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CMS > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what is diabetes?

A

disorder of the metabolism causing excessive thirst and the production of large amounts of urine

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2
Q

two categories of diabetes?

A

mellitus
insiupidus
same symptoms

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3
Q

what is diabetes mellitus?

A

group of metabollic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both

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4
Q

types of diabetes?

A

type 1
type 2
MODY
gestational

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5
Q

what is type one diabetes?

A

pancreatic beta cell destruction/insulin required for survival
= anti GAD, anti islet cell antibodies

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6
Q

what is type two diabetes?

A

if patient does not have type one, monogenic or result of other medical condition/tx = secondary diabetes

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7
Q

what are secondary causes of diabetes?

A

diabetes as a result of drugs
pancreatic pathology
endocrine cause

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8
Q

when was insulin discovered?

A

1922 - banting, best, macleod, collip - discovered insulin. Removed pancreas of a dog - treatment by insulin injections

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9
Q

when was the 1st diabetes patient treated with insulin?

A

1922 in toronto - 14yr old leonard thompson

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10
Q

Type 2 diabetes caused by?

A

insulin resistance and beta cell function has core defects

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11
Q

genetic susceptibility, obesity and western lifestyle lead to what that causes type 2 diabetes?

A

insulin resistance and beta cell dysfunction

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12
Q

normally what happens to insulin?

A

insulin binds to a receptor triggering production of glucose transport proteins to allow glucose to enter cell q

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13
Q

if someone is insulin resistance what happens?

A

receptor not as responsive to the binding insulin molecule, therefore there is less glucose entering the cell and a build up of glucose in the blood

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14
Q

some causes of insulin resistance?

A

ectopic fat accumulation and increase in free fatty acids

increase in inflammatory mediators CRP

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15
Q

the increase in free fatty acids and CRP mediators results in?

A

inhibition of insulin via serine kinases responsible for phosphorylation of insulin receptor substrate 1 (IRS1)
= reduction in insulin stimulated glycogen synthesis due to reduced glucose transport

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16
Q

insulin resistance associated with?

A 
intra abdominal obesity
inactivity
meds
genetics
smoking
fetal malmutrition
endothelial disease
aging
hypertension
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17
Q

what is the therapy staircase for type 2 diabetes?

A

diet and exercise
oral monotherapy
oral combination
injectable and oral therapy

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18
Q

lifestyle changes for type 2?

A

weight loss
smoking cessation
improve diet
exercise

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19
Q

drugs to treat type 2?

A

metformin - biguanide
sulfonylureas
insulin

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20
Q

considerations for drug choices in type 2?

A 
duration of diabetes
degree of improvement required
mode of delivery 
adverse effects
pt preference
cost
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21
Q

what is HbAIC?

A

measure of blood glucose over a prolonged period pf 6-8 weeks
ref range = 6.6-7.5%/ 48-58 mmol

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22
Q

how to do home blood glucose monitoring?

A

target should be between 4 and 7 before meals and under 10 after meals

23
Q

reducing chronic complications allows?

A

avoidance of microvascular disease
avoidance of acute metabolic complications - DKA
reduced physiological morbidity

24
Q

macrovascular disease?

A

IHD, stroke

25
Q

microvascular disease?

A

neuropathy
nephropathy
retinopathy

26
Q

what is diabetes the leading cause of?

A

blindness
dialysis
amputation

27
Q

how to screen for microvascular complications?

A
  • annual urinary albumin creatinin ratio ACR for diabetic kidney disease
  • annual retinal photograph
  • annual foot screening
28
Q

what is metabolic syndrome?

A

central obesity
high bp
high triglycerides - low hdl cholesterol
insulin resistance

29
Q

how is cholesterol treated in diabetes?

A

lipid lowering statins in all diabetic patients over 40 regardless of baseline cholesterol

30
Q

ensure bp is what in a diabetic pt?

A
31
Q

aspirin and diabetes?

A

not recommended for primary prevention but may be used in secondary prevention if CVR >10% in 10 years

32
Q

what happens when glucose falls?

A

there is a release of counter regulatory hormones - glucagon, adrenaline and cortisol
aim is to stimulate glycogenolysis
side effects = sweats, palpitations, flushing

33
Q

symptoms of hypoglycaemia?

A

sweats, shakes, flushing, palpitations = autonomic

neuroglycopenic= confusion, reduced gcs, collapses, seizures, coma

34
Q

what happens with repeated exposures to hypo’s?

A

a gradual reduction in warning signs
progressive loss of counter regulatory hormone response = glucagon, adrenaline
more likely to have neuroglycopenic symptoms

35
Q

precipitating factors for hypoglycaemia?

A 
dosage of ohg/insulin
errors in dose given
timing of meds - esp insulin
delay in meals
exercise
alcohol
co morbidity - e.g renal insufficiency
adrenal insufficiency
pituitary insufficiency
36
Q

hyperglycaemia in type 1? type 2?

A

1 - diabetic ketoacidosis DKA

2 - hypermolar non ketotic coma

37
Q

hyperglycaemic b/c?

A 
acute illness
co morbidity
injury/infection
meds
poor compliance/errors in compliance with tx
psychological or social issues
38
Q

in hyperglycaemia measure?

A

ketones
acidosis
need iv fluids and insulin

39
Q

increased risk of hypo/hyperglycaemia in emergency patients bc

A

poor oral intake
sepsis
sleep deprivation
= modification of normal drug regime

40
Q

higher risk of perio disease in diabetic pt’s because?

A

high glucose = poor healing and increased infection risk

small blood vessel damage = reduced blood flow

41
Q

increase BG monitoring when?

A

during acute illness

42
Q

what is the bg for a hypoglycaemic pt?

A
43
Q

what patients should ketone monitor?

A

type 1 diabetic patients

44
Q

what is being measured with a ketone monitor?

A

beta hydroxybutyrate

45
Q

what is the range for ketone monitoring?

A

0-8mmol/l

46
Q

what is the normal ketone measurement?

A
47
Q

insulin secreted at s low basal rate is responsible for how much of insulin produced?

A

50%

48
Q

post meal glucose stimulates?

A

post prandial insulin

49
Q

what types of insulin are available?

A

long acting
short acting
rapid acting

50
Q

how can insulin be administered?

A

syringe
disposable pen
reusable cartridge pen
continuous subcutaneous insulin fusion pump

51
Q

what is a CSII?

A 
for type 1
programmable infusion pump
self managed
pulsates alanouge insulin continuously
bolus dose of insulin pumped out at mealtimes calculated on CHO content of food
52
Q

management of diabtes during illness?

A

increased monitoring

insulin increased b/c body response to stress

53
Q

what can corticosteroids precipitate?

A

hyperglycaemia

CMS (42 decks)

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