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MS3 - Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

T1DM presentation?

A

polyuria
polydipsia
wt loss
dka

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2
Q

T1DM genetics?

A

30% concordance

HLA-D3 and –D4

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3
Q

T1DM antibodies?

A

anti-islet,

anti-GAD

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4
Q

T2DM presentation?

A

polyuria
polydipsia
complications

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5
Q

Genetics of T2DM?

A

concordance in 80%

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6
Q

Risk factors for T2DM

A

obesity,
reduced exercise
calorie and alcohol excess

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7
Q

Diagnosis of diabetes?

A

I. symptoms + one reading of fasting glucose above 7 or random above 11.1

II. asymptomatic + 2 readings of raised plasma glucose
or OGTT: above 11.1 mM

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8
Q

OGTT: Normal people fasting glucose level?

A

<6.1

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9
Q

OGTT: Normal people 2hrs post 75g sugar glucose level?

A

<7.8

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10
Q

OGTT: diabetes fasting glucose level?

A

equal or greater than 7

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11
Q

OGTT: diabetes 2hrs post 75g sugar glucose level?

A

equal or greater than 11.1

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12
Q

Drugs causing DM?

A
  • steroids,
  • anti-HIV,
  • atypical neuroletics,
  • thiazides
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13
Q

Metabolic Syndrome

A 
↑ risk of MI
Central obesity (↑ waist circumference) and two of:   
- ↑ Triglycerides
- ↓ HDL
- HTN
- Hyperglycaemia: DM, IGT, IFG
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14
Q

Principles of monitoring of diabetes?

A

Monitor 4Cs every 6mo/year

  • glycaemic Control
  • Complications
  • Competency (injection)
  • Coping (psychosocial)
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15
Q

Diet modifications for diabetes?

A
  • ↓ total calorie intake
  • ↓ refined CHO, ↑ complex CHO
  • ↑ soluble fibre
  • ↓ fat (esp saturated)
  • ↓Na
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16
Q

Statins in pts with DM?

A

if >40yrs regardless of lipids

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17
Q

Aspirin in pts with DM?

A

if >50yrs

or <50 with other CVD RFs

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18
Q

Oral hypoglycaemics?

A
  • metformin

- sulfonylurea

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19
Q

Side effects of metformin?

A
  • nausea,
  • diarrhoea,
  • abdo pain,
  • lactic acidosis
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20
Q

CIs to metfromin?

A
  • GFR<30,

- tissue hypoxia (sepsis, MI),

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21
Q

Solfonylurea example and dose?

A

gliclazide MR 30mg with breakfast

22
Q

SE of gliclazide?

A
  • hypoglycaemia

- wt gain

23
Q

1st line treatment of T2DM?

A

oral hypoglycaemics + insulin

24
Q

2nd line treatment of T2DM

A
  • if insulin
    unacceptable
  • metformin + sulfonylurea + sitagliptin (DPP-4 inhibitor) / pioglitazon (thiazolidinedione)
25
Q

3rd line treatment of T2DM?

A
  • Add exenatide (SC) if insulin unacceptable or BMI>35

- metformin + sulfonylurea + exenatide

26
Q

Common insulin regimes?

A
  • BD biphasic regime
  • basal-bolus regime
  • OD long-acting before bed
27
Q

BD biphasic insulin regime?

A
  • BD insulin mixture 30min before breakfast and dinner (for regular lifestyle eg elderly and tom)
  • Rapid-acting: e.g. actrapid
  • Intermediate- / long-acting: e.g. insulatard
28
Q

Basal-bolus regime?

A
  • Bedtime long-acting (e.g. glargine) + short acting before each meal (e.g. lispro)
  • T1DM allowing flexible lifestyle
29
Q

OD Long-Acting Before Bed

A

Initial regime when switching from tablets in T2DM

30
Q

Insulin requirements during illness?

A
  • Insulin requirements usually ↑ (even if food intake ↓)

- (liver always making glucose even when not eating)

31
Q

Side effects of insulin therapy?

A
  • hypoglycaemia
  • lipohypertrophy
  • wt gain in T2DM (give metformin to reduce wt)
32
Q

Diabetes complications?

A
  • Hyperglycaemia: DKA, HHS
  • Hypoglycaemia
  • Infection
  • Macrovascular
  • Microvascular
33
Q

Macrovascular complications of diabetes?

A
  • MI (may be silent due to autonomic neuropathy)
  • PVD: claudication, foot ulcers
  • CVA
34
Q

Diabetic feet ischaemic features?

A
  • critical toes
  • pulseless
  • painful ulcers
35
Q

Diabetic feet neuropathic features?

A
  • loss of sensation
  • deformity: charcot’s joints, pes cavus, claw toes
  • painless ulcers
36
Q

Abx of diabetic foot infection?

A

benpen + fluclox ± metronidazole

37
Q

Nephropathy pathophysiology in DM?

A

Hyperglycaemia → nephron loss and glomerulosclerosis

38
Q

Feature of nephropathy in DM?

A

Microalbuminuria

- urine albumin:Cr (ACR) ≥30mg/mM

39
Q

Presentation of eye complications of diabetes?

A
  • Retinopathy and maculopathy
  • Cataracts
  • Rubeosis iris: new vessels on iris → glaucoma
  • CN palsies
40
Q

Ix for diabetic retinopathy?

A

fluorescein angiography

41
Q

Background diabetic Retinopathy features?

A
  • Dots: microaneurysms
  • Blot haemorrhages
  • Hard exudates: yellow lipid patches
42
Q

Pre-proliferative diabetic Retinopathy features?

A
  • Cotton-wool spots (retinal infarcts)
  • Venous beading
  • Haemorrhages
43
Q

Proliferative diabetic Retinopathy features?

A
  • New vessels

- Pre-retinal or vitreous haemorrhage

44
Q

Diabetic Maculopathy features?

A
  • ↓ acuity may be only sign

- Hard exudates w/i one disc width of macula

45
Q

Neuropathy pathophysiology?

A

I. Metabolic:

  • glycosylation,
  • Reactive Oxygen Species (ROS),

II. Ischaemia: loss of vasa nervorum

46
Q

Diabetic symmetric sensory neuropathy signs and symptoms?

A
  • Glove and stocking loss
  • absent ankle jerks
  • numbness, tingling and pain
47
Q

Treatment of Diabetic symmetric sensory neuropathy?

A
  • Paracetamol
  • Amitriptylin, Gabapentin, SSRI
  • Capsaicin cream
  • Baclofen
48
Q

Diabetic Autonomic neuropathy

A
  1. Postural hypotension
  2. Gastroparesis → early satiety, GORD, bloating
  3. Diarrhoea
  4. Urinary retention
  5. Erectile dysfunction
49
Q

Rx of Postural hypotension?

A

fludrocortisone

50
Q

Dose of metformin?

A

500mg after evening meal, ↑ing to 2g max.

MS3 - Endocrine (8 decks)

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