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Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes diagnosis by random BG

A

over 11.1 = diabetes

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2
Q

Risks of uncontrolled T1DM during pregnancy

A

Teratogenic, CNS deformities (spina bifida, anencephaly), great vessels abnormalities, larger birth weight, stillbirth, pre-eclampsia, prematurity

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3
Q

Management of diabetes in pregnancy

A

T1DM: insulin
T2DM: Metformin or insulin (for pregnancy)
Stop smoking/alcohol, take folic acid

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4
Q

Autoimmune diseases associated with diabetes

A

Cushings, Acromegaly, Addisons, aplastic anaemia

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5
Q

When can you start diabetes drugs?

A

If lifestyle changes have been tried for at least 1 month

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6
Q

Which pathway is responsible for macroscopic vascular complications of diabetes?

A

Poyol pathway/aldose-reductase pathway (active when high IC glucose)

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7
Q

Aldose reductase has a _____ Km compared with glucokinase

A

High

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8
Q

How often is creatinine checked in diabetes and what does it mean?

A

Once a year - AKI

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9
Q

Effect of insulin on BP

A

increases BP (Na retention)

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10
Q

BP target in diabetes

A

140/80

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11
Q

Capillary microangiopathy

A

Thickened, permeable, dilated BVs –> neuropathy, nephropathy, retinopathy

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12
Q

Neuropathic foot ulcer

A

Over areas of high pressure, metatarsal heads or big toe

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13
Q

Ischaemic foot ulcer signs/symptoms

A

Margins of feet, cold feet, absence of pulses, loss of hair, skin thinning, gangrene

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14
Q

X-ray appearance of charcot arthropathy

A

bag of bones appearance

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15
Q

Max dose of Metformin

A

3g per day

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16
Q

When do you have to inform the DVLA?

A

If on insulin, had >1 severe hypo in last year, neuropathy, retinopathy

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17
Q

Management of DKA

A

1) Fluids - 500ml 0.9% NaCl in 30 mins (3L by 4 hours)
2) IV insulin 6 units/hour
3) 10% dextrose
3) NG tube, ECG, screen for MI, antibiotic prophylaxis, CXR
4) BG hourly, BK 4 hourly, UandEs every 2 hours
5) K replacement once if less than 5

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18
Q

ECG signs of hyperkalaemia

A

Tall tented T waves, broad QRS

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19
Q

Why is there hyperkalaemia in DKA?

A

No insulin to drive K into cells = high EC K, but total body K is low

20
Q

How long should you wait to stop IV insulin after subQ Insulin given?

A

30 mins (takes 30 mins for subQ to start working and IV has a half life of a few mins)

21
Q

When do you stop IV Insulin?

A

Patient is eating and drinking
Ketones cleared
Bicarbonate is normal

22
Q

Fasting BG in diabetes

A

over 7 = diabetes
6 or less = normal
6.1-6.9 = pre-diabetes

23
Q

Differences in managing DKA in adults and kids

A

10ml/kg fluids
Fluid restriction (risk of cerebral oedema)
Insulin 1 hour after IV fluids started

24
Q

How much insulin should you give (carb counting)?

A

1 unit per 10g

1 unit drops by 2mmol

25
Q

Macrosomia

A

Larger birth weight over 4kg

26
Q

Treatment of MODY

A

SU - Glibenclamide

27
Q

Management of gestational DM

A

Lifestyle, Metformin, Insulin

OGTT 6 weeks post natal

28
Q

Gestational DM

A

Mother has a degree of insulin resistance and placental hormones tip over the edge
Increased risk of developing T2DM
Presents in 3rd trimester

29
Q

BP treatment in pregnancy

A

Methyldopa, Nifedipine

30
Q

Diabetes complications

A

Macrovascular: IHD, Stroke
Microvascular: neuropathy, nephropathy, retinopathy
Psychiatric
ED

31
Q

Peripheral neuropathy

A

Pain/loss of feeling in feet or hands

32
Q

Autonomic neuropathy

A

Changes in bower/bladder function, sexual response, sweating, HR, BP, hypoglycaemic unawareness
Gastric slowing/gastroparesis, dysphagia

33
Q

Proximal neuropathy

A

Pain in thighs/hips/buttocks = weakness in legs (amyotrophy)

34
Q

Focal neuropathy

A

sudden weakness in nerve/group of nerves = muscle weakness/pain e.g. CTS, foot drop

35
Q

Only drug used in end stage kidney failure/dialysis

A

Pioglitazone (TZD)

36
Q

Treatment of ED

A

Lose weight, less alcohol, improve lipids, review drugs, Sildenafil

37
Q

Treatment of hypoglycaemia

A

15g carbs/glucose (glucose tabs, gel, lucozade, sweets)

Glucagon 1mg

38
Q

Hypoglycaemic unawareness

A

Inability to detect hypo, no symptoms, longstanding DM

39
Q

Biochemical diagnosis of DKA

A 
Ketnonaemia over 3 (0.06 or less is normal)
BG over  11
Bicarbonate less than 15
K over 5.5
Low Na
High lactate
pH less than 7.3
40
Q

Complications of DKA

A

Cardiac arrest
Cerebral oedema
ARDS
Gas in stomach -> aspiration and gastric dilation -> ARDS

41
Q

HHS

A 
Elderly, MI, sepsis, steroids/diuretics, fizzy drinks
T2DM
Higher glucose than DKA
Bicarbonate raised
Elevated osmolality (normal 285-295)
42
Q

How to calculate osmolality

A

2 x (Na + K) + urea + glucose

43
Q

Treatment of HHS

A

Cautious fluids
Slow insulin
Screen for vascular event
Diet

44
Q

How is lactate formed?

A

Anaerobic metabolism of glucose

45
Q

Lactic acidosis

A 
High lactate
High anion gap
Type B - diabetes
Type A - tissue hypoxia
Hyperventilation, confusion, coma
46
Q

How to calculate anion gap

A

[Na + K] - [HCO3- + Cl-]

47
Q

Diagnosis of diabetes by HbA1c

A

Over 48 = diabetes

42-47 = pre-diabetes

Endocrine (13 decks)

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