Diabetes Flashcards
What is C-peptide indicative of?
Endogenous insulin production
Ketosis is characteristic of Type _ diabetes
type 1
What is the use of HbA1c in diabetes monitoring?
HbA1c is a measure of blood glucose control over past 2-3 months
What can be used in diagnosis of Diabetes?
Oral Glucose tolerance test
Fasted blood glucose
What is T1DM?
A state of absolute insulin deficiency
-autoimmune destruction of pancreatic Beta cells in response to an environmental trigger in a generically susceptible individual
What mutations are present in a large proportion of T1DM patients?
HLA gene mutations
What is the management of T1DM?
insulin injections
What is monitored in T1DM patients?
Blood glucose and ketone
HbA1c - check glycaemic control
Renal function
Lipids
In T1DM management, what is the aim of basal bolus insulin injections?
Mimicking endogenous insulin production
-inject insulin before meals
Insulin resistance does not always result in diabetes (T/F)
True
-insulin resistance must be coupled with loss of compensatory beta-cell hyperplasia
What are the 3 main risk factors for T2DM?
genetics
obesity
lack of activty
What is the main action of Metformin?
reduction of hepatic gluconeogenesis
increases peripheral glucose uptake
What are the main side effects of Metformin?
GI upset
lactic acidosis
Metformin is weight neutral (T/F)
True
-can be used in obese patients
How do Sulfonylurea drugs work?
-block Katp potassium channels, inducing insulin secretion
What is the Incretin effect?
Increased stimulation of insulin secretion elicited by oral absorption
What is the mode of action of Gliptins?
aka DPP-4 inhibitors
-reduce glucagon and blood glucose levels by promoting incretin production
How do SGLT-2 inhibitors work?
Reduce blood glucose by blocking the sodium/glucose cotransporter, SGLT-2.
How does Glitazone work?
Enhance peripheral glucose uptake
What are the adverse effects of Glitazide?
- increased fracture risk (fatty marrow)
- weight gain
What is the appropriate T2DM treatment for patients with CV disease risk?
metformin + SGLT2 antagonists
What are the types of neuropathy present in diabetes?
- 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
Neuropathy is more common in T2DM than in T1DM(T/F)
False
more common in T1DM
How can painful diabetic neuropathy be managed?
Amitryptyline
Gabapentin
Preganalin
Proximal neuropathy is mor common in T2DM (T/F)
True
-elderly patient with T2DM
What important GI complication can arise due to Autonomic Neuropathy?
Gastroparesis
-slow stomach emptying
What are the characteristics of Gastroparesis?
Nausea, vomiting, bloating, loss of appetite
-blood glucose levels fluctuate widely
How is gastroparesis managed?
Diet: small frequent meals, low in fat and fibre
Promotility drugs: metocopramide,
Anti-nausea: Ondansetron
Botulim toxin
Gastric pacemaker
What are the risk factors for progression of Diabetic nephropathy?
- hypertension (target 130/70)
- cholesterol
- smoking
- glycaemic control (target HbA1c <53mmol/mol)
- albuminuria (start on ACE inhibitor)
Control these!
What is a cataract?
Clouding of the lens
What is glaucoma?
increase in fluid pressure in the eye, cauing optic nerve damage
List abnormalities that cane be present on a retinal image of a diabetic patient?
HICH
Haemorrhages: red dots/blots/flames
IRMA: intra-retinal microvascular abnormalities
Cotton Wool Spots: ischaemic areas
Hard exudates: lipid breakdown products
What treatment is available for diabetic retinopathy?
Laser treatment
Vitrectomy (vitreus gel removal)
Anti-VEGF injections (inhibit angiogenesis)
Erectile dysfunction is a rare complication of diabetes (T/F)
False
present in 50% diabetic men
How can diabetic erectile dysfunction be treated?
Anti-hypertensive drugs
Cyclic Antidepressants
Tranquilizers
Sedatives
Analgesics
What are the macrovascular complications of diabetes?
TIAs and stroke
Angina and MI
Cardiac failure
Peripheral Vascular disease
What are the microvascular complications of diabetes?
Diabetic retinopathy
Micro/macro-albuminuria
Renal disease
Erectile Dysfunction
Autonomic nueropathy
Peripheral neuropathy
Osteomyleitis
Amputation
What is the main purpose of dietary change in Type 2 diabetes?
weight management
How is glycaemic control achieved in T2DM?
-reduce total energy intake; food groups not important
What is the role of diet in glycaemic control for Type 1 diabetes patients?
Carbohydrate counting allows to adjust insulin dosage appropriately
Hypoglycaemia is likely to arise in Type __ diabetics. Why?
Type 1
- missed meals
- wrong dose of insulin
- high physical activity
- alcohol
What is Glycaemic index?
Rate at which food induces a rise in blood glucose
What are the biochemical characteristics of blood results during Diabetic ketoacidosis?
Ketonaemia (.3mmol/L)
High blood glucose (>11mmol/L)
Low Bicarbonate (,15mmol/L)
What are the signs and symptoms of Diabetic ketoacidosis?
Thirst and polyuria Dehydration Flushed Vomiting Abdo pain and tenderness Breathlessness (compensation for acidosis)
What complication of diabetic ketoacidosis, occuring in young patients, can affect the brain?
Cerebral oedema
-can be fatal
What DKA complication can arise in the lungs?
RDS (respiratory distress syndrome)
What DKA complication can arise in the heart?
Ventricular tachycardia
What GI complication of DKA can arise?
Severe stomach dilatation
What must be replenished as part of DKA management?
Fluid
Insulin
Potassium
What medication can exacerbate the Hyperglycaemic Hyperosmolar Syndrome in diabetic patients?
Steroids
What patients tend to get Hyperglycaemic Hyperosmolar Syndrome?
Elderly (or african) patients with Type 2 diabetes
-treated by diet alone
What are the biochemical features of Hyperglycaemic Hyperosmolal Syndrome?
High Glucose
Renal impairment (creatinine)
Raised sodium
Raised Osmolality (~400)
Hyperglycaemic Hyperosmolal Syndrome is treated as DKA: fluids, insulin and potassium. (T/F)
False-ish
- give fluids, but avoid fluid overload
- give Insulin, but slowly
- may need sodium
What is Type A lactic acidosis associated with?
Tissue hypocaemia
infarcts, cardiogenic shock
What is Type B Lactic Acidosis associated with?
Liver disease
Diabetes
What are the lab findings for lactic acidosis?
What is the clinical picture?
Reduced bicarbonate
Raised Phosphate
Raised anion gap
Hyperventilation
Confusion
Stupor/coma
What is HbA1c?
Component of glycosylated haemoglobin
-formed by non-enzymatic glycation of gaemooglobin on exposure to glucose
What happens to glucagon in Type 1 diabetics?
It stops being produced 5 years after diagnosis
What is the treatment of severe hypoglycamia?
Glucagon injection
-1mg, into buttock/arm
What is the risk for pregnant diabetics?
- High blood glucose impairs foetal organogenesis
- Babies are large - risk at delivery
- Post partum hyperglycaemia - baby used to high glucose
Carbimazole is used for Hyperthyroidism. What’s the issue in pregnancy?
Causes embryopathy
What should be done for a pregnant hypothyroid patient?
Increase thyroxine dosage
