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SBOMS > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Features of metabolic syndrome?

A 
Increased BP
Increased waist circumference
Increased TGs
Increased fasting glucose 
Reduced HDL
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2
Q

Catabolic hormones that are involved in diabetic ketoacidosis?

A

Glucagon
Catecholamines
Cortisol
GH

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3
Q

What type of diabetics get DKA?

A

Type 1 only

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4
Q

Process of ketoacidosis development in T1DM?

A

1) Glucagon = Increased PEPCK = more gluconeogenesis = less oxaloacetate
2) Therefore acetyl CoA accumulates
3) In T1DM, no insulin = hormone sensitive lipase activation = lipolysis = ketogenesis

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5
Q

Main complications of diabetes?

A
  • Retinopathy
  • CVD (2-3x risk of CHD or stroke)
  • Nephropathy (leading cause of kidney transplants)
  • Erectile dysfunction (~50% of men with long term diabetes)
  • Foot problems
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6
Q

What is charcot arthropathy?

A

Bone & joint destruction from minimal trauma, common in diabetics

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7
Q

In what situations should metformin not be used?

A

Patients with AKI

Acutely unwell/dehydrated patients (lactic acidosis risk)

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8
Q

Mode of action of the sulphonylureas? example of one?

A

Stimulate the pancreas to release insulin, gliclazide.

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9
Q

Example of a GLP-1 agonist?

A

Exanatide

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10
Q

Mode of action of GLP-1 agonists

A

Stimulate the release of insulin from the pancreas and delay gastric emptying.

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11
Q

When should you not use GLP-1 Agonists?

A

suspended in patients with N&V, due to delay in gastric emptying

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12
Q

Problems with Sulphonylureas?

A

Risk of hypos. cannot be used in renal impairment.

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13
Q

Mode of action of SGLT2 antagonists?

A

Cause raised glucose excretion in kidneys.

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14
Q

Cautions with using SGLT2 inhibitors?

A
  • Increased UTI risk
  • Used with caution with diuretics
  • Suspended in dehydration
  • Patients on an SGLT2 will always have positive urine dipsticks
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15
Q

What is the target for pre-meal glucose in diabetics?

A

4-12mmol/L

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16
Q

What is the target for bedtime glucose in diabetic inpatients?

A

8-10mmol/L

17
Q

Minimum target for elderly/ill diabetics?

A

6mmol/L

18
Q

Symptoms of hyperglycaemia?

A
  • Thirst
  • Polyuria
  • Blurred vision
  • Nausea
  • Fatigue
  • Headaches
  • Drowsiness

(imagine being drunk)

19
Q

Blood glucose level to be considered a hyper- or a hypoglycaemia?

A

> 12mmol/L hyper

20
Q

Symptoms of hypoglycaemia?

A
  • Sweating
  • Palpitations
  • Shaking
  • Hunger
  • Confusion
  • Drowsiness
  • Speech difficulty
  • Headache
  • Nausea
21
Q

What other conditions are usually present in metabolic syndrome?

A

Obesity
NAFLD
Vascular and clotting abnormalities

22
Q

Three areas of the body that insulin causes the uptake of glucose?

A

Muscle, fat, liver

23
Q

How does glucagon and insulin effect hepatic release of glucose?

A

Glucagon causes the release of PEPCK, which stimulates hepatic glucose release

Insulin directly inhibits hepatic glucose output.

24
Q

How does pancreatic islet destruction lead to hyperglycaemia in T2DM?

A

Alpha cells hypertrophy and release more glucagon.

Beta cell number decreases, less insulin is released.

25
Q

Biochemical features of DKA?

A

Ketosis- raised ketone bodies (urine)

Acidosis- reduced pH (blood gases)

Hyperglycaemia- raised blood glucose

26
Q

Causes of diabetic foot ulceration?

A

Neuropathy

Ischaemia (peripheral vascular disease, small vessel disease)

Infection

27
Q

Two main types of insulin administration regimens?

A

Premixed insulin - has both a short acting and a basal component

Basal - bolus insulin take long acting once daily and short acting with food.

28
Q

Percentage of inpatients with diabetes?

A

15-20%

29
Q

hospital actions that can promote safe diabetes care?

A

Identification of diabetic patients

Appropriate blood glucose monitoring

Action on abnormal BG trends

Care of foot disease

30
Q

If a diabetic patient is eating less, how would you adjust their insulin?

A

reduce fast one, review long acting, but never withhold

31
Q

How many times do you do BG monitoring for a stable patient with diet controlled diabetes?

A

Once a week

32
Q

How many times do you do BG monitoring for a patient with insulin/medication controlled diabetes?

A

Twice a day

33
Q

Causes of hyperglycaemia in diabetic patients?

A

Missed medication

DKA or HHS

Infections

Steroid/antipsychotic medication

Other pancreatic disease

34
Q

Actions to consider in a hyperglycaemic attack?

A

Assess the patient (Drowsy, vomiting)

Insulin dose right?

Exclude DKA/HHS

check ABG, VBG, U&E etc

perform full exam for sepsis

35
Q

When might you use a variable rate IV insulin infusion? (sliding scale)

A

Recurrent vomiting

Severe illness

36
Q

Causes of hypoglycaemia in hospital?

A

Missed, smaller or delayed meals

Change in timing of the usual largest meal of the day, snacks

Nausea & vomiting

? Gastric surgery

Reduced appetite

Excess insulin (wrong dose given etc.)

37
Q

What is lipohypertrophy?

A

Build up of fat in the skin due to repeated use of same injection sites

SBOMS (18 decks)

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