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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
Q

What is the 1st line pharmacological therapy for type 2 diabetes?

A

Biguanides (metformin)

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26
Q

Give examples of sulphonylureas

A

Glicazide
Glibenclamide
Glimeparide

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27
Q

Give an example of a thiazolidinedione (TZD)

A

Pioglitazone

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28
Q

What are the main effects of metformin?

A

Reduces insulin resistance (causing reduced HbA1c)
Prevents vascular complications
Reduces tryglycerides + LDL

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29
Q

List some adverse effects of metformin

A

GI upset
Lactic acidosis
Liver failure
Rash

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30
Q

Sulphonylureas have more rapid reduction of hyperglycaemia compared to metformin. True/False?

A

True

31
Q

Sulphonylureas prevent micro- and macro- vascular complications. True/False?

A

False

Do not prevent macrovascular complications

32
Q

TZDs can cause weight gain. True/False?

A

True

33
Q

TZDs increase the risk of hip fractures. True/False?

A

True

Not recommended in those over 65

34
Q

What are incretins?

A

Hormones that cause intestinal secretion of insulin (additional insulin production)

35
Q

Name the two main incretin hormones

A

GLP-1 from L cells

GIP from K cells

36
Q

List the effects of incretins

A

Delay gastric emptying
Decrease appetite
Stimulate insulin secretion
Reduce glucose production by liver

37
Q

Name a GLP-1 agonist that can be used for diabetes

A

Exenatide

38
Q

Name a DPP-1 inhibitor that can be used for diabetes

A

Sitagliptin

39
Q

How are SGLT2 inhibitors useful in diabetes?

A

Reduce reabsorption of glucose, causing glycosuria

40
Q

What is the downside of SGLT2 inhibitors?

A

Increase risk of UTIs

41
Q

List the ways we evaluate metabolic control of diabetes

A

HbA1cBlood glucose (home/clinic)Ketone monitoringUrinalysis

42
Q

What is the main treatment for type 1 diabetes?

A

Insulin

43
Q

List the devices available for administering insulin

A

Syringe
Disposable pen
Cartridge pen
Continuous subcutaneous pump

44
Q

What is basal insulin?

A

Background production of insulin to keep blood glucose normal outwith meal times

45
Q

What is prandial insulin?

A

Insulin produced in relation to increased glucose following a meal

46
Q

What is the onset of + peak action of rapid-acting insulin analogues?

A

Onset: 15 mins
Peak: 1-2 hrs

47
Q

Give examples of rapid-acting insulin analogues

A

NovoRapid (insulin aspart)

Humalog (lispro)

48
Q

What is the onset of + peak action of short-acting (soluble) insulin analogues

A

Onset: 30-60 mins
Peak: 2-4 hrs

49
Q

Give examples of short-acting (soluble) insulin analogues

A

Actrapid

Humulin S

50
Q

What is the onset of action of basal (intermediate-acting) insulin analogues?

A

Onset: 1-3 hrs

51
Q

Give examples of basal insulin analogues

A

Insulatard

Humulin I

52
Q

What is Humalog Mix25 (a rapid-intermediate acting insulin) composed of?

A

25% short-acting

75% intermediate-acting

53
Q

What is the aim behind a basal-bolus insulin regime?

A

Mimic endogenous insulin production

i.e. take short-acting before meal, long-acting before sleep

54
Q

What is involved in a once-daily insulin regime?

A

Long/intermediate -acting given before bedtime

Not really suitable for type 1 diabetes

55
Q

What is involved in a twice-daily (biphasic) insulin regime?

A

Injection pre-breakfast and pre-dinner
Assumes patient eats 3 meals/day
Significant hypoglycaemic risk

56
Q

What is the target for blood glucose pre-meal?

A

3.9-7.2 mmol/L

57
Q

What is the target for blood glucose 1-2hrs after starting a meal?

A

Less than 10 mmol/L

58
Q

Do insulin pumps deliver short, intermediate or long -acting insulin?

A

Short-acting

59
Q

What are the 3 main limitations of insulin injection/pump, versus pancreatic insulin?

A

Injected into subcutaneous tissue vs. blood
Slower peak
Slow clearance

60
Q

Name a long-acting human insulin injection

A

Ultratard

61
Q

Name a long-acting insulin analogue

A

Lantus (glargine)

Levemir (detemir)

62
Q

Which discriminatory tests are useful in distinguishing type 1 diabetes from type 2?

A

Autoantibodies
Ketones
C peptide

63
Q

When is gestational diabetes most likely to occur?

A

In 2nd or 3rd trimester

64
Q

List two of the main endocrine causes of DM, and the pathogenesis behind them

A

Acromegaly - insulin resistance from excess GH

Cushings - increased cortisol inhibits uptake of glucose in muscles

65
Q

Why is it difficult to maintain weight loss?

A

Adaptive thermogenesis

66
Q

List lifestyle changes that should be advised in diabetes

A

Smoking cessation
Fluids
Low calorie diet
Exercise four times a week (150 minutes/ week)

67
Q

List some adverse effects of SUs

A

Hypoglycaemia
Weight gain
GI upset
Headache

68
Q

List some adverse effects of TZDs

A

Oedema (leading to fluid retention and HF)
Fracture risk
Hepatotoxicity

69
Q

List the main clinical side effect of DPP4Is and GLP1RAs

A

Nausea

70
Q

What are the two main clinical indications of SUs

A

Underweight type 2 diabetic

Intolerant to metformin

71
Q

Name the education technique that should be adopted by T1DM to help control their diabetes

A

Carb counting

DAFNE or Tayside programme

72
Q

What clinical complication can result from injecting your insulin incorrectly?

A

Lipohypertrophy

73
Q

List some adverse effects of metformin

A 
GI irritation
Anorexia
Nausea
Diarrhoea
Abdominal pain

Y2 ENDOCRINOLOGY (19 decks)

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