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Phase 3 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Define DM:

A

Metabolic disorder of multiple aetiologies characterised by chronic hyperglycemia with disturbance of carbohydrate, protein and fat metabolism resulting from defects from insulin secretion, resistance or both

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2
Q

WHO criteria for DM:

A

Fasting plasma >7mmol/L

Oral glucose tolerance test/ Random Plasma: >11.1mmol/L

HbA1c >6.5% / 48mmmol

*need one abnormal value + symptoms

**need two abnormal values if asymptomatic

Important out with unequivocal hyperglycemia, these results should be repeated on another day.

***only oral glucose tolerance test needed for GDM

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3
Q

Can diabetes be diagnosed via urine dip stick?

A

No.

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4
Q

There are two phenotypes that lie somewhere between typical T1DM and typical T2DM, what are they?

A

Mature onset diabetes of the young

Secondary DM

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5
Q

What are some commonly associated hereditary markers of T1DM?

A

HLA DR3

HLA DR4

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6
Q

What is a common antibody found in Type I?

A

Glutamic Acid Decarboxylase - GAD

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7
Q

What’s a useful marker for endogenous insulin secretion?

A

C - peptide

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8
Q

Outline disease progression of Diabetes Type I:

A
  1. Genetic Risk factor
    - HLA DR3
  2. Immune activation
  3. Immune response
    - antibody made
  4. Stage I
    - 2 autoantibodies made
    - normal blood glucose
  5. Stage II:
    - abnormal blood glucose
  6. Stage III
    - clinical diagnosis
  7. Stage IV
    - long standing diabetes
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9
Q

What are some supposed risks for T1DM?

A

Viral infections
- entovirus

Immunization

Diet
- early exposure to cows milk

Obesity

Vit D deficiency

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10
Q

If you have a first degree relative with T2DM, how much more likely are you to develop type II?

A

5-10x more likely

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11
Q

What’s the most common cause of MODY?

A

Single gene change.

HNF- alpha

disrupt normal insulin cascade production

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12
Q

what are the main features of MODY?

A

< 25 years old

runs in families

Manaed by diet, medication and occasionally insulin.

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13
Q

Define Gestational Diabetes:

A

Where the first onset is recognised during pregnancy

Fasting >5.1
OGTT: >8.5

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14
Q

When should GLP-1 be offered?

A

BMI >30kg/m2
in combination with oral glucose lowering drugs

in treatment where oral glucose lowering drugs haven’t been sufficient

Type II and cardiovascular disease

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15
Q

When should SGLT2 inhibitors be offered?

A

Type II add on therapy to metformin

Type II and cardiovascular disease
- proven cardiovascular disease benefits

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16
Q

How does metformin achieve its action?

A

Working on the AMP - activated protein kinase - AMPK

  • insulin signallying
  • energy balancing
  • metabolism of glucose and lipids

in consequence there is:

  • reduced hepatic gluconeogenesis
  • increase in peripheral insulin sensitivity
  • reduced uptake from intestines
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17
Q

What is the stages of insulin?

A

Pre

Pro

Insulin + C peptide

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18
Q

If you have a twin with T1DM, what is the increased risk?

A

36% of developing it

19
Q

If you carry out a random plasma glucose test and the result comes back >6.1, what should your next step be?

A

Carry out a fasting plasma glucose test

20
Q

What are the typical loses during DKA?

A

Fluid loss of 6-8L

K+ 300- 1000

21
Q

What methods can be used for glycaemic control?

A

Short term:
Home blood glucose monitoring

Long term:
HbA1c. Target is 53mmol/ 7%

22
Q

Education that is needed prior to discharge of a newly discovered diabetic:

A
  1. never stop insulin
  2. How to use the insulin - pens etc
  3. outline the base regime of insulin use
  4. sick day rules
  5. hypo’s
  6. alcohol
  7. smoking
  8. driving
  9. exercise
  10. diabetes UK
  11. contact diabetes specialist nurse
  12. reasons why long term control is important
  13. pregnancy planning
23
Q

What s a complication of gestational diabetes?

A

shoulder dystocia

very large babies

24
Q

What features are typical of a T2DM?

A 
>30s 
gradual onset 
diagnosis often missed 
25-30% 
typically over weight 
not associated with ketoacidosis 
negative autoimmune markers
25
Q

If there is a 1% drop in HbA1c what effects may this have?

A

33% risk reduction in albuminuria

21% reduction in retinopathy

25% reduction in peripheral vascular disease

26
Q

How much higher is cardiovascular disease in those with T2DM?

A

2-5x higher

27
Q

What’s the target blood pressure in people with T2DM?

A

130/80

28
Q

Name the long acting insulins in order of their duration from shortest to longest

A

Detimer

Glargine

Degludec

29
Q

Name a rapid acting insulin

A

novorapid

30
Q

Name an intermediate acting:

A

NPH

Humulog Mix

31
Q

Out line the management of HHS:

A
  • fluid replacement - 0.9% saline
  • move to 0.45% if no improvement in blood osmolality following fluid replacement
  • insulin
    if glucose still high despite fluids given
  • no more than 5mmol/ hour
  • Low molecular weight heparin
  • prevent DVT
32
Q

In DKA, what levels would Potassium Chloride be given at?

A

20mmol if <3.5mmol/L

10mmol if 3.5-5mmol/L

none if >5mmol/L

33
Q

When do you give dextrose in DKA?

A

Blood glucose below <14mmol

34
Q

In the carb counting, what is dose of insulin for carbs?

A

1 unit for 10g of carbs

therefore - 50g = 5 units of short acting insulin

35
Q

Who mainly uses the twice daily mix insulin or once daily insulin regimen?

A

Type II diabetics

36
Q

State the times that insulines take to act:

A

Rapid:
15 mins till in blood
30-90mins - peak
5 hours

Short acting:
30 mins till in blood
2-4 hours peaks
4-8 hours

Intermediate acting:
2-6 hours in blood
4-14 hours - peaks
20 hours

Long acting:
6-14 hours till reaching blood
doesn’t peak
24 hours long

37
Q

If some is highly hyperglycaemic but has normal electrolytes/ normal kidney functioning - what is the most appropriate step?

A

Sub- Cut insulin

38
Q

What the biggest cause of Diabetic ketoacidosis - and list some other causes:

A

Poor insulin compliance

Acute illness
First time presentation
Steroid use

39
Q

What are the diagnostic criteria for keto acidosis:

A

Glucose: >13.9 mmol

Acidosis: <18mmol/L

Ketonaemia: 3 mmol/L
or
Ketones in urine >++

40
Q

What tests would you organise in someone with DKA?

A

Blood glucose

Ketones

  • blood
  • urine

FBC

U&Es

  • looking for level dehydration
  • K+

Osmolality

ABGs
- looking for acidosis

41
Q

What is the treatment for DKA:

A

Achieved in two stages:
0-4 hours:

  • IV fluids
  • Insulin - regular
  • Glucose
  • even when glucose level starts to rise - continue glucose.

*Potassium

Stage Two: >4 hours.

*maintain blood glucose at 9-14 mmol/L

*do not remove until HCO3- normal
and
patient eating normally

42
Q

What is the treatment of HHS?

A

IV saline
- first 0.9%, consider switching to 0.45% if osmolality not improving

Insulin
- slow infusion

LMWH
- DVT risk

43
Q

What is the type of diabetes that is associated with adult onset, that causes type 1 and is also implicated with other autoimmune disease.
List these and list the genes associated.

A 
Autoimmune Polyendocrine syndrome 2 
Triad of:
- addisons 
- T1DM
- autoimmune thyrotiis

Others include:

  • Coeliac
  • alopecia
  • Myasthenia gravis

HLA DRQ
HLA DR3
HLA DR4

Phase 3 (50 decks)

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