macrosomia
  • Increased risk of pre-eclampsia
  • Women have an increased risk of developing type 2 in 10-15 years
52
Q

What is the intrapartum and postpartum care of GDM?

A
  • May not need insulin during labour
  • Sliding scale
  • Stop insulin when placenta delivered
  • Insulin requirements rapidly return to pre pregnancy levels postpartum
  • PN oral GTT at 6 weeks and counselling
53
Q

What is the later PN care for GDM?

A
  • Lifestyle advise
  • Fasting BG at 6 weeks
  • Annual fasting BG
54
Q

Diabetes and pregnancy and the neonate

A
  • Babies should be kept with their mothers unless a clinical complication
  • Do not transfer home unless 24 hours old, feeding well and maintaining BG levels
  • Prevent hypoglycaemia with early feeds and warmth
  • Check BG routinely every 2-4 hours and the 4 hourly for first 24 hours
  • Aim for BG >2.5mmol/L
  • If BG low check after feed and if still low inform paed
  • If
55
Q

What are the signs of neonatal hypoglycaemia?

A
  • Jittery
  • Hypothermia
  • Poor feeding
  • Poor tone
56
Q

What are the actions for neonatal hypoglycaemia?

A
  • Well clothes and warm
  • Regular feeds
  • Skin to skin

Medical Complexities (8 decks)

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