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ENDOCRINE - RIA > diabetes > Flashcards

diabetes Flashcards

1
Q

name a SULFONYUREA

A

gliclazide

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2
Q

how do sulfonyureas (e.g. gliclazide) work?

A

They work by increasing pancreatic insulin secretion

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3
Q

Common side effects of sulfonyureas?

A

weight gain and hypoglycaemic episodes

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4
Q

Name a THIAZOLIDINEDINOE and how do they work?

A

Pioglitazone

Agonists to PPAR-gamma recepor and reduce peripheral resistance to insulin

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5
Q

Common side effects of thiazolidinediones?

A

weight gain, liver impairment, fluid retention

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6
Q

what is Myxoedema coma

A

acute medical emergency defined by extremely low thyroid hormone levels

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7
Q

presenting symptoms of myxoedema coma

A
  • LoC
  • hypothermia
  • confusion
  • coma
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8
Q

precipitating factors for myxoedema coma

A
  • infection
  • hypothermia
  • CHF
  • trauma
  • electrolyte imbalance
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9
Q

management of myxoedema coma

A

1) resuscitation: ventilation, IV fluid resus, vasoactive agents,
2) for acid base and electrolytes: supportive care, glucose, manage Na

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10
Q

specific therapy for management myxoedema coma

A

Hydrocortisone 100mg 6 hourly

replacement of thyroid hormone

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11
Q

what is T1DM characterised by

A

inability to produce/secrete insulin due to autoimmune destruction of the beta cells in the pancreatic islets of Langerhan

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12
Q

what is T2DM characterised by

A

combination of peripheral resistance & inadequate insulin secretion

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13
Q

human leucocyte antigens assoc with T1DM

A

HLA-DR4

HLA-DR3

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14
Q

what are the 3 main insulin regimes for T1DM

A

1) Basal-bolus regime
2) One, Two or three injections per day regime
3) Continuous insulin infusion via a pump

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15
Q

frequency of blood glucose monitoring per day in T1 diabetic

A

at least 4 times a day e.g. 3 times, before each meal & before sleeping

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16
Q

T1 diabetic target on waking?

A

5-7 mmol/L (fasting)

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17
Q

T1 diabetic target before meals

A

4-7 mmol/L

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18
Q

T1 diabetic post meals

A

test after 90 minutes: 5-9 mmol/L

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19
Q

what is HbA1c

A

measure of glycated haemoglobin, indicative of average blood glucose over 3 months

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20
Q

HbA1c target in T1 diabetic

A

< 48 mmol/L

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21
Q

annual screening in T1 diabetic for what?

A
  • Retinopathy
  • Nephropathy (eGFR & ACR
  • Diabetic foot problems
  • CV risk factors
  • Thyroid disease
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22
Q

Name the non-proliferative features of diabetic retinopathy

A

Background: dot & blot haemorrhages, hard exudates, cotton wool spots

Pre-proliferative: intraretinal microvascular abnormalities, venous beading

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23
Q

Proliferative diabetic retinopathy features?

A

New vessels at the disc, fibrosis, traction retinal detachment

24
Q

Maculopathy diabetic retinopathy features

A

Exudates, oedema & NVE

25
Q

how to manage proliferative diabetic retinopathy?

A

Photocoagulation

26
Q

marker of systemic microvascular damage to kidneys?

A

microalbuminuria

27
Q

what is gastoparesis

A

delayed gastric empyting leading to vomiting

28
Q

complex neuropathic arthropathy that results from loss of sensation & subsequent repeated micro-trauma to foot

A

Charcot’s joint

29
Q

triad of DKA

A
  • Hyperglycaeamia
  • Ketonaemia
  • Acidosis

1) Glucose > 11.0 or known DM
2) Ketones >3 or sig on dipstick
3) venous pH < 7.3 or bicard <15.0

30
Q

precipitants for DKA?

A
  • infection
  • non compliance
  • inappropriate dose alteration
  • new diagnosis of DM
  • MI
31
Q

sweat pear drop smell

A

ketotic breath

32
Q

DKA bedside tests

A
  • urine pregnancy
  • unrinanalysis +/- MSU
  • ECG
33
Q

Blood tests for DKA

A
  • FBC
  • U&E
  • CRP
  • LFTs
  • blood cultures
  • Trop
34
Q

management of DKA (3)

A

1) Fluid resuscitation
2) Potassium replacement
3) Fixed rate IV insulin infusion

35
Q

how is IV insulin infusion set up for DKA?

A

mixing 50 units of short acting insulin (actrapid) with 50 mls of 0.9& normal saline

36
Q

clinically significant hypoglycaemia is defined as?

A

Glucose < 3.0 mmol/L

37
Q

what should a formal diagnosis of hypoglycaemia be based on?

A

Whipples triad

38
Q

what is whipples triad

A

1) Low blood glucose concentration
2) symptoms of hypoglycaemia
3) reversal of symptoms when blood glucose conc is restored to normal

39
Q

which T2DM are at risk of hypoglycaemia?

A

those being treated with insulin or sluphonylureas

40
Q

symptoms of low glucose

A
  • anxiety
  • tremor
  • palpitatons
  • sweating
  • hunger
  • paraesthesia
41
Q

environmental risk factors for T2DM

A
  • poor dietary habit (low fiber, high GI diet)
  • low birth weight
  • medications
  • PCOS
  • history of GDM
42
Q

role of GLUT-4 & where are they located

A

activation of insulin receptor initiates translocation of glucose receptor which is found in the cytosol of adipose & striated muscle (allowing movement of glucose intracellularly)

43
Q

when is HbA1c a non reliable investigation?

A
  • EPO use
  • Iron deficiency
  • CKD
  • alcoholism
  • haemolysis
  • ## splenectomy
44
Q

mechanism of metformin

A

biguanide.

inhibition of hepatic gluconeogenesis whilst peripheral insulin sensitivity & enhancing peripheral uptake of glucose

45
Q

when should dual therapy for T2 diabetics be introduced?

A

HbA1c > 58

46
Q

name groups of antidiabetic medications

A

1) Sulfonyurea
2) Dipeptidyl peptidase-4 inhibitor (DPP-4i)
3) Thiazodidinediones e.g. Pioglitazone
4) SGLT-2i

47
Q

HbA1c aim in a T2DM patient with lifestyle mod & single antidiabetic emd

A

< 48

48
Q

HbA1c aim in a T2DM patient on a medx associated with hypoglycaemia

A

< 53

49
Q

2 major acute complications with T2DM

A

1) Hypoglycaemia

2) HHS - Hyperosmolar hyperglycaemic state

50
Q

HHS characterised by? (4)

A

1) Hypovolemia
2) Hyperglycaemia
3) Mild/absent ketonaemia
4) High osmolality

51
Q

diagnosis of HHS (3)

A
  • marked hyperglycaemia
  • raised serum osmolality
  • mild/absent ketonaemia
52
Q

example and side effects of sulfonyureas? & mechanism

A

Gliclazide: augments insulin secretion

se: weight gain & increased hunger

53
Q

side effects of metformin?

A
  • N& v
  • diarrhoea
  • abdo pain
  • decreased B12 absorption
54
Q

DDP4 inhibitor

  • example
  • mechanism
  • side effects
A
  • gliptins
  • increase incretin levels which inhibit glucagon secretion & reduce blood glucose
  • headaches, dizziness, nausea
55
Q

Thiazolidinedione

  • example
  • mechanism
  • side effects
A

Glitazones

  • decrease peripheral insulin resistance to decrease blood glucose
  • weight gain, eyesight
56
Q

GLP-1 agonists mechanism

A

increase insulin secretion and decrease insulin degradation

ENDOCRINE - RIA (7 decks)

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