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JMS - Endocrinology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what is type 1 DM?

autoimmune destruction of?

A

insulin deficiency due to autoimmune destruction of insulin secreting pancreatic beta cells

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2
Q

in type 1 DM does diet and medications help?

A

no - persistent hyperglycaemic state

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3
Q

when do you tend to develop T1DM?

A

childhood and adulthood

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4
Q

which type of DM is more prone to DKA?

A

T1DM

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5
Q

which type requires insulin more?

A

T1DM

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6
Q

what is T2DM?

A

body isn’t responding to insulin due to excess adipose tissue

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7
Q

which type of DM has a HLA association?

what is it?

A

T1DM - HLA D3 + D4 association

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8
Q

which pts is T2DM found commonly in?

A

Asians
elderly
men

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9
Q

what is prediabetes?

A

for those that don’t meet criteria for a formal diagnosis.

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10
Q

what is gestational diabetes?

A

pregnant women have a raised blood glucose

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11
Q

what is maturity onset diabetes of young? (MODY)

A

Autosomal dominant
affecting insulin production in young
presents like T2DM

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12
Q

what is latent autoimmune diabetes of adults (LADA)?

how does patient present?

A

adults who present with auto-immune related diabetes

think of patients who are ketotic and respond poorly to oral hypoglycaemics

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13
Q

how would you expect a T1DM patient to present?

A

polydipsia (thirst)
polyuria
weight loss
nausea and vomiting

may present with DKA:
abdo pain
vomiting
reduced consciousness

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14
Q

how would you expect a T2DM patient to present?

A 
polydipsia (thirst)
polyuria 
Blurred vision 
Candidal (vaginal/penile infections) 
Skin infections (cellulitis)
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15
Q

why do you get polydipsia and polyuria?

A

water being dragged out following excess glucose being excreted in urine (glycosuria)

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16
Q

RF for T2DM

A 
Old age 
obesity 
HTN 
FHx 
Gestational Diabetes 
black, hispanic 
CVS disease
17
Q

what are the four ways of checking your blood glucose?

A
  1. Finger-prick bedside glucose monitor
  2. One-off blood glucose (fasting or non-fasting)
  3. HbA1c (measures amount of glycosylated Hb + represents average blood glucose over past 3 months.
  4. Glucose tolerance test – fasting glucose is taken and then 75g glucose load is taken. Then 2hrs later a second blood glucose is taken.
18
Q

why is HbA1c good?

A

represents average blood glucose over 3 months

19
Q

what is the criteria for diagnosing DM in a symptomatic patient with regards to:

  • fasting glucose
  • glucose tolerance test/random glucose
A

fasting glucose >7 mmol/L

random glucose/glucose tolerance test >11.1 mmol/L

20
Q

what is the criteria for diagnosing DM if someone is asymptomatic with regards to:

  • fasting glucose
  • glucose tolerance test/random glucose
  • HbA1c
A
  • fasting glucose >7
  • random/glucose tolerance test >11.1

BUT Both have to be above on two separate occasions

  • HbA1c >48 mmol/mol or >6.5%.
21
Q

what is the criteria for pre-diabetes

  • fasting glucose
  • HbA1c
A

fasting glucose = 6.1 - 6.9

HbA1c = 42 - 48

22
Q

why is HbA1c sometimes misleading?

A

increased if there is an increase in red cell turnover

23
Q

in general for DM what sort of conservative measures can a patient take to help control their diabetes?

A

exercise - increases insulin sensitivity

food - high fibre and low glycaemic index sources of carbs, low sat fat and fat dairy products.

24
Q

Tx for T1DM (Managing mesurements)

HbA1c - how often should it be measured and what is the target?

Self monitoring of blood glucose:

  • how often?
  • when?
  • when should you increase frequency of measurements?
  • target?
A

HbA1c

  • every 3-6 months
  • target of 48 or less than 6.5%

blood glucose

  • 4 times a day
  • before each meal and once before bed
  • if hypoglycaemic episodes
  • target of 5-7 mmol/Lon waking and 4-7 mmol/L during the day
25
Q

Tx for T1DM (insulin)

  • what is the insulin regimen of choice + how often do you take it?
  • if you wanted just a once daily insulin injection - what is it? how does it work?
  • when do you offer Novorapid and why?
  • when would Metformin be indicated in a T1DM patient?
A
  • basal-bolus Detemir twice daily
  • basal-bolus Glargine - long acting so good for overnight
  • before meals - rapid acting
  • if patient has BMI over 25
26
Q

Tx for T2DM

  • how often do you check for HbA1c? what is the target?
  • what does metformin do?
  • when do you avoid metformin?
  • SE of metformin?
A
  • every 3-6 months, target is 48 mmol/l
  • increases insulin sensitivity
  • if patient has a low GFR due to risk of lactic acidosis
  • diarrhoea
27
Q

Tx for T2DM

Alongside metformin: there are four classes of drugs that can be given adjunct to metformin, explain the following four classes:

DPP4-inhibitors?
Glitazone?
Sulfonylurea?
SGLT-2 inhibitor?

A 
DPP4 inhibitors (DPP4 enzyme inactivates GLP-1 which stimulates insulin secretion - therefore they increase insulin secretion) 
i.e. Gliptin/Sitagliptin

Glitazone increases insulin sensitivity but SE: osteoporosis, CCF, fluid retention
i.e. Pioglitazone

Sulfonylurea increases insulin secretion but increases weight + appetite, + risk of hypoglycaemia
i.e. Glicazide

SGLT-2 inhibitors block reabsorption of glucose in kidneys promoting excretion
i.e. Empagliflozin

28
Q

Tx for T2DM

what is GLP-1 mimetic?
example?

who is it indicated in?

A

glucagon-like-peptide 1
Exenatide

indicated if BMI >35
or if BMI <35 and triple therapy was ineffective /insulin is contraindicated

29
Q

Tx for T2DM

if starting insulin: what do NICE recommend and how often?

A

Human NPH insulin (isophane)

BD or at bedtime

30
Q

Tx for T2DM (metformin is tolerated)

1) Metformin

if HbA1c is >58

2) Metformin + 1 out of 4

(DPP4 inhibitor, sulfonylurea, glitazone, SGLT2 inhibitors)

if HbA1c is >58

3) Metformin + (2 out of 4 OR insulin)

if triple therapy not effective or insulin is contraindicated:

4) Metformin + sulfonylurea + GLP-1 mimetic

A

for those that metformin is tolerated

31
Q

Tx for T2DM (metformin not tolerated)

1) 1 out of 3

(DPP4 inhibitor, sulfonylurea, glitazone)

if HbA1c >58

2) 2 out of 3

if HbA1c >58

3) insulin

A

Tx for T2DM (metformin not tolerated)

JMS - Endocrinology (16 decks)

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