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Metabolic > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diagnosis of type 2 diabetes?

A

Fasting glucose >7.0
Random glucose >11.1
HbA1c >48

If asymptomatic must be demonstrated on two occasions

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2
Q

What is pre-diabetic HbA1c?

A

42-47 mmol/mol

or 6.0-6.4%

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3
Q

When can’t HBa1c be used?

A 
Haemoglobinopathies
Haemolytic anaemia
Iron deficiency anaemia
Gestational diabetes
Children
HIV
Chronic kidney disease
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4
Q

Symptoms of diabetes?

A 
Polyuria
Polydipsia
Blurred vision
Fatigue
UTI
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5
Q

Stimulants of insulin release?

A 
Increased glucose
Amino acids
Fatty acids
Cortisol
Gastrin
Secretin
Glucagon
Incretins
Parasympathetic stimulation
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6
Q

Inhibitors of insulin release?

A

Sympathetic stimulation
Decreased glucose
Somatostatin

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7
Q

Actions of GLP-1?

A

Enhanced insulin secretion
Inhibition of glucagon release
Prolonged gastric emptying
Satiety

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8
Q

Normal insulin release?

A

Biphasic
Immediate - stored insulin
Later - newly synthesised insulin

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9
Q

Effects of insulin on the liver?

A

Increased glycogen synthesis
Increased protein synthesis
Decreased gluconeogenesis

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10
Q

Effects of insulin on muscle?

A

Increased protein synthesisi
Increased glycogen synthesis
Increased glucose uptake
Increased amino acid uptake

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11
Q

Effects of insulin on adipose tissue?

A

Increased triglyceride storage
Increased triglyceride synthesis
Decreased lipolysis

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12
Q

Causes of hypoglycaemia?

A 
EXPLAIN
EXogenous drugs - sufonylureas+insulin
Pituitary insufficiency
Liver failure
Addison's disease
Islet cell tumours
Non-pancreatic neoplasms
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13
Q

When to add another medication after metformin therapy?

A

HbA1c >58

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14
Q

Recommended blood glucose monitoring in type 1?

A

4 times a day

Including before each meal + before bed

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15
Q

What can give falsely high HbA1c level?

A

Splenectomy
Iron deficiency anaemia
Vitamin B12/folic acid deficiency

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16
Q

Lower than expected HbA1c level?

A

Sickle cell anaemia
GP6D deficiency
Hereditary spherocytosis

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17
Q

Sick day rules for insulin?

A

Increase monitoring frequency
Drink at least 3L in 24h
Maintain carbohydrate intake

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18
Q

What is diabetic ketoacidosis?

A

A state of hyperglycaemia, acidosis and ketonemia

19
Q

Mild DKA?

A 
Plasma glucose >13.9
Arterial pH 7.25-7.3
Serum bicarbonate 15-18
Ketones - +
Anion gap >10
Alert
20
Q

What is MODY?

A

Maturity onset diabetes of the young
Type 2 diabetes in <25
Autosomal dominant

21
Q

MODY3?

A

HNF1A mutation
60% of cases
Risk of HCC

22
Q

MODY2?

A

Glucokinase gene mutation

20% of cases

23
Q

Features of MODY?

A

<25
Family history of early onset diabetes
Ketosis not a feature
Sensitive to sulfonylurea

24
Q

DVLA diabetes mellitus?

A

No severe hypo event in last 12 months
Full hypo awareness
Adequate control of glucose monitoring
Understanding of risks of hypoglycaemia

25
Q

How to differentiate between sulfonylurea hypo and insulin hypo?

A

Sulfonylurea - raised insulin and C-peptide

26
Q

What is C-peptide

A

Cleaved part of insulin

Only present in endogenous insulin

27
Q

Causes of secondary diabetes?

A 
Pancreatic disease
Pheochromocytoma
Thyroxicosis
Acromegaly
Cushing's syndrome
Glucagonoma
Drug induced
Congenital lipodystrophy
Haemochromatosis
Glycogen storage disease
28
Q

Risk factors for T2DM?

A 
Obesity
Lack of physical activity
Ethnicity
Gestational diabetes
Low fibre, high glycemic diet
Metabolic syndrome
Polycystic ovary syndrome
29
Q

First line T2DM?

A

Dietary control

if pharmacological metformin

30
Q

Second line T2DM?

A

Sulfonylureas
DPP4 inhibitors
SGLT2 inhibitors
Meglitinides

31
Q

Adverse of sulfonylureas?

A

Hypoglycemia

Weight gain

32
Q

Adverse of DDP4 inhibitors?

A

?

33
Q

Adverse of SGLT2 inhibitors?

A

Urinary infections
DKA
Weight loss

34
Q

Adverse of meglitinides?

A

?

35
Q

Features of a hypo?

A 
Tachycardia
Sweating, clammy
Anxiety
Numbness of extremities
Sleepiness
Confusion
Headaches
Slurred speech
36
Q

Treatment of hypo?

A

Glucose

Glucagon

37
Q

Treatment of hypo secondary to excess insulin secretion?

A

Diazoxide - potassium channel activator - inhibition of insulin release

38
Q

What HHS?

A

Hyperosmolar hyperglycemic syndrome
Brought on by illness or poorly controlled diabetes
Hyperglycemia result in body getting rid of excess sugar through urine = loss of salt

39
Q

Symptoms of HHS?

A

Thirst
Fever
Dry mouth

40
Q

HHS treatment?

A

0.9% NaCl
Insulin
Potassium

41
Q

Severe non-proliferative diabetic retinopathy?

A

Microaneurysms
>20 intraretinal haemorrhage in each quadrant
Cotton wool spots
Venous bleeding

42
Q

Proliferative diabetic retinopathy?

A

Neovascularisation

Preretinal haemorrhage

43
Q

Advanced diabetic eye disease?

A

Fibrovascular tissue formation

Retinal detachment

44
Q

Mild non proliferative diabetic retinopathy?

A

Microaneurysms only

Metabolic (5 decks)

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