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Y2 ENDOCRINOLOGY > Diabetes > Flashcards

Diabetes Flashcards

1
Q

In Scotland, incidence of diabetes has overtaken CVD and cancer. True/False?

A

True

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2
Q

Define “diabetes mellitus” and “diabetes insipidus”

A

Group of metabolic diseases characterised by hyperglycaemia, due to inadequate insulin production/availability/action
Normal blood glucose levels but kidneys cannot balance fluid levels in body

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3
Q

Why is type 1 diabetes an example of absolute insulin deficiency?

A

Insulin is not produced because beta-cells in pancreas are destroyed

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4
Q

Why is type 2 diabetes an example of relative insulin deficiency?

A

Insulin is produced, but there is not enough to maintain normal glucose levels

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5
Q

What is the normal range of glycated haemoglobin (HbA1c)?

A

41 m/m and below

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6
Q

What is the normal range for fasting glucose?

A

6 mmol/l and below

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7
Q

What value of HbA1c is diabetes diagnosed at?

A

48 mmol/mol and above

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8
Q

What value of fasting glucose is diabetes diagnosed at?

A

7 mmol/l and above

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9
Q

What value of random blood glucose is diabetes diagnosed at?

A

11.1 mmol/l

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10
Q

Which antibodies are associated with type 1 diabetes?

A

Anti-GAD
Anti-islet cell
Insulin auto-antibody
ZnT8 transporter

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11
Q

Autoantibodies in type 1 diabetes actually appear years before the onset of diabetes. True/False?

A

True

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12
Q

List clinical features of type 1 diabetes

A

ACUTE ONSET
Triad: Polyuria
Polydipsia
Weight loss

Fatigue
Ketonuria

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13
Q

What is the typical age onset for type 1 diabetes?

A

Pre-school/pre-puberty

Also peak in late 30’s

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14
Q

Is obesity more associated with type 1 or type 2 diabetes?

A

Type 2 diabetes

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15
Q

List clinical features of type 2 diabetes

A 
Thirst
Polyuria
Weakness
Thrush/abscess
Blurred vision
Neuropathy
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16
Q

What is LADA?

A

Late-onset autoimmune diabetes of adulthood

Increase in pancreatic autoIgs in recently diagnosed DM who previously didn’t require insulin

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17
Q

Is ketosis more associated with type 1 or type 2 diabetes?

A

Type 1 diabetes

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18
Q

What does HbA1c provide a measure of?

A

Glycated Hb

Provides a measure of blood glucose over 2-3 months

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19
Q

List macro-vascular complications of diabetes

A

MI
Stroke
PVD

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20
Q

List micro-vascular complications of diabetes

A

Retinopathy
Nephropathy
Neuropathy

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21
Q

HLA genes represent how much of familial risk of type 1 diabetes?

A

30-50%

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22
Q

What is the highest risk genotype for type 1 diabetes?

A

DR3-DQ2

DR4-DQ8

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23
Q

People with weight distribution in shape of a pear have higher risk of CVD than those with apple-shaped weight distribution. True/False?

A

False

Apples have increased risk

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24
Q

What are the main aims behind diabetes therapy?

A

Alleviate hyperglycaemic symptoms
Weight loss
Reduce risk of complications

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25
What is the 1st line pharmacological therapy for type 2 diabetes?
Biguanides (metformin)
26
Give examples of sulphonylureas
Glicazide Glibenclamide Glimeparide
27
Give an example of a thiazolidinedione (TZD)
Pioglitazone
28
What are the main effects of metformin?
Reduces insulin resistance (causing reduced HbA1c) Prevents vascular complications Reduces tryglycerides + LDL
29
List some adverse effects of metformin
GI upset Lactic acidosis Liver failure Rash
30
Sulphonylureas have more rapid reduction of hyperglycaemia compared to metformin. True/False?
True
31
Sulphonylureas prevent micro- and macro- vascular complications. True/False?
False | Do not prevent macrovascular complications
32
TZDs can cause weight gain. True/False?
True
33
TZDs increase the risk of hip fractures. True/False?
True | Not recommended in those over 65
34
What are incretins?
Hormones that cause intestinal secretion of insulin (additional insulin production)
35
Name the two main incretin hormones
GLP-1 from L cells | GIP from K cells
36
List the effects of incretins
Delay gastric emptying Decrease appetite Stimulate insulin secretion Reduce glucose production by liver
37
Name a GLP-1 agonist that can be used for diabetes
Exenatide
38
Name a DPP-1 inhibitor that can be used for diabetes
Sitagliptin
39
How are SGLT2 inhibitors useful in diabetes?
Reduce reabsorption of glucose, causing glycosuria
40
What is the downside of SGLT2 inhibitors?
Increase risk of UTIs
41
List the ways we evaluate metabolic control of diabetes
HbA1cBlood glucose (home/clinic)Ketone monitoringUrinalysis
42
What is the main treatment for type 1 diabetes?
Insulin
43
List the devices available for administering insulin
Syringe Disposable pen Cartridge pen Continuous subcutaneous pump
44
What is basal insulin?
Background production of insulin to keep blood glucose normal outwith meal times
45
What is prandial insulin?
Insulin produced in relation to increased glucose following a meal
46
What is the onset of + peak action of rapid-acting insulin analogues?
Onset: 15 mins Peak: 1-2 hrs
47
Give examples of rapid-acting insulin analogues
NovoRapid (insulin aspart) | Humalog (lispro)
48
What is the onset of + peak action of short-acting (soluble) insulin analogues
Onset: 30-60 mins Peak: 2-4 hrs
49
Give examples of short-acting (soluble) insulin analogues
Actrapid | Humulin S
50
What is the onset of action of basal (intermediate-acting) insulin analogues?
Onset: 1-3 hrs
51
Give examples of basal insulin analogues
Insulatard | Humulin I
52
What is Humalog Mix25 (a rapid-intermediate acting insulin) composed of?
25% short-acting | 75% intermediate-acting
53
What is the aim behind a basal-bolus insulin regime?
Mimic endogenous insulin production | i.e. take short-acting before meal, long-acting before sleep
54
What is involved in a once-daily insulin regime?
Long/intermediate -acting given before bedtime | Not really suitable for type 1 diabetes
55
What is involved in a twice-daily (biphasic) insulin regime?
Injection pre-breakfast and pre-dinner Assumes patient eats 3 meals/day Significant hypoglycaemic risk
56
What is the target for blood glucose pre-meal?
3.9-7.2 mmol/L
57
What is the target for blood glucose 1-2hrs after starting a meal?
Less than 10 mmol/L
58
Do insulin pumps deliver short, intermediate or long -acting insulin?
Short-acting
59
What are the 3 main limitations of insulin injection/pump, versus pancreatic insulin?
Injected into subcutaneous tissue vs. blood Slower peak Slow clearance
60
Name a long-acting human insulin injection
Ultratard
61
Name a long-acting insulin analogue
Lantus (glargine) | Levemir (detemir)
62
Which discriminatory tests are useful in distinguishing type 1 diabetes from type 2?
Autoantibodies Ketones C peptide
63
When is gestational diabetes most likely to occur?
In 2nd or 3rd trimester
64
List two of the main endocrine causes of DM, and the pathogenesis behind them
Acromegaly - insulin resistance from excess GH | Cushings - increased cortisol inhibits uptake of glucose in muscles
65
Why is it difficult to maintain weight loss?
Adaptive thermogenesis
66
List lifestyle changes that should be advised in diabetes
Smoking cessation Fluids Low calorie diet Exercise four times a week (150 minutes/ week)
67
List some adverse effects of SUs
Hypoglycaemia Weight gain GI upset Headache
68
List some adverse effects of TZDs
Oedema (leading to fluid retention and HF) Fracture risk Hepatotoxicity
69
List the main clinical side effect of DPP4Is and GLP1RAs
Nausea
70
What are the two main clinical indications of SUs
Underweight type 2 diabetic | Intolerant to metformin
71
Name the education technique that should be adopted by T1DM to help control their diabetes
Carb counting | DAFNE or Tayside programme
72
What clinical complication can result from injecting your insulin incorrectly?
Lipohypertrophy
73
List some adverse effects of metformin
``` GI irritation Anorexia Nausea Diarrhoea Abdominal pain ```

Y2 ENDOCRINOLOGY (19 decks)

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