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my Endocrinology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is C-peptide indicative of?

A

Endogenous insulin production

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2
Q

Ketosis is characteristic of Type _ diabetes

A

type 1

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3
Q

What is the use of HbA1c in diabetes monitoring?

A

HbA1c is a measure of blood glucose control over past 2-3 months

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4
Q

What can be used in diagnosis of Diabetes?

A

Oral Glucose tolerance test

Fasted blood glucose

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5
Q

What is T1DM?

A

A state of absolute insulin deficiency

-autoimmune destruction of pancreatic Beta cells in response to an environmental trigger in a generically susceptible individual

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6
Q

What mutations are present in a large proportion of T1DM patients?

A

HLA gene mutations

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7
Q

What is the management of T1DM?

A

insulin injections

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8
Q

What is monitored in T1DM patients?

A

Blood glucose and ketone
HbA1c - check glycaemic control
Renal function
Lipids

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9
Q

In T1DM management, what is the aim of basal bolus insulin injections?

A

Mimicking endogenous insulin production

-inject insulin before meals

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10
Q

Insulin resistance does not always result in diabetes (T/F)

A

True

-insulin resistance must be coupled with loss of compensatory beta-cell hyperplasia

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11
Q

What are the 3 main risk factors for T2DM?

A

genetics
obesity
lack of activty

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12
Q

What is the main action of Metformin?

A

reduction of hepatic gluconeogenesis

increases peripheral glucose uptake

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13
Q

What are the main side effects of Metformin?

A

GI upset

lactic acidosis

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14
Q

Metformin is weight neutral (T/F)

A

True

-can be used in obese patients

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15
Q

How do Sulfonylurea drugs work?

A

-block Katp potassium channels, inducing insulin secretion

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16
Q

What is the Incretin effect?

A

Increased stimulation of insulin secretion elicited by oral absorption

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17
Q

What is the mode of action of Gliptins?

A

aka DPP-4 inhibitors

-reduce glucagon and blood glucose levels by promoting incretin production

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18
Q

How do SGLT-2 inhibitors work?

A

Reduce blood glucose by blocking the sodium/glucose cotransporter, SGLT-2.

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19
Q

How does Glitazone work?

A

Enhance peripheral glucose uptake

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20
Q

What are the adverse effects of Glitazide?

A
  • increased fracture risk (fatty marrow)

- weight gain

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21
Q

What is the appropriate T2DM treatment for patients with CV disease risk?

A

metformin + SGLT2 antagonists

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22
Q

What are the types of neuropathy present in diabetes?

A
  • peripheral: pain/loss of feeling in feet, hands
  • autonomic: changes in bowel and bladder function, sexual response. sweating heart rate, blood pressure
  • proximal: pain in the thighs, hips, buttocks, leading to weakness in legs
  • focal neuropathy: sudden weakness of one nerve/group of nerves, causing muscle weakness/pain
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23
Q

Neuropathy is more common in T2DM than in T1DM(T/F)

A

False

more common in T1DM

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24
Q

How can painful diabetic neuropathy be managed?

A

Amitryptyline
Gabapentin
Preganalin

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25
Q

Proximal neuropathy is mor common in T2DM (T/F)

A

True

-elderly patient with T2DM

26
Q

What important GI complication can arise due to Autonomic Neuropathy?

A

Gastroparesis

-slow stomach emptying

27
Q

What are the characteristics of Gastroparesis?

A

Nausea, vomiting, bloating, loss of appetite

-blood glucose levels fluctuate widely

28
Q

How is gastroparesis managed?

A

Diet: small frequent meals, low in fat and fibre

Promotility drugs: metocopramide,

Anti-nausea: Ondansetron

Botulim toxin

Gastric pacemaker

29
Q

What are the risk factors for progression of Diabetic nephropathy?

A
  • hypertension (target 130/70)
  • cholesterol
  • smoking
  • glycaemic control (target HbA1c <53mmol/mol)
  • albuminuria (start on ACE inhibitor)

Control these!

30
Q

What is a cataract?

A

Clouding of the lens

31
Q

What is glaucoma?

A

increase in fluid pressure in the eye, cauing optic nerve damage

32
Q

List abnormalities that cane be present on a retinal image of a diabetic patient?

A

HICH
Haemorrhages: red dots/blots/flames

IRMA: intra-retinal microvascular abnormalities

Cotton Wool Spots: ischaemic areas

Hard exudates: lipid breakdown products

33
Q

What treatment is available for diabetic retinopathy?

A

Laser treatment

Vitrectomy (vitreus gel removal)

Anti-VEGF injections (inhibit angiogenesis)

34
Q

Erectile dysfunction is a rare complication of diabetes (T/F)

A

False

present in 50% diabetic men

35
Q

How can diabetic erectile dysfunction be treated?

A

Anti-hypertensive drugs

Cyclic Antidepressants
Tranquilizers
Sedatives
Analgesics

36
Q

What are the macrovascular complications of diabetes?

A

TIAs and stroke

Angina and MI
Cardiac failure

Peripheral Vascular disease

37
Q

What are the microvascular complications of diabetes?

A

Diabetic retinopathy

Micro/macro-albuminuria
Renal disease

Erectile Dysfunction

Autonomic nueropathy
Peripheral neuropathy
Osteomyleitis
Amputation

38
Q

What is the main purpose of dietary change in Type 2 diabetes?

A

weight management

39
Q

How is glycaemic control achieved in T2DM?

A

-reduce total energy intake; food groups not important

40
Q

What is the role of diet in glycaemic control for Type 1 diabetes patients?

A

Carbohydrate counting allows to adjust insulin dosage appropriately

41
Q

Hypoglycaemia is likely to arise in Type __ diabetics. Why?

A

Type 1

  • missed meals
  • wrong dose of insulin
  • high physical activity
  • alcohol
42
Q

What is Glycaemic index?

A

Rate at which food induces a rise in blood glucose

43
Q

What are the biochemical characteristics of blood results during Diabetic ketoacidosis?

A

Ketonaemia (.3mmol/L)

High blood glucose (>11mmol/L)

Low Bicarbonate (,15mmol/L)

44
Q

What are the signs and symptoms of Diabetic ketoacidosis?

A 
Thirst and polyuria
Dehydration
Flushed
Vomiting
Abdo pain and tenderness
Breathlessness (compensation for acidosis)
45
Q

What complication of diabetic ketoacidosis, occuring in young patients, can affect the brain?

A

Cerebral oedema

-can be fatal

46
Q

What DKA complication can arise in the lungs?

A

RDS (respiratory distress syndrome)

47
Q

What DKA complication can arise in the heart?

A

Ventricular tachycardia

48
Q

What GI complication of DKA can arise?

A

Severe stomach dilatation

49
Q

What must be replenished as part of DKA management?

A

Fluid
Insulin
Potassium

50
Q

What medication can exacerbate the Hyperglycaemic Hyperosmolar Syndrome in diabetic patients?

A

Steroids

51
Q

What patients tend to get Hyperglycaemic Hyperosmolar Syndrome?

A

Elderly (or african) patients with Type 2 diabetes

-treated by diet alone

52
Q

What are the biochemical features of Hyperglycaemic Hyperosmolal Syndrome?

A

High Glucose

Renal impairment (creatinine)

Raised sodium

Raised Osmolality (~400)

53
Q

Hyperglycaemic Hyperosmolal Syndrome is treated as DKA: fluids, insulin and potassium. (T/F)

A

False-ish

  • give fluids, but avoid fluid overload
  • give Insulin, but slowly
  • may need sodium
54
Q

What is Type A lactic acidosis associated with?

A

Tissue hypocaemia

infarcts, cardiogenic shock

55
Q

What is Type B Lactic Acidosis associated with?

A

Liver disease

Diabetes

56
Q

What are the lab findings for lactic acidosis?

What is the clinical picture?

A

Reduced bicarbonate
Raised Phosphate
Raised anion gap

Hyperventilation
Confusion
Stupor/coma

57
Q

What is HbA1c?

A

Component of glycosylated haemoglobin

-formed by non-enzymatic glycation of gaemooglobin on exposure to glucose

58
Q

What happens to glucagon in Type 1 diabetics?

A

It stops being produced 5 years after diagnosis

59
Q

What is the treatment of severe hypoglycamia?

A

Glucagon injection

-1mg, into buttock/arm

60
Q

What is the risk for pregnant diabetics?

A
  • High blood glucose impairs foetal organogenesis
  • Babies are large - risk at delivery
  • Post partum hyperglycaemia - baby used to high glucose
61
Q

Carbimazole is used for Hyperthyroidism. What’s the issue in pregnancy?

A

Causes embryopathy

62
Q

What should be done for a pregnant hypothyroid patient?

A

Increase thyroxine dosage

my Endocrinology (23 decks)

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