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TCD Cases > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Give 3 complications of pregnancy that are associated with diabetes

A
  1. Congenital abnormalities
  2. Accelerated growth
  3. IUGR (intrauterine growth restriction
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2
Q

Which anabolic hormone is principally involved in intermediary metabolism?

A

Insulin

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3
Q

Define intermediary metabolism

A

The intracellular process by which nutritive material is converted into cellular components

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4
Q

Name the 4 catabolic hormones that are involved in intermediary metabolism

A
  1. Glucagon
  2. Catecholamines
  3. Cortisol
  4. Growth hormone
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5
Q

Name the 3 processes by which inadequate insulin action (leading to hyperglycaemia) may occur

A
  1. Reduced insulin production
  2. Reduced insulin target organ sensitivity
  3. Overwhelming increase in catabolic hormones
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6
Q

Define Diabetes Mellitus

A

A reduction in insulin action significant enough to cause a level of hyperglycaemia that, over time, will result in diabetic specific, microvascular (capillary) pathologies in the eyes, kidneys and nerves.

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7
Q

What is non diabetic hyperglycaemia?

A

Reduced insulin action resulting in hyperglycaemia but not of a sufficient degree to cause microvascular damage

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8
Q

What is the most common cause of end stage kidney disease (ESKD)?

A

Diabetes

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9
Q

Roughly, what is the ratio between type 1 and type 2 diabetics?

A

1:9

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10
Q

What % of patients with non diabetic hyperglycaemia (NDH) are thought to progress to T2DM each year?

A

5-10%

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11
Q

What level of HbA1c is considered diagnostic for Diabetes Mellitus?

A

> 48mmol/mol

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12
Q

Give the HbA1c range for those individuals considered to have non diabetic hyperglycaemia

A

42-47 mmol/mol

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13
Q

What is MODY?

A

Maturity onset diabetes of the young - autosomal dominates genetic defect that leads to hereditary diabetes. Distinct from either type 1 or type 2 diabetes

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14
Q

Name 3 diseases of the exocrine pancreas that can result in diabetes

A
  1. Pancreatitis
  2. Cancer
  3. Cystic fibrosis
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15
Q

Name 3 endocrinopathies that can cause diabetes

A
  1. Cushing’s
  2. Acromegaly
  3. Pheochromocytoma
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16
Q

Give 2 classes of drugs that can give rise to drug induced diabetes

A
  1. Steroids

2. Antipsychotics

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17
Q

Briefly differentiation between the pathophysiology of type 1 and type 2 diabetes

A

Type 1 - beta cell destruction + organ specific autoimmunity
Type 2 - Insulin resistance and beta cell dysfunction

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18
Q

Contrast the appearance of ketosis in Type 1 and Type 2 diabetes

A

Type 1 - Ketosis prone

Type 2 - Ketosis resistant

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19
Q

Give 3 non modifiable risk factors for the development of insulin resistance

A
  1. Age
  2. Family history
  3. Ethnicity
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20
Q

Give 2 ethnicities that have a greater susceptibility to developing type 2 diabetes

A
  1. Afro-carribean

2. South east asian

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21
Q

Give 3 modifiable risk factors that are associated with the development of insulin resistance

A
  1. Diet composition
  2. Lack of exercise
  3. Overweight/ Obesity
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22
Q

Give 3 potential causes of polyuria

A
  1. Diabetes mellitus
  2. Diabetes Insipidus
  3. Hypercalcaemia
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23
Q

Define diabetes insipidus

A

Deficiency or resistance to the action of vasopressin leadings to excessive water loss (polyuria) accompanied by polydipsia.

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24
Q

Name the 2 types of diabetes insipidus

A
  1. Central

2. Nephrogenic

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25
Q

What is the pathophysiology of central diabetes insipidus?

A

Either as a result of pathology in the pituitary gland resulting in inhibited vasopressin release from the posterior pituitary or a congenital abnormality that affects the synthesis of the hormone.

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26
Q

What is the pathophysiology of nephrogenic diabetes insipidus?

A

Resistance to the action of vasopressin in the kidney resulting in excessive water loss from the renal tubule

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27
Q

Give 3 potential causes of nephrogenic diabetes insipidus

A
  1. Electrolyte disturbance
  2. Renal disease
  3. Drug toxicity (particularly lithium)
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28
Q

What blood concentration is used to define hypercalcemia?

A

10.5 mg/dL

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29
Q

Define the hyperglycaemic emergency associated with type 1 and type 2 diabetes respectively

A

Type 1 - Diabetic ketoacidosis

Type 2 - Hyperosmolar hyperglycaemic state

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30
Q

What are the 3 main treatment goals for diabetes?

A
  1. Minimise treatment side effects
  2. As near normal blood glucose as possible
  3. Cardiovascular risk management
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31
Q

Give 3 patient psychological factors which are important when considered treatment adherence

A
  1. Locus of control
  2. Motivation
  3. Self esteem
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32
Q

Compare the possible routes of administration of quick and slow acting insulins

A

Quick acting - Subcutaneous or IV

Long acting - can only be administered subcutaneously

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33
Q

Give an example of a biguanide drug used in the treatment of T2DM

A

Metformin

34
Q

Name a thiazolidenedione

A

Pioglitazone

35
Q

Broadly, what is the mechanism of action of Pioglitazone?

A

Reduces degree of insulin resistance

36
Q

Name 2 drug classes which act by increasing beta cell activity

A
  1. Sulphonylureas

2. Meglitinides

37
Q

Give 3 examples of sulphonylureas drugs

A
  1. Gliclazide
  2. Glipizide
  3. Glibenclamide
38
Q

Give 2 examples of meglitinides

A
  1. Nateglinide

2. Repaglinide

39
Q

Name 2 drug classes that act by increasing GLP1 activity

A
  1. DPP4 inhibitors

2. Incretins

40
Q

Name 4 DPP4 inhibitors

A
  1. Sitagliptin
  2. Vildagliptin
  3. Linagliptin
  4. Alogliptin
41
Q

Give 2 examples of GLP1 agonists

A
  1. Exenatide

2. Liraglutide

42
Q

Classify the drug Acarbose

A

alpha-glucosidase inhibitor

43
Q

What is the mechanism of action of Acarbose?

A

alpha-glucosidase inhibitor which serves to slow the absorption of glucose

44
Q

Which drug class serves to increase glucose excretion?

A

SGLT2 antagonists

45
Q

Give 3 examples of SGLT2 antagonists

A
  1. Dapagliflozin
  2. Canagliflozin
  3. Empagliflozin
46
Q

Which medication class used in the treatment of T2DM is associated with increased incidence of UTI?

A

SGLT2 inhibitors

47
Q

Give 3 drug classes used in the treatment of T2DM which can be associated with weight loss

A
  1. Metformin
  2. Incretins
  3. SGLT2 inhibitors
48
Q

Which T2DM drug is associated with the development of osteoporosis as a potential side effect?

A

Pioglitazone

49
Q

What are the 7 annual checks required in all patients with diabetes?

A
  1. Lipids - Total cholesterol
  2. Lipids - HDLC
  3. Lipids - Total cholesterol/HDLC
  4. UACR
  5. eGFR
  6. Foot exam: intact pulses, palpable pulses and no deformities
  7. Diabetic eye screening program
50
Q

Define secondary prevention of diabetic complications

A

Preventing early manifestations of tissue damage progressing to the point of threatening organ function

51
Q

What are the aims of complex (salvage) therapies for advanced diabetic complications?

A

To restore or reproved function to a functionally impaired organ

52
Q

What are the 4 main eye diseases that have an increased incidence in diabetic patients?

A
  1. Diabetic retinopathy
  2. Diabetic macula oedema
  3. Glaucoma
  4. Cateracts
53
Q

Name the 2 principle stages of diabetic retinopathy

A
  1. Non-proliferative

2. Proliferative

54
Q

What are the primary prevention methods for preventing blindness in diabetic patients?

A
  1. Blood Glucose control

2. Control BP

55
Q

What is the salvage therapy for blindness secondary to diabetes for some patients?

A

Vitrectomy

56
Q

Kidney failure in the context of chronic kidney disease is define at what eGFR value?

A

<15

57
Q

What is diabetic cheiroarthropathy?

A

Skin thickening and limiting mobility in the hands and figures secondary to uncontrolled diabetes. Often identified by a positive prayer sign on clinical examination.

58
Q

Give an ethnic group in which heart failure has been identified as a more common presentation that in the general population

A

South Asian

59
Q

Classify and give an indication for the drug Tropicamide

A

Acts as a mydriatic agent, often used to dilate the pupil before fundoscopy

60
Q

What are the 3 main diabetic emergencies?

A
  1. DKA
  2. HHS
  3. Severe Hypoglycaemia
61
Q

What are the 3 principle physiological components of DKA?

A
  1. Hyperglycaemia
  2. Hyperketonemia
  3. Acidosis
62
Q

What are the 5 principle clinical features of DKA?

A
  1. Hyperventilation (due to metabolic acidosis)
  2. Vomiting (due to ketosis and hyperglycaemic gastric stasis
  3. Dehydration (Osmotic diuresis and vomiting)
  4. Hypotension with warm peripheries (dehydration and vasodilation)
  5. Decreased conscious level (due to severe hypotension)
63
Q

Outline the 5 metabolic characteristics of DKA?

A
  1. Water deficiency
  2. Hyponatraemia
  3. Hypokalaemia
  4. Hyperglucaemia
  5. Metabolic acidosis
64
Q

What are the 2 pathophysiological causes of raised urea and creatine levels seen in DKA?

A
  1. Muscle breakdown

2. Hypotensive AKI

65
Q

Recall the ‘6 ways to prevent disaster’ when either DKA or HHS has developed

A
  1. NEVER STOP BASAL INSULIN
  2. Fluid resuscitation - to prevent hypovolemic shock
  3. Airway protection if the patient is comatosed - prevent aspiration pneumonitis
  4. Careful IF fluid titration - in order to avoid cerebral oedema
  5. Monitor/ replace K+ - to prevent fatal arrhythmia
  6. Prophylactic LMWH - to prevent PE
66
Q

Give 3 clinical characteristics of neuroglycopenia

A
  1. Paraesthesiae
  2. Blurred vision
  3. Confusion
67
Q

Outline 7 risk factors for severe hypoglycaemia

A
  1. Alcohol excess
  2. Extremes of age
  3. Long duration DM
  4. History of sever hypoglycaemic episodes
  5. Pregnant
  6. Autonomic neuropathy
  7. Renal or hepatic impairment
68
Q

Give 3 hormones which oppose the action of insulin

A
  1. Glucagon
  2. Cortisol
  3. Noradrenaline
69
Q

Classify the drug Irbesartan and give a potential risk factor associated with its use

A

Angiotensin II receptor antagonist - Can cause hyperkalemia

70
Q

Give 3 side effects associated with insulin

A
  1. Hypoglycaemia
  2. Weight gain
  3. Lipodystrophy
71
Q

List 5 associated factors for NASH (non-alcoholic steatohepatitis)

A
  1. Obesity
  2. T2DM
  3. Hyperlipidemia
  4. Jejunileal bypass
  5. Sudden weight loss/ starvation
72
Q

Give 4 clinical features associated with non-alcoholic steatohepatitis

A
  1. Usually asymptomatic
  2. Hepatomegaly
  3. ALT is typically greater than AST
  4. Increased echoegenicty on ultrasound
73
Q

Which 3 components are reported on an enhanced liver fibrosis (ELF) blood test

A
  1. Hyaluronic acid
  2. Procollagen III
  3. Tissue inhibitor of metalloproteinase 1
74
Q

Give 2 examples of insulin sensitising drugs

A
  1. Metformin

2. Pioglitazone

75
Q

List 6 drugs which are known to cause impaired glucose tolerance

A
  1. Thiazide diuretics
  2. Steroids
  3. Tacrolimus, cyclosporin
  4. Interferon-alpha
  5. Nicotinic acid
  6. Antipsychotics
76
Q

Name 2 pathological processes that affect the pancreas and can lead to secondary diabetes developing

A
  1. Chronic pancreatitis

2. Haemochromatosis

77
Q

Give 3 side effects associated with long term insulin use

A
  1. Hypoglycaemia
  2. Weight gain
  3. Lipodystrophy
78
Q

Give 2 side effects associated with thiazolidinediones

A
  1. Fluid retention

2. Weight gain

79
Q

Which drug class works by inhibiting glucose reabsorption in the kidneys?

A

SGLT-2 inhibitors

80
Q

What is the mechanism of action of thiazolidinediones?

A

Work by activating PPAR - gamma receptors in adipocytes to promote adipogenesis and fatty acid uptake

81
Q

Give 3 side effects associated with sulphonylureas

A
  1. Hypoglycaemia
  2. Weight gain
  3. Hyponatremia

TCD Cases (25 decks)

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