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3RD YEAR - Long Term Conditions/FOCP > Diabetes > Flashcards

Diabetes Flashcards

1
Q

How is T2DM diagnosed (3 ways)

A

HbA1c > 6.5% (48mmol/mol) (39-46mmol/mol = pre-diabetes) OR Random blood glucose >11.1 in presence of symptoms OR Random blood glucose >11.1 on two occasions with no symptoms

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2
Q

What factors can affect HbA1c, and make it invalid as a diagnostic tool?

A
  • Conditions with increased red cell turnover eg. acute blood loss, pernicious anaemia, haemolytic anaemia, malaria, haemoglobinopathies - Pregnancy - Liver and renal disease - Ethnic variations
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3
Q

Describe the pathophysiology behind Type 1 diabetes

A

Insulin deficiency due to autoimmune attack of beta cells in the pancreas Linked to HLA D3/4

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4
Q

Describe the pathophysiology behind Type 2 diabetes

A

Acquired insulin resistance due to the body being unable to meet the requirement for insulin.

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5
Q

What conditions can cause secondary diabetes?

A
  • Acromegaly - Cushing’s syndrome - Haemochromatosis - Pancreatitis
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6
Q

Describe the pathophysiology behind gestational diabetes

A

Excessive production of counter-insulin hormones (cortisol,oestrogen), produced during pregnancy, leading to a state of insulin resistance in the mother

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7
Q

Which patients are prone to ketoacidosis?

A

Type 1

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8
Q

Which patients usually are diagnosed through the complications that have arisen as a result of their diabetes?

A

Type 2

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9
Q

Who gets screened for T2 diabetes?

A
  • Women with previous gestational diabetes - People aged 65 and over - Afro caribbean and south asians aged 35 and over - People over 50 who have BMI>30, T2DM first degree relative or hypertension - People with clinical cardiovascular disease - Women who are obese and have polycystic ovary syndrome
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10
Q

What measures can reduce microvascular complications of diabetes?

A

Tight blood glucose control (FBG<5.5)

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11
Q

What measures can reduce microvascular complications of diabetes?

A

Tight blood pressure control (<130/80)

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12
Q

What measures can decrease the incidence of cardiovascular events in diabetes?

A

Control of lipids (T.chol<4)

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13
Q

What are the microvascular changes seen in diabetes?

A

Retinopathy, nephropathy, neuropathy, erectile dysfunction, absent foot pulses, ischaemic skin chances

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14
Q

What are the macrovascular changes seen in diabetes?

A

Ischaemic heart disease, cerebrovascular disease, peripheral vascular disease

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15
Q

How can diabetic foot be managed?

A
  1. Examine feet of all those with diabetes 2. Suspect: infection, fracture, ulceration, Charcot 3. Investigations: WBC, CRP, ESR, U&E, Swab, X-ray 4. Treatment: bed rest, IV abx, refer
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16
Q

What does infection cause DKA?

A
  1. Infection leads to high cortisol and catecholamines 2. These cause gluconeogenesis
17
Q

How is DKA diagnosed?

A

Glucose > 11 mmol/l Ketones > 3 mmol/l Acidosis <7.3 pH

18
Q

What is the pathophysiology behind DKA?

A
  1. Glucose cannot be broken down as there is no insulin 2. The body breaks down fatty acids to get ketones for energy 3. This causes acidosis
19
Q

What are the signs and symptoms of DKA?

A

SYMPTOMS: Polyuria, polydipsia, weight loss, weakness, drowsiness, coma SIGNS: dehydration, hypovolaemia, increased respiration

20
Q

What is the protocol for DKA?

A

ABCDE

  1. IV fluids
  2. IV fluids + potassium
  3. IV insulin infusion
  4. Investigations to see what causes DKA, treat cause
  5. Establish monitoring regimen
  6. Once insulin in normal range, switch to glucose-insulin infusion to prevent hypos
21
Q

What are the pros and cons of the oral glucose tolerance test?

A

Pros - sensitive, early marker of impairment Cons - affected by short term lifestyle changes, expensive, takes time and effort

22
Q

What are the pros and cons of the glycated haemoglobin concentration (HbA1c)

A

Pros - reflects long term glucose, unaffected by acute change, convenient, high correlation with risks of complication Cons - lower sensitivity, expensive, not recommended for rapidly progressing diabetes

23
Q

What is metabolic syndrome?

A

Central obesity + 2 of: - High triglycerides - High BP - Low HDL - High fasting glucose - DM This can cause vascular events

24
Q

How can glucose control be monitored?

A

HbA1c, finger prick test (if on insulin)

25
Q

What is the definition of hypoglycaemia?

A

Plasma glucose <3

26
Q

What are the symptoms of hypoglycaemia?

A

AUTONOMIC - sweating, anxiety, hunger, tremor, palpitations NEUROGLYCOPENIC - confusion, drowsy, seizures, coma

27
Q

What causes hypoglycaemia EXPLAIN?

A

EXogenous drugs (insulin) Pituitary insufficiency Liver failure Addison’s disease Islet cell tumours Non-pancreatic neoplasms

28
Q

How is a hypoglycaemic attack managed?

A

ABCDEFG (dont ever forget glucose) Conscious - oral glucose Unconscious - IV dextrose, glucogel, IM glucagon - monitor BMs every 15 min - give long acting carbohydrate - review medication

29
Q

What is the target BP for diabetics?

A

Below 140/80

30
Q

What are the features of background diabetic retinopathy?

A

Dots, blots and deposits

31
Q

What are the features of pre-proliferative diabetic retinopathy?

A

Cotton-wool spots, haemorrhages and venous beading

32
Q

What are the features of proliferative diabetic retinopathy?

A

New vessel formation

33
Q

How can diabetes affect the eyes?

A

Retinopathy, maculopathy, blurred vision, cataracts, rubeosis iridis

34
Q

What is rubeosis iris?

A

New vessel formation on the eye, leading to glaucoma

35
Q

What are the signs of neuropathy in the feet?

A

Decreased sensation, absent ankle jerks, deformity

36
Q

What is Charcot’s foot?

A

A condition in which sugar damages the bones of the foot, causing weakness

37
Q

What is a hyperosmolar hyperglycaemic state?

A

T2DM - extremely high blood glucose causing severe dehydration, dry skin, confusion, coma

38
Q

How is hyperosmolar hyperglycaemic state diagnosed?

A

Glucose >30mmol/l and ABSENCE OF DKA FEATURES (vomiting)

39
Q

How is HH state managed?

A

IV fluids slowly and electrolyte replacement (potassium)

3RD YEAR - Long Term Conditions/FOCP (39 decks)

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