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J Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what is the function of GLUT2

where are they

A

pancreatic cells

allow diffusion of glucose for insulin production

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2
Q

what is the function of GLUT4

where are they

A

in peripheral cells

allow the diffusion of glucose at peripheral cells in the presence of insulin

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3
Q

where do GLUT4 transporters originate

where do they translocate to

A

in cytoplasm of cell

move to cell membrane

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4
Q

which cells secrete insulin

A

pancreatic islets of Langerhans (beta cells)

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5
Q

when is insulin secreted (a change in what…)

A

increase in blood glucose

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6
Q

what is the most common cells in the pancreas

what does it secrete

A

beta cells

insulin

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7
Q

what is broken down to give insulin and C peptide

A

pre-proinsulin

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8
Q

what is the ration of C peptide to insulin after they have been cleaved

A

1:1

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9
Q

what can be monitored to measure insulin levels

what is the ratio of this compound to insulin

A

C peptide

1:1

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10
Q

which GLUT transporter is on pancreatic cells

A

GLUT2

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11
Q

what enzyme phosphorylates glucose

A

glucokinase

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12
Q

what is the product of glucose phosphorylation by glucokinase

A

glucose-6-phosphate

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13
Q

what is the Km and affinity of glucokinase for glucose

A 
high Km (5mmol)
low affinity
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14
Q

which molecule directly correlates to insulin secretion

A

glucokinase

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15
Q

what happens after glucose-6-phosphate is made

A

increase in intracellular ATP = blocks ATP sensitive K channel (KATP)

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16
Q

what type or Kir are in the KATP channel in the pancreas

A

Kir6.2

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17
Q

what 2 things can close the KATP channel in the pancreas

A

ATP

sulphonylurea inhibitors

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18
Q

what is released when KATP channels are blocked (by ATP or sulphonyl urea inhibitors)

A

insulin

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19
Q

which part of the KATP channel does ATP bind to (and hence block)

A

Kir6.2

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20
Q

what does KATP channel closure cause in the cell membrane

A

depolarisation = Ca2+ influx

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21
Q

what does presence of insulin cause in adipose tissue and the liver

A

lipogenesis

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22
Q

what does the absence of insulin cause (3)

A

lipolysis - creates ketones

gluconeogenesis in the liver

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23
Q

which part of the world has highest prevalence of diabetes

A

middle east

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24
Q

diabetes definition

A

insufficient insulin secretion/action to maintain glucose homeostasis leading to hyperglycaemia

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25
Q

what % of diabetics are type 2

A

90%

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26
Q

aetiology of type 1 diabetes

A

autoimmune (islet autoantibodies)

genetic (mainly) and environmental

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27
Q

which age group does type 1 diabetes present in (3)

A

preschool children early puberty

late 30s

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28
Q

what physique of children get type 1 diabetes

A

lean

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29
Q

which other paediatric condition is closely associated with type 1 diabetes

A

cystic fibrosis

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30
Q

which 2 autoimmune conditions is type 1 diabetes associated with

A

coeliac disease

thyroid disease

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31
Q

pathogenesis of type 1 diabetes

A

loss of insulin secreting beta cells in pancreas = absolute insulin deficiency

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32
Q

how much insulin do type 1 diabetics make

A

none

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33
Q

what does having no insulin result in

A

hyperglycaemia (need insulin to transport glucose from blood to cells, to recruit GLUT4)

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34
Q

presentation of a kid with type 1 diabetes (4)

A 
TTTT;
toilet
tired (TATT - tired all the time) 
thinner
thirsty
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35
Q

investigations for type 1 diabetes (5)

A 
anti-islet cell antibodies (anti-ICA) 
ketones 
c peptide 
anti-GAD antibodies 
glucose (random, fasting)
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36
Q

what is c peptide results in type 1 diabetes (think about it)

A

low

bc you dont produce any insulin…

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37
Q

what is c peptide results in MODY

A

high

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38
Q

how do you differentiate between type 1 diabetes and MODY

A

c peptide

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39
Q

can you cure type 1 diabetes

A

no

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40
Q

treatment of type 1 diabetes

A

insulin

drugs (if insulin ineffective)

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41
Q

lifestyle recommendations for kid with type 1 diabetes (1)

A

carb counting/food diary

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42
Q

which drug is the only drug that WONT work in type 1 diabetes (though none are ideal)

A

sulphonylureas

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43
Q

how many grams of carbs does a type 1 diabetic need to take 1 unit of insulin for

A

10g

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44
Q

which type of surgery could be used LAST LINE for a kid with type 1 diabetes

A

pancreatic islet cell transplant

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45
Q

which type of diabetes is also known as ‘type 1.5’

A

latent autoimmune diabetes of adulthood (LADA)

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46
Q

what is similar between LADA and type 1 diabetes

what is similar between LADA and type 2 diabetes

A

aetiology - autoimmune

age of onset - adulthood

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47
Q

investigations for LADA

A

islet cell autoantibodies

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48
Q

aetiology of type 2 diabetes

A

genetic and environmental (mainly environmental)

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49
Q

risk factors for type 2 diabetes (3)

A

middle aged
obesity (BMI >30)
genetics/family history

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50
Q

what is the pathophysiology of type 2 diabetes

A

reduced pancreatic beta cell function = reduced insulin secretion

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51
Q

is there insulin secreted in type 2 diabetes

A

yes just not much

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52
Q

is type 2 diabetes reversible

how

A

yes

lifestyle and drugs

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53
Q

as BMI increases, what happens to insulin sensitivity

A

decreases

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54
Q

presentation of type 2 diabetes

A

tired all the time (TATT)
thirsty
polyuria

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55
Q

how can type 2 diabetes present on the penis

A

balanitis - inflammation of the head of the penis

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56
Q

first line treatment for type 2 diabetes (3)

A

lifestyle change;
diet
exercise
smoking cessation

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57
Q

how long after someone with type 2 diabetes has changed their lifestyle can you give drugs

A

3 months

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58
Q

second line treatment for type 2 diabetes (after lifestyle change)

A

metformin

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59
Q

third line treatment for type 2 diabetes (after lifestyle change and metformin)

A

metformin + something else (sulphonylurea/gliptin/GLP1 analogue/SGLT2 inhibitor/glitazone)

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60
Q

forth line treatment for typ 2 diabetes (after lifestyle change, metformin and something else)

A

metformin + sulphonylurea + insulin

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61
Q

which 3rd line drug is used alongside metformin in type 2 diabetes if there is weight gain

A

SGLT2

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62
Q

what other drugs might you consider for type 2 diabetes treatment

why

A

ACE inhibitors
statins

for CVD risk

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63
Q

what is type 3 diabetes also known as

A

gestational diabetes

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64
Q

when does type 3 diabetes occur

A

2nd/3rd trimester of pregnancy

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65
Q

treatment of type 3 diabetes (4)

A

metformin
insulin
lifestyle!!!!
folic acid

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66
Q

complications in baby if mother has type 3 diabetes

why

A

hypoglycaemia after birth = fits (as baby has been used to producing extra insulin to cope with mums hyperglycaemia)

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67
Q

is the baby of mother with type 3 diabetes likely to be overweight or underweight

A

overweight

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68
Q

what risk is increased postnatally in a mother with type 3 diabetes during pregnancy

how would you monitor this

A

type 2 diabetes

GTT 6 weeks after birth

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69
Q

aetiology of type 4 diabetes (3)

A

pancreatic disease
endocrine disease
drugs

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70
Q

definition of neonatal diabetes

A

diabetes in <6 month old

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71
Q

2 types of neonatal diabetes

A

transient neonatal diabetes (TNDM)

permanent neonatal diabetes (PNDM)

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72
Q

what is the treatment of all neonatal diabetes

A
  1. SU

2. insulin if SU not effective

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73
Q

what is transient neonatal diabetes

A

diabetes that ‘goes away’ after 12 weeks in a baby

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74
Q

aetiology of neonatal diabetes (and pathophysiology)

A

Kir6.2 mutation = no insulin release

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75
Q

what is permanent neonatal diabetes

A

when after 12 weeks a baby still has diabetes (if it resolves it was just transient neonatal diabetes)

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76
Q

when do you stop insulin/SU in neonatal diabetes

A

after 12 weeks if it resolves

never if it doesnt resolve

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77
Q

what is maturity onset diabetes of the young (MODY)

A

early onset type 2 diabetes

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78
Q

what age group does MODY present in

A

15-30

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79
Q

aetiology of MODY

A

genetic - mutation or familial

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80
Q

examples of monogenic diabetes (2)

A

MODY

neonatal diabetes

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81
Q

MODY1 aetiology

A

HNF4 alpha transcriptase factor mutation

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82
Q

MODY2 aetiology

A

glucokinase mutation

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83
Q

MODY3 aetiology

A

HNF1 alpha transcriptase factor mutation

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84
Q

which type of diabetes presents as stable/non progressive hyperglycaemia

A

MODY2

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85
Q

what is the pathophysiology of MODY2 (non progressive hyperglycaemia)

A

normal beta cells, they just aren’t being stimulated enough = high levels of glucose occur before the insulin is made to compensate

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86
Q

which type of diabetes has NON FUNCTIONING beta cells

A

type 1 diabetes

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87
Q

which type of diabetes has REDUCED beta cell function

A

type 2 diabetes

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88
Q

which type of diabetes has NORMAL beta cells, but they need more glucose to be stimulated than normal

A

MODY2

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89
Q

treatment of MODY1 and MODY3

A

diet
insulin
SU

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90
Q

treatment of MODY2

A

diet

no drugs can help - you just need to be aware they will always have hyperglycaemia

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91
Q

general presentation of diabetes (4)

A

thirsty
polyuria (pee lots)
blurred vision
lethargy

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92
Q

investigations for diabetes (7)

A 
c peptide 
ketones 
anti-islet cell antibodies
HbA1C
OGTT
fasting glucose 
blood plasma glucose (finger prick)
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93
Q

which type of diabetes has positive anti-islet cell antibodies

A

type 1

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94
Q

which type of diabetes has low c peptide

why

A

type 1

bc they dont produce any insulin at all!!

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95
Q

which type of diabetes has high c peptide

A

type2/MODY

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96
Q

which unit do we measure HbA1C in

what is the old unit

A

mmol/mol

%

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97
Q

how do you convert from % to mmol/mol for HbA1C

A

minus 2, minus another 2, add answers together

eg 12%; 12-2=10, 10-2=8 so 12% = 108

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98
Q

HbA1C in diabetes

A

> 48mmol/mol (6.5%)

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99
Q

target HbA1C in diabetes after treatment

A

<53mmol/mol (7%)

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100
Q

target HbA1C in diabetic pregnancy

A

<43mmol/mol (6.1%)

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101
Q

normal HbA1C (not diabetes)

A

<42mmol/mol (6%)

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102
Q

what is oral glucose tolerance testing (OGTT)

A

fast overnight, test blood glucose at 9am then give glucose and keep testing levels

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103
Q

what is fasting blood glucose

A

fast overnight, test blood glucose at 9am

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104
Q

which glucose measurement is needed for diagnosis of diabetes

A

fasting blood glucose

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105
Q

advantages of finger prick test (blood plasma glucose)

A

can be done at home

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106
Q

alternatives to blood plasma glucose for diabetics on insulin (mainly type 1) (2)

A 
continuous glucose monitoring (attached to a pump) 
flash glucose (device on arm you scan with phone)
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107
Q

annual screening for diabetics (6)

A 
retinal screening (with pics) 
diabetic foot exam 
renal impairment 
weight/BMI 
BP 
HbA1C
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108
Q

what is the Tayside programme used for recording diabetic screening results on

A

SCI-DC

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109
Q

fasting glucose diabetes diagnosis

A

> 7mmol/mol

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110
Q

HbA1C diabetes diagnosis

A

> 48mmol/mol

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111
Q

OGTT diabetes diagnosis

A

> 11.1mmol/mol

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112
Q

random blood glucose

A

> 11.1mmol/mol

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113
Q

which type of diabetes doesnt get complications

A

MODY2

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114
Q

are the aims of diabetes treatment to prevent hypoglycaemia or hyperglycaemia

A

both

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115
Q

lifestyle modification for type 2 diabetes (3)

A

diet - lower cholesterol
exercise - 150mins moderate intensity per week
stop smoking

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116
Q

what type of diabetes uses insulin

A

type 1

type 2 if other medications ineffective

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117
Q

why do type 1 diabetics need endogenous insulin

A

they dont have functioning beta cells so cant make their own insulin

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118
Q

consequence of too much insulin

A

hypoglycaemia

119
Q

more or less modifications in the protein makes insulin last longer

A

more modifications = lasts longer

120
Q

what type of insulin is taken at meal times

A

prandial/bolus insulin

121
Q

what type of insulin is taken OD or BDS to provide a constant level of insulin in blood

A

basal insulin

122
Q

what are basal insulins made of

A

a mixture of insulins that last different lengths, to cover the entire day

123
Q

example of long acting insulin

124
Q

example of rapid acting insulin (2)

A

novorapid

humolog

125
Q

what is the standard insulin regime for type I diabetic kids

A

insulin QDS;
3 prandial insulin before meals
1 basal insulin before bed

126
Q

what is the total number of insulin units required for a type I diabetic (standard)

127
Q

what type of insulin regime can a teenager with bad compliance with a TDS regime be changed to

A

BDS insulin;

taken with breakfast and dinner

128
Q

is someone takes insulin and plays football one night a week, what would you suggest them to do on that night

consequence of not altering insulin in this case

A

take less insulin
monitor blood glucose levels

hypoglycaemia

129
Q

if someone on insulin had a meal with no carbs in it, how should they alter their insulin

A

take less/none at that meal time

130
Q

if a patient phones in worried bc they gave themselves too much insulin, what do you recommend

A

eat more to compensate, lots of sugar

131
Q

standard insulin administration method

A

subcut injection

132
Q

what can happen if a patient doesnt rotate their insulin injection site

A

lipohypertrophy

infection

133
Q

how often should a patient change their insulin needle

134
Q

what are the insulin injection sites (4)

A

abdo
upper outer thigh
upper outer arm
buttock

135
Q

alternative insulin administration to insulin pens that gives 24 hour insulin administration

A

insulin pump

136
Q

what type of insulin does an insulin pump deliver

A

short acting basal insulin

137
Q

what do diabetics with an insulin pump still need to do

A

take prandial insulin

inject themselves at meal times

138
Q

how can insulin be administered in someone acutely unwell with diabetes (eg DKA)

A

IV insulin

139
Q

if a patient eats 50g of carbs in their lunch meal, how many units of insulin should they take

140
Q

ratio of insulin (units) to carbs (g)

A

1 unit : 10g

141
Q

how much does 1 unit of insulin reduce your blood glucose by

142
Q

why does prandial insulin need to be taken 30 mins before a meal

A

exogenous insulin takes longer to work than endogenous insulin

143
Q

what are the 2 options for home monitoring of blood glucose

A

fingerprick tests

continuous glucose monitor (eg in pump or on arm)

144
Q

what is the glucose target before a meal for a diabetic on insulin

145
Q

what is the glucose target 1-2 hours after a meal for a diabetic on insulin

146
Q

how often should a diabetic on insulin check their blood glucose

when else should they check it

A

4 times per day

before they drive

147
Q

side effects of insulin

A

weight gain

hypoglycaemia

148
Q

what is it called when hyperglycaemia occurs to compensate with hypoglycaemia

A

somogyi effect

149
Q

example of a biguanide

150
Q

dose of metformin (start and final)

A

500mg OD to 1g BD

151
Q

is metformin safe in pregnancy

152
Q

does metformin cause weight loss/gain

in who

A

weight loss in obese people

153
Q

contraindication of metformin

A

renal failure

154
Q

if renal function is eGFR <30ml/min what should you do to metformin dose

A

stop metformin

155
Q

what eGFR result (renal function) requires metformin dose to be halved to 500mg BD

A

30-45ml/min

156
Q

metformin side effects

A

GI disturbance

B12 deficiency anaemia

157
Q

sulphonylurea drug examples (2)

A

glibenclamide
gliclazide

(start in ‘gli-‘ and end in ‘-amide’ or ‘-azide’)

158
Q

what do sulphonylurea drugs cause the potassium channels to do (bc of them binding to the SU1 receptor)

159
Q

when sulphonylureas cause the potassium channel to close what do they cause (3)

A

depolarisation of cell = Ca2+ influx = insulin released

160
Q

what is important about the B cells that are present when sulphonylureas are used as treatment for diabetes

(and hence why they dont work in type 1 diabetes)

A

need to be functioning, just need a stimulus

161
Q

why is sulphonylureas preferred as second line drug in addition to metformin (instead of GLP1 analogues, gliptins etc)

162
Q

side effects of sulphonylureas (2)

A

weight gain

hypoglycaemia in elderly

163
Q

which 2 diabetes treatments have the side effects of weight gain and potential hypoglycaemia

A

insulin

sulphonylureas

164
Q

contraindication to sulphonylureas (4)

A

pregnancy
renal failure
hepatic failure
obesity

165
Q

what class of drugs are gliptins

A

DPP4 agonists

166
Q

example of a gliptin

A

sitagliptin

all end in ‘gliptin’

167
Q

do gliptins cause weight gain

168
Q

how effective are glitpins

169
Q

which drug do gliptins work similarly to

A

GLP1 analogues

170
Q

which pathway does GLP1 analogue and DPP4 agonist (gliptins) stimulate

A

incretin pathway

171
Q

in the use of GLP1 analogues and DPP4 agonist (gliptins), stimulating the incretin pathway causes release of… from…

A

insulin from pancreas

172
Q

what drug class is an exenatide

A

GLP1 analogue

173
Q

what does DPP4 break down

hint: something you want lots of to secrete insulin, so you dont want to break it down = DPP4 antagonists

A

GLP1 and GIP

174
Q

which diabetes treatment is injectable (2)

A 
insulin 
GLP1 analogues (exenatide)
175
Q

what is the incretin pathway (think about what it stands for)

A

INtestinal seCRETion of INsulin

176
Q

when are GLP1 and GIP usually secreted

what does increased GLP1 and GIP secretion cause

A

food ingestion

insulin secretion

177
Q

does GLP1 analogues cause weight loss

how

A

yes

causes increased incretin pathway = increased insulin AND early satiety = reduces appetite

178
Q

what type if drug is a flozin (eg dapagliflozin)

A

SGLT2 inhibitor

179
Q

how do SGLT2 inhibitors work

A

make you pee out glucose by decreasing glucose reabsorption

180
Q

side effects of GLP1 analogues (2)

A

nausea

increased risk of pancreatitis

181
Q

side effects of SGLT2 inhibitors

why (think about it!)

A

thrush
UTI

peeing out glucose!

182
Q

what drugs are safe to use in renal failure

A

gliptins
GLP1 analogues
glitazones (TZDs)

183
Q

what diabetes drugs promote weight loss

A

metformin
GLP1 analogue
SGLT2 inhibitor

DPP4 analogues are weight neutral

184
Q

what diabetes drugs cause weight gain

A

sulphonylureas
insulin
glitazones (TZDs)

185
Q

what class of drug is pioglitazone (glitazone)

A

thiazolidinediones (TZDs)

186
Q

example of a glitaZone (thiaZoldinedione)

A

piaglitazone

187
Q

which part of the body does glitaZones (thiaZoldinediones) work

A

peripheral adipose tissue (not the pancreas like most drugs)

188
Q

how do glitaZones (thiaZoldiinediones) work (2)

A

fat redistribution (from visceral fat to adipocytes (subcut fat))

water retention (dk why lol)

189
Q

side effects of glitaZones (thiaZoldinediones)

A

increased fracture risk
CVD (from fluid retention)
weight gain (from fluid retention)

190
Q

generally what is the add on drug to metformin in someone with type 2 diabetes

A

sulphonylurea

191
Q

what is the add on drug to metformin in someone with type 2 diabetes and obesity (3)

A

GLP1 analogue (exenatide)

gliptins
SGLT2 inhibitors

192
Q

what is the add on drug to metformin in someone with type 2 diabetes and renal failure

A

GLP1 analogue (exenatide)

gliptins
glitazones

193
Q

what is the add on drug to metformin in someone with type 2 diabetes, renal failure and obesity (2)

A

GLP1 analogue (exenatide)

gliptins

194
Q

which drug is superior, GLP1 analogues (exenatide) or gliptins

why

A

GLP1 analogue (exenatide)

more potent

195
Q

if someone with type 2 diabetes is on metformin and exenatide (GLP1 analogue) and is experiencing nausea, what drug would you switch them to

196
Q

what may a child with a diabetic mother present with after birth

why

A

fits from hypoglycaemia

if mother is hyperglycaemic baby is used to producing enough insulin to cope with that (so after birth will produce too much insulin)

197
Q

macrovascular complications of diabetes (1)

A

cardiovascular disease

198
Q

how does cardiovascular disease associated with diabetes present in the legs (peripheral vascular disease)

A

leg ulcers

199
Q

where on the foot do vascular complications (macrovascular) of diabetes occur

200
Q

microvascular complications of diabetes (3)

A

retinopathy
neuropathy
nephropathy

201
Q

where on the foot do neuropathic complications (microvascular) of diabetes occur

A

plantar surface

202
Q

which pathway is involved in the microvascular complications of diabetes

A

poyol/aldose-reductase pathway

203
Q

what can diabetic retinopathy result in (3 conditions)

A

blindness
cataract clouding of lens
glaucoma (from optic nerve damage)

204
Q

what are the 4 stages of diabetic retinopathy

A 
R0 = no retinopathy 
R1 = mild non proliferative retinopathy 
R2 = moderate non proliferative retinopathy
R3 = severe non proliferative retinopathy 
R4 = proliferative retinopathy
205
Q

which type of retinopathy;
<4 haemorrhages (dot/blot haemorrhages, superficial flame)
cotton wool spots

A

R1 = mild non proliferative retinopathy

206
Q

which type of retinopathy;
new vessel formation
vitreous haemorrhages (sudden change in vision)
tractional retinal detachment

A

R4 = proliferative retinopathy

207
Q

which type of retinopathy;
hard exudates
>4 haemorrhages (dot/blot haemorrhages, superficial flame)

A

R2 = moderate non proliferative retinopathy

208
Q

which type of retinopathy;
venous bleeding
>8 haemorrhages (dot/blot haemorrhages, superficial flame)

A

R3 = severe non proliferative retinopathy

209
Q

why does ischaemia of the eye cause new vessel formation in diabetic retinopathy

A

induces TNF

210
Q

what do you do for someone with non proliferative diabetic retinopathy (R1, R2 or R3)

A

review in 1 year

211
Q

what do you do for someone with proliferative diabetic retinopathy (R4)

A

refer to ophthalmology

212
Q

how do cotton wool spots arise in diabetic retinopathy

A

ischaemic areas with nerve damage

213
Q

what are hard exudates in diabetic retinopathy

A

lipid breakdown products

214
Q

what type of injections might someone with proliferative diabetic retinopathy get

why

A

anti-VEGF injections

prevent further new vessel formation

215
Q

what is the treatment of someone with nephropathy on screening (2)

A

ACE inhibitor or ARB for hypertension

renal replacement therapy - dialysis or transplant if decreasing GFR

216
Q

what examination is used to screen for diabetic neuropathy (2)

A

microfilament exam

low pitch tuning fork

217
Q

what sort of distribution does diabetic neuropathy typically present with

A

glove stocking distribution

218
Q

what is the programme used for recording diabetic screening called

219
Q

what is the first microvascular complication of diabetes (typically)

A

peripheral neuropathy

220
Q

what are complications of diabetic neuropathy (3)

bc of the lack of sensation

A

foot ulcers
charcot foot (‘bag of bones’)
painless trauma

221
Q

why do foot ulcers occur in diabetic neuropathy

A

decreased blood supply to feet

222
Q

what microorganism usually causes diabetic ulcers

A

staph aureus

223
Q

what are the signs of AUTONOMIC neuropathy in diabetics (5)

A

erectile dysfunction
changes in bladder function
gastroparesis - weight loss, vomiting, bloating, loss of appetite
atypical sweating
no hypoawareness (when having a hypo they cant tell)

224
Q

what level of blood glucose is hypoglycaemia

A

<4mmol/l

‘4 is the floor’

225
Q

which type of diabetics get hypoglycaemia

A

type 1 (on insulin)

226
Q

prevention of hypoglycaemia (3)

A

frequent blood glucose monitoring
eating regularly
tailoring insulin to meals (dont take too much!)

227
Q

aetiology of hypoglycaemia (4)

A

after drinking alcohol
excessive
missed/delayed meals
too much insulin

228
Q

presentation of hypoglycaemia (6)

A 
hunger 
irritability 
palpitations 
fatigue 
cold 
loss of consciousness/seizures
229
Q

which condition is typically associated with hypoglycaemia (in exams!)

230
Q

what happens when a non diabetic gets hypoglycaemia

A

counter regulation = increased glucose release from glycogen stores

231
Q

treatment of hypoglycaemia in a conscious patient (3 options)

A

100ml Lucozade
4-5 glucotabs
15-20g of carbs/glucose

232
Q

treatment of hypoglycaemia in a conscious but drowsy patient

where

A

glucose gel subbucally (absorbed in mouth)

233
Q

treatment of hypoglycaemia in an unconscious patient (2 options)

A

IV glucose over 12 mins

1mg IM glucagon

234
Q

what should you do after treating hypoglycaemia

then

A

recheck blood glucose 15 mins after treatment

if still hypo = fast acting glucose
if fine = carb snack

235
Q

what is hyperosmolar hyperglycaemic state (HHS)

A

hyperglycaemia causing high osmolarity but without ketoacidosis

236
Q

hyperosmolar hyperglycaemic state (HHS) risk factors (2)

A

elderly

steroids

237
Q

level of hyperglycaemia in hyperosmolar hyperglycaemic state (HHS)

A

v high <60

238
Q

what is the difference between HHS and DKA

A

no ketoacidosis in HSS

239
Q

how do you calculate osmolarity (equation)

A

2(Na + K) + urea + glucose

240
Q

treatment of hyperosmolar hyperglycaemic state (HHS) (3)

A

diet
metformin
IV insulin

241
Q

which has higher mortality HHS or DKA

A

HHS (hyperosmolar hyperglycaemic state)

242
Q

aetiology of diabetic ketoacidosis (DKA) `

A

insulin omission
infection
intoxication (alcohol)
illness

the 4 i’s

243
Q

where are ketone bodies formed

by which process

A

liver mitochondria

lipolysis (breakdown of fat)

244
Q

what happens when ketone bodies are in the blood

A

turn blood acidic

245
Q

where do ketone bodies come from (biochemistry)

A

acetyl-CoA (from beta oxidation of fatty acids)

246
Q

why are ketone bodies released in hyperglycaemia

A

no insulin = cells dont have glucose (its all in the blood), so need energy from somewhere else (ie ketones)

247
Q

how do ketone bodies provide cells with energy

A

converted back into acetyl-CoA then go into TCA cycle = ATP generated

248
Q

what do ketone bodies smell like

A

pear drops

249
Q

what is the initial state of potassium in DKA

why

A

hyperkalaemia (but low in the cells)

no insulin = potassium cant be transferred into cells = build up of K in blood

250
Q

what happens after hyperkalaemia in DKA

why (2)

A

hypokalaemia

  1. so much K in blood that it is secreted in urine and vomiting
  2. treatment of insulin starts to make the potassium go back into cells
251
Q

how does insulin act on the Na/K pump

A

moves K into cells

252
Q

consequence of hypokalaemia in DKA

A

arrhythmias (U waves on ECG)

253
Q

presentation of DKA (6)

A 
thirsty 
nausea 
vomiting 
abdo pain 
hyperventilation/kussmauls breathing 
pear drop breath
254
Q

what is the ABGs in DKA

A

metabolic acidosis from ketone bodies in blood

255
Q

what is done to try and compensate for the metabolic acidosis in DKA

A

hyperventilation/kussmauls breathing

to ‘blow off’ the acid in the blood

256
Q

glucose levels in DKA

257
Q

ketone levels in DKA

258
Q

bicarb levels in DKA

A

low (acidosis

259
Q

investigations for DKA (4)

A

urinalysis - ketones, potassium, glucose
bloods - glucose, ketones
ABGs
ECG

260
Q

what is measured for ketones in blood

A

beta-hydroxybutarate

261
Q

what is measure for ketones in urine

A

acetoacetate

262
Q

treatment of DKA (4)

A

oxygen (ABCDE)
IV insulin slowly
IV fluids
IV potassium

263
Q

is treatment of DKA different in kids and adults

A

yes slightly

higher risk of cerebral oedema

264
Q

which diabetes drug is associated with lactic acidosis

265
Q

why is metformin contraindicated in renal failure

A

can cause lactic acidosis

266
Q

investigations (and results) for lactic acidosis in a diabetic on metformin (4)

A

lactate >5
bicarb low
H+ high
raised anion gap

267
Q

anion gap equation (for lactic acidosis, to tell if its different from other types of acidosis)

A

(Na + K) - (HCO3 + Cl)

268
Q

why must ALL diabetics inform DVLA of condition

A

risk of hypo = collapse

269
Q

which diabetes presents in young people

270
Q

which diabetes does BMI not affect

271
Q

which diabetes is family history more significant

272
Q

which type of diabetes is likely to present with DKA

273
Q

which type of diabetes is likely to present with HHS (hyperosmolar hyperglycaemia)

274
Q

which type of diabetes is anti-GAD/IA2 antibodies present in

275
Q

which type of diabetes is associated with no C peptide

276
Q

kimmelstiel-wilson lesions

A

diabetic nephropathy

277
Q

which glomerular layers are affected in diabetic nephropathy (2)

what does this result in

A

basement membrane thickening
podocyte dysfunction

proteinuria (proteins can leak through this barrier layer)

278
Q

what is the initial GFR in diabetic nephropathy

think about it!

A

increased GFR

to compensate for glomerular hypertension

279
Q

what is the GFE in diabetic nephropathy after 20 years

think about it!

A

reduced GFR

280
Q

first sign of diabetic nephropathy

A

microalbuminurea

281
Q

why do people pee lots in diabetes (hyperglycaemia) (3 steps)

A
  1. hyperglycaemia = glucose excreted in urine
  2. increase in urine osmolarity (high glucose conc) = creates an osmotic pull (osmotic diuresis)
  3. pulls water into urine to compensate = increased urine output
282
Q

what reabsorbs 90% of glucose from filtrate in tubules of the kidneys (normally and in hyperglycaemia)

283
Q

in normal people what reabsorbs about 10% (remaining) glucose form the filtrate in the tubules of the kidney

284
Q

in hyperglycaemia (glucose >11mmol/l), which transporter in the kidneys isnt able to reabsorb ALL the remaining glucose (like it usually does)

285
Q

what happens to the glucose that isnt able to be reabsorbed by SGLT1 and SGLT2 in hyperglycaemia

A

excreted in urine

286
Q

first sign of diabetic nephropathy

A

microalbuminuria

287
Q

how might diabetic nephropathy present (2)

A

oedema
ascites

(nephrotic syndrome)

288
Q

which other complication of diabetes is basically what causes diabetic nephropathy

A

hypertension

289
Q

diabetic nephropathy

what does glomerular hypertension cause (5 steps)

A 
increased glomerular pressure 
= thickening of membrane 
= nodular glomerulus sclerosis (scarring) 
= non effective filter in kidneys 
= proteinuria
290
Q

diabetic nephropathy

histology appearance (and hence pathology)

A

nodular glomerular sclerosis (scarring of kidney)

291
Q

diabetic nephropathy

scarring of membrane causes ineffective what

A

filtration

292
Q

diabetic nephropathy

ineffective filtration at glomerulus causes leakage of … into urine (+ clinical condition)

A

proteins (proteinuria)

293
Q

another name for diabetic nephropathy

A

kimmelsteil Wilson syndrome/lesion

294
Q

what syndrome does diabetic nephropathy present as (nephrotic or nephritic)

why

A

nephrotic

proteinuria = oedema

J Endocrine (12 decks)

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