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Endocrine Y2 JC > Diabetes > Flashcards

Diabetes Flashcards

1
Q 
What is the relative risk of a 1st degree family member getting diabetes if the 
a. Mom 
b. Dad 
c. Monozygotic twin 
d. Sibling HLA identical 
has it?
A

A. Mom; 5-6%
B. Dad; 10%
C. Mono twins 30-40%
D. HLA sibling 15%

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2
Q

What are some of the common presentations of type 1 diabetes?

A

Weight loss, thirst, polyuria (frequent peeing), dehydrated, tired, ketoacidosis, blurred vision, infections (resp, UTI, soft tissue), kussmaul breathing (deep laboured breathing)

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3
Q

You suspect type 1 diabetes in a young individual. What investigations would you-run? What results would you expect from a positive type 1 diabetic.

A

HbA1c; 48mmol/l or >
Fasting glucose; >7mmol/l
2hr glucose oral glucose tolerance test (OGTT); 11.1mmol/l or >
Random glucose; 11.1mmol/l or >

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4
Q

What is the ‘honeymoon period’ of type 1 diabets?

A

Where there is still some residual insulin secretion from the beta cells so C-protein is still present. Usually for 3yrs or less

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5
Q

What are the chances for a type 1 diabetic to also get
A. Hypothyroid
B. Coeliac disease

A

1:20

5% chance

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6
Q

What are some of the common other autoimmune disease that co-exist with type 1 diabets?

A 
Hypothyroid
Coeliac
Addisons
Pernicious anaemia
Vitiligo
IgA deficiency
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7
Q

What monitory tests will a type 1 diabetic get thorughout the year?

A

Hb1ac done every 2/3 months. Measure of glycated haemoglobin should be 43-56

Weight
Blood pressure (130/80 or less)
Renal function
Lipids
Retinal screening
Foot screening
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8
Q

What type of fast acting insulin is taken 15 minutes before mealtimes?

A 
Novorapid (aspart)
Or
Apidra
Or 
Humalog
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9
Q

What is the target blood sugar range?

A

4-10mmol/l

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10
Q

What is defined as hypoglycaemia?

A

<4mmol/l

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11
Q

What are some of the classic symptoms of hypoglycaemia?

A

Trembling, anxiety, palpitations, numbness, irritability, hunger, pale and sweaty, unable to conc, poor coordination, slurred speech, vision issues, loss of consciousness, seizures

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12
Q

Waht is the treatment for a conscious hypoglycaemic who can swallow?

A

15-20g of quick acting carbohydrate like fruit juice, glucojuice, glucotabs

Then
Complex 20g carbohydrate snack

Recheck glucose in 15 minutes

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13
Q

What is the treatment for an unconscious hypoglycaemic patient ?

A 
ABC
Ambulance
Subcutaneous glucagon 
or
 IV glucose (75ml 20% glucose or equivalent)
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14
Q

What is the treatment for hypoglycaemia in a drowsy/ confused diabetic

A

1.5-2 tubes of glucose gel into the inside of the mouth between the gums and cheek

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15
Q

Young diabetic presents with nausea, vomiting and abdominal pain. What is the investigations with expected result and likely diagnosis?

A

Elevated plasma or urine ketones
Venous bicarbonates <15mmol/l
Or
Arterial Ph <7.3

Ketoacidosis

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16
Q

What is the treatment for ketoacidosis?

A

ABCDE
Rehydration 1L sodium chloride at 1000ml/hr

IV insulin at 6units/hr

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17
Q

What is the pathology of developing type 2 diabetes?

A

Hyperglycaemia with hyperinsulinaemia leading to desensitisation ofthe beta cells

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18
Q

What is epidemiology of type 2 diabetes?

A

Men middle aged, elderly >60yrs, OBESE, first degree relative with type 2, waist circumference >90cm

19
Q

What are some of the associated conditions predisposing to type 2 diabets?

A 
CVD (hypertension, High LDL cholesterol)
Women iwth polycystic ovary syndrome
Antipsychotic medications
Statins
Smoking
20
Q

What are the investigations for type 2 diabets?

A

Diagnosis of exclusion
Located risk factor score, fast plasma glucose,
1 diagnosic test positive with symptoms is diagnosis e.g fasting glucose >7.0, random glucose >11.1, hb1ac >48.

21
Q

Is metformin safe to take during pregnancy?

A

Yes, but if isnt controlled on metformin then need insulin. High risk of stillbirth, preclampsia and maternal death

22
Q

What is the treatment for a recently diagnosed type 2 diabetic?

A

Lose weight, diet with high veg and fibre, exercise, GIVE UP SMOKING

Pharmacology after 1 month of the above trialed minimum. Start with metformin then if hb1ac rises to 53mmol/l add another drug like sulphonylureas like gliclazide, or thiazolidinediones like priolitazone

23
Q

What is the major side effect of sulphonylureas? Give an example of a drug in this class

A

Hypoglycaemia as not glucose dependent

Gliclazide, tolbutamide, chlorpropamide

24
Q

What are some of the drugs that can be used to treat type 2 diabetes?

A

Gliclazide, metformin, priolitazone, exenatide, sitagliptin, diazoxide

25
Q

Ifyou suspect gestational diabetes mellitus what investigations should you run?

A

C-peptide positive with GAD negative

Lifelong testing every 3 yrs for type 2

26
Q

What are the two types of maturity onset of diabetes in the young (MODY)

A

Glucokinase mutations

Transcription factgor mutations; HNF-1 alpha and HNF-4 alpha

27
Q

What is the treatment for MODY type glucokinase mutation

A

No treatment as messed up glucose sensing but still correctes with insulin production

28
Q

What is the treatment for MODY type HNF-1 alpha mutations

A

Sulphonylureas like gliclazide

29
Q

Baby 4 months presents with hyperglycaemia, he has a kir6.2 mutationwhat is the likely diagnosis? treatment?

A

Neonatal diabetes

Sulphonylureas like gliclazide- blocks the ATP channel so causes depolarisation of the cell to then secrete insulin

30
Q

Diabetic presents with peripheral neuropathy with pain. What are the treatment options?

A

Cant bring back sensation

Treat pain with amitrptyline
Duloxetine
Gabapentin

31
Q

What are the treatment options for retinopathy?

A

Laser treatment, virectomy, anti-vegf injections

32
Q

What is orlistat?

A

Inhibits lipase action at the brush border of the intestins so dont absorb the energy from fat so lose weight

33
Q

At what age should diabetics start statin therapy?

A

40yrs

34
Q

What are some of the common side effects of biguanide therapy? Give an example of this

A

Metformin

Lactic acidosis, vomititng, diarrhoea, nausea

35
Q

What groups of people are biguanides contraindicated in?

A 
Renal failure
Alcoholism
Cirrhosis
Lung disease
Cardiac failure

Due to inhibition of hepatic gluconeogenesis

36
Q

What groups of people are sulphonyluras contraindicated in?

A

Not to be prescribed with corticosteroids or thiazide diuretics due to their effect on insulin.

As gliclazide works to inhibit the atp dependent potassium channel to then cause depolarisation and insulin release, would be counterintuitive.

37
Q

What are the side effects of thiazolideinediones? Give examples of drugs in this class

A

Priolitazone
Glitazones

Higher fracture risk, weight gain
(Due to conversion of haemopoetic cells into fat)

38
Q

What groups of people should you avoid prescribing metformin to? Why? What would the second line therapy be?

A

Hepatic or renal failure
Alcoholics

As can cause lactic acidosis which would be incopable in these groups

Sulphonylureas like gliclazide

39
Q

What groups of people should avoid thiazolidindiones (glitazones)? Why?

A

As can cause fluid retention then should avoid in heart failure and kidney failure

40
Q

Explain how release of insulin occurs in beta cells from glucose levels

A

When glucose is high, ATP is high in the cell.

Hence this closes the ATP dependent channel causing depolarisation of the cell

This then causes insulin secretion

41
Q

What two hormones during pregnancy cause insulin resistance in the mother?

A

HPL and progesterone

42
Q

What are some of the consequences to the fetus if the mother has high blood sugars during pregnancy?

A 
Congenital malformation
Prematurity
Intrauterine growth retardation
Macrosomia (large babies with likley breathing problems and shulder dislocations)
Polyhydramnios
Intrauterine death
43
Q

What are some of the consequences to the neonate if the mother had high blood sugars during pregancy?

A

More likely to have respiratory distress
Hypoglycaemia
Hypocalcaemia

Spina bifida
Ureteric duplication

44
Q

Young women with type 1 diabetes comes to you saying she wants to get pregnant. What management and treatment do you offer

A

Tell she needs 3 months in range before trying to ensure safe healthy pregnancy

Prescribe 5mg folic acid (usually 400mcg but more in diabetics)

While pregnant need more regular retinopathy appointments as can accelerate during pregnancy

If on ACE inhibitor MUST switch to labetalol
STOP STATINS

Endocrine Y2 JC (8 decks)

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