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03- Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what is diabetes mellitus?

A

a group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both

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2
Q

what is the normal level of HbA1c?

A

41m/m and below

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3
Q

what is the level of HbA1c needed to diagnose diabetes?

A

48m/m and above

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4
Q

what is teh normal level for fasting glucose?

A

6 mmol and below

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5
Q

what is the level of fasting glucose needed to daignose diabetes?

A

7mmol and above

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6
Q

what is the normal level of 2hr glucose in OGTT?

A

7.7mmol and below

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7
Q

what is the level of 2hr glucose in OGTT needed for a diagnosis of diabetes?

A

11.1mmol and above

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8
Q

what is the level of random glucose needed for a diagnosis of diabetes?

A

11.1mmol and above

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9
Q

what characterises T1DM?

A

pancreatic beta cell destruction

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10
Q

what antibodies are presetn in T1DM?

A

anti-GAD

anti-islet

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11
Q

T2DM is a diagnosis of ______

A

exclusion

if a person does not have type 1, monogenic or secondary diabetes they are thought to have type 2

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12
Q

T1DM is not diagnosabel before what age?

A

1yr- neonatal diabetes can be transient

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13
Q

what is the pathogenesis of T1DM?

A

cell failure and absolute insulin deficiency

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14
Q

what is the pathogenesis of T2DM?

A

hyperinsulinaemia

insulin resistance

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15
Q

what are some useful discriminatory tests for diabetes?

A

GAD/anti-islet cell antibodies

ketones

C-peptide (plasma)

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16
Q

what type of diabetes may patients presenting with ‘typical’ type 2 diabetes have?

A

LADA- late onset type 1 diabetes

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17
Q

who is affected by type 4 diabetes?

A

pregnant women

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18
Q

type 4 diabetes is also referred to as what?

A

gestational diabetes

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19
Q

what does HbA1c provide a measure of?

A

glucose control over the past 2-3months

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20
Q

what are the three main types of complicartion in diabetes?

A

macrovascular

microvascular

psychiatric/psychological

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21
Q

what are the macro-vascuar complications of diabetes?

A

heart disease and stroke

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22
Q

what are the micro-vascualr complication of diabetes?

A

retinopathy

nephropathy (kidney damage)

neuropathy (peripheral nerve damage)

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23
Q

what is the UK prevelance of diabetes?

A

0.3-0.4%

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24
Q

how many people have been diagnosed with diabetes worldwide?

A

20 million

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25
Q

T1DM is defined as?

A

a state of absolute insulin deficicency

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26
Q

how is a diagnosis of diabetes made?

A

fasting glucose: > 7mmol

random glucose: > 11.1mmol

and symtpoms/repeat test

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27
Q

what can be seen under microscope in T1DM?

A

lymphocytes attacking the islets

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28
Q

what can be seen under microscope in T2DM?

A

amyloid deposit

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29
Q

50% of familial risk of T1DM is related to which genes?

A

HLA genes

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30
Q

what is the ‘classic triad’ in diagnosing diabetes?

A

polyuria (excessive urine production)

polydipsia (excessive thirst)

weight loss

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31
Q

describe the management of a newly diagnosed patient with T1DM (5 points)

A

blood fluocse and ketone montoring

insulin (usually basal bolus)

carbohydrate estimation

dieticain contact

medical clinic review

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32
Q

what is looked at duting the annual review of T1DM?

A

weight

blood pressure

bloods: HbA1c, renal function and lipids

retinal screening

foot risk assessment

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33
Q

children are more likely to develop diabetes if which one of their parents has the condition?

A

three times more liekly ot develop diabetes if father has condition

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34
Q

20% of patients with which condition will develop secondary diabetes?

A

cystic fibrosis

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35
Q

what are the possible diagnoses in someone presenting under 30yrs with diabetes?

A

T1DM

T2DM

MODY

LADA

secondary diabetes

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36
Q

children diagnosed under the age of 6months are much more likely to have which type of diabetes?

A

monogenic

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37
Q

what is present to establish a diagnosis of LADA?

A

elevated levels of pancreatic auto-antibodies

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38
Q

when would you suspect LADA?

A

young adults 25-40

usually non-obese

auto-antibody +ve

assoc autoimmune conditions

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39
Q

what are the clinical findings in Bardet-Biedl syndrome?

A

often very obese

polydactyly

visual/hearing impairment

diabetes

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40
Q

what are some common autoimmune conditions associated with diabetes?

A

thyroifd disease

coeliac disease

pernicious anaemia

IgA deficiency

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41
Q

what are the symptoms associated with coeliac?

A

bloating

diarrhoea

malabsoprtion

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42
Q

what is associated with anaemia in diabetes?

A

low albumin

low calcium

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43
Q

what is asscoiated with thyroid disease in diabetes?

A

FHx

weight change

deterioration n HbA1c

hypoglycaemia

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44
Q

what devices are there available to self administer insulin?

A

disposable pen

re-usable cartridge pen

continous subcutaneous insulin infusion pump

45
Q

insulin is secreted at a low _____ rate which accounts for 50% of insulin prod

A

basal

46
Q

what is the name given to the insulin secreted in relation to post-meal glucose

A

post-prandial insulin

47
Q

what is seen to be the best regime in mimicing physiological insulin production?

A

basal bolus

48
Q

other than basal bolus what ohter two kinds of insulin regime are there?

A

twice dialy

once daily

49
Q

what is the target for blood glucose pre meal in T1DM?

A

4-7mmol

50
Q

what is the target for blood glucose 1-2 hours after the beginning of a meal in T1DM?

A

<10mol/l

51
Q

what is the onest of action in prandial insluin analogues?

A

10-15mins

52
Q

what is the duration of prandial insulin analogues?

A

4-5hrs

53
Q

what is the onset of action of soluble prandial insulin?

A

30-60mins

54
Q

what is the duration of prandial soluble insulin?

A

5-8hrs

55
Q

what are the two types of basal insulins?

A

isophane ‘basal’ insulins

analogue basal insulins

56
Q

most patients with T1DM should be on which type of insulin?

A

analogue basal insulin

57
Q

what is DAFNE?

A

Dose Adjustment For Normal Eating

58
Q

what is advanced carbohydrate counting?

A

synchronizing the amount of insulin taken to the amount of carbohydrate consumed

59
Q

who is advanced carbohydrate counting suitabel for?

A

those on multiple daily injections (MDI)

people on continous subcutaneous insulin infusion (SCII) pumps

60
Q

isulin sensitivity factor is also known as what?

A

correction factor

61
Q

what is the ratio of insulin to carbs?

A

i unit of insulin per 10g CHO

62
Q

in carbohydrate counting how many units of insluin should be given if consuming 65g of carbs?

A

6.5 units of insulin

63
Q

insulin pumps deliver continous adminstration of _____ _____ insulin subcutaneously

A

short acting

64
Q

at what rate do insulin pumps deliver insulin?

A

basal rate

this can be programmed in advance and set to different rates at different times of the day

65
Q

what are some examples of different meal bolus profiles with an insulin pump?

A

standard

dual

multiple

short extended

long extended

66
Q

what are some tests used to evaluate metabolic control?

A

home blood gluocse monitoring

urine testing (glucose/ketones)

glycated hemoglobin (HbA1c)

67
Q

how is HbA1c formed?

A

non-enzymatic glycation of haemoglobin on exposure ot glucose

68
Q

HbA1c measures average blood glucose over what period of time?

A

6-8 weeks

69
Q

what are the targets for HbA1c?

A

53mmol- good control

48mmol- very good control

70
Q

what are methods available to monitor yur blood glucose?

A

fingerstick testing

continous glucose monitoring

71
Q

what are the factors affecting insulin absorption through injection?

A

temperature

injection site

injection depth

exercise

pen accuracy

leakage

72
Q

what can occur at the site of insulin injection when used multiple times?

A

lipohypertrophy- accumulation of fat

73
Q

whata are the blood glucose targets pre-prandial and post meal?

A

pre-prandial: 4-7mmol

post meal: <10mmol

74
Q

when would insulin be prescribed IV?

A

diabetic ketoacidosis

hyperosmolar hyperglycaemic state

acute illness

fasting patients

75
Q

how often should blood glucose be tested when on IV insulin?

A

Houlry

76
Q

what is the target for blood glucose when on IV insulin?

A

5-12mmol/L

77
Q

other than injection what are the other formulations of insulin?

A

inhlaed

oral

78
Q

what are some non-insulin adjunct therapies in T1DM?

A

metformin

leptin

GLP-1

SGLT2

79
Q

what are some more drastic surgical treatments of diabetes?

A

kidney-pancreas autotransplantation

islet autotransplantation

80
Q

what are the 4 key steps in islet cell transplantation?

A
  1. pancreas donation and retrieval
  2. islet isolation
  3. islet culture
  4. islet transplantation
81
Q

which type of diabetes carries a higher genetic risk?

A

T2DM

82
Q

what level of HbA1c is the cut off for poor control?

A

75mmol

83
Q

what is the natural history of T2DM?

A

inc in weight and insulin resistance

84
Q

what accelerates the presentation of T2DM?

A

obesity

85
Q

what two things affect the rate of progression and severity of beta cell destruction in T2DM?

A

genetics

environmental stress

86
Q

CVD risk in diabetic is best treated throught the use of what drugs?

A

statins

anti-hypertensives

87
Q

what is the mechamism of metformin?

A

decreases hepatic gluconeogenisis

increases peripheral glucose uptake

88
Q

what are some potential side effects of metformin?

A

GI

lactic acidosis

89
Q

what is the first line drug treatment of T2DM?

A

metformin

90
Q

what are the SIGN treatment steps for T2DM?

A
  1. metformin
  2. metformin + one of SU/ TZD/DDP-4/ GLP-1/insulin
  3. metformin + two from above
91
Q

what is the mechanism of sulphonyurea?

A

blocks B-cell KATP channel

increases 1st and 2nd pahse insulin secretion

92
Q

what are some potential side effects of sulphonyurea?

A

abnormal LFTs

inc CHD in elderly potentially

93
Q

does increasing the dose of Sulphonyurea increase its efficacy?

A

no- efficacy is reduced at higher doses

94
Q

is it more beneficial to inc the dose of a drug or to add in another therapy?

A

better to add in further drug

95
Q

describe the incriton effect?

A

increased stimulation of insulin elicited by oral gluocse compared to IV

96
Q

what would a graph showing insulin secretion stimulated by oral and IV glucose look like? (incriton effect)

A

oral curve woul dbe much greater in comaprison to the flat IV curve

97
Q

metformin works by lowering insulin _______

A

resistance

98
Q

metformin can cause weight gain/loss/nothing?

A

often weight loss althoug pretty neutral

99
Q

is metformin safe in pregnancy?

A

yes

100
Q

why cant many patients not tolerate metformin?

A

GI upset

101
Q

a side effect of metformin is its interference with the absorption of what?

A

vit B12

folic acid

102
Q

metformin can cause which organ failure?

A

liver failure

renal toxicity

103
Q

sulphonylureas are what kind of drug?

A

insulin secretagogues

104
Q

what SU is first generation?

A

tolbutamide

105
Q

what are some second generation SUs

A

Glicazide

Glibenclamide

Glipizide

106
Q

which generation of sulphonylureas is short acting and which is fast acting?

A

first generation- fast 4-6hrs

second generation- slow 16-24hrs

107
Q

what si teh main side effect of sulphonylureas?

A

Hypoglycaemia

108
Q

who is at most at risk of a hypo due to sulphonylurea drugs?

A

elderly

chronic kidney disease

109
Q

sulphonylureas can cause weight gain/loss/nothing

A

weight gain

03- Endocrine (9 decks)

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