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Endocrinology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

How is diabetes defined using the WHO criteria?

A 
Fasting plasma glucose >7.0mmol/l
Random plasma glucose >11.1 mmol/L
HbA1c >48mol/mol
One abnormal value + symptoms = diabetes
OR
Two abnormal values = diabetes
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2
Q

In what cases of diabetes is an oral glucose tolerance test required for diagnosis?

A

Gestational diabetes mellitus

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3
Q

Other than type one and two, what types of Diabetes Mellitus are there?

A

MODY
Gestational diabetes
Pancreatic diabetes mellitis
Latent autoimmune disease of adulthood

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4
Q

What diagnostic investigations can be used to help different between different types of Diabetes Mellitus?

A

Ketone testing +/- bicarbonate
Pancreatic auto-antibodies
C peptide testing

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5
Q

What autoantibodies are often found in type one Diabetes Mellitus?

A

Glutamic acid decarboxylase antibodies

Insulinoma associated antigen 2 antibodies

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6
Q

Patients with type two Diabetes Mellitus can have islet autoantibodies. T/F?

A

True

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7
Q

What substance is secreted in equimolar concentrations to insulin and is a useful marker of endogenous insulin secretion?

A

C-peptide

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8
Q

At what point in the diagnosis of diabetes is the c-peptide test most useful?

A

3-5 years from diagnosis

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9
Q

Describe the cause of type one diabetes?

A

Autoimmune destruction of the insulin producing beta cells in the islets of lagerhands.

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10
Q

What environmental factors have been linked to an increased risk fo T1DM?

A 
Viral infections (enterovirus)
Immunisations
Diet (early exposure to cow's milk)
High socioeconomic status
Obesity
Vitamin D deficiency
Perinatal factors - maternal age, history of preeclampsia, neonatal jaundice, low north weight (protective factor)
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11
Q

A family history of diabetes is more significant in type one diabetes than type two. T/F?

A

False - the opposite is true

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12
Q

What type of diabetes makes up the majority of cases?

A

Type two Diabetes Mellitus

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13
Q

What can cause pancreatic diabetes?

A 
Pancreatectomy
Pancreatitis
Haemochromatosis
Carcinoma
Cystic fibrosis
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14
Q

Why is there a higher risk of hypoglycaemia in pancreatic diabetes than in type one diabetes?

A

Because pancreatic diabetes also results in loss of alpha cells which produce glucagon

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15
Q

What are the main features of MODY?

A

<25 years at onset
C peptide not low
Pancreatic autoantibodies negative
Runs in families in AD pattern

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16
Q

How is MODY managed?

A

By managing diet, oral hypoglycaemic agents and insulin

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17
Q

What genes are. particularly associated with T1DM?

A

HLA DR3/4

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18
Q

What endocrinopathies can cause diabetes?

A

Acromegaly, Cushing’s, phaechromocytoma

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19
Q

What immunosuppressive agents can cause diabetes?

A

Clozapine

Olanzzipine

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20
Q

What genetic syndrome can cause diabetes>

A

Down’s syndrome
Friedreich’s ataxia
Turner’s myotonic dystrophy
Kleinfelter’s syndrome

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21
Q

How is T1DM managed?

A 
Insulin replacement
Glucose/ketone monitoring
Carbohydrate counting
Structured education
Supported self management
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22
Q

What insulin regimen are most T1DM patients on?

A

Basal bolus regimen

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23
Q

A BD mix insulin regime requires less injections. What are the disadvantages of this regimen?

A

Requires regimented diet and eating time

Increased likelihood of hypos

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24
Q

How can glucose monitoring be conducted?

A

Glucose/ketone meters

Flash glucose monitoring (freestyle libra)

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25
Q

How can insulin be administered?

A

Insulin pen

Insulin pump

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26
Q

What HbA1c target is aimed for in T1DM?

A

<53 mol/L

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27
Q

What is the target blood sugar level before breakfast in T1DM?

A

5.5-7 mol/l

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28
Q

What is the target blood sugar level before lunch and dinner in T1DM?

A

4.5-7.5 mol/l

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29
Q

What is the target blood sugar level before bed in T1DM?

A

6.5-8 mol/l

30
Q

What factors need to be discussed when educating patients with T1DM?

A 
Administration of insulin
Glucose/ketone monitoring
Sick day rules
Hypoglycaemia
Driving regulations
Exercise and alcohol
Pregnancy
Targets
Complications
31
Q

Carbohydrate counting is only used in which insulin regimen?

A

Basal bolus regimen

32
Q

What are the goals of therapy in T2DM?

A

Reduce rates of microvascular complications
Minimise CVD risk
Reduce rates of microvascular complications

33
Q

Give examples of microvascular complications of T2DM?

A

Retinopathy
Nephropathy
Foot disease

34
Q

Give examples of macrovascular complications of T2DM?

A

MI
Stroke
Heart failure
Peripheral vascular disease

35
Q

What factor is most important in preventing microvascular disease in T2DM?

A

Good glycemic control

36
Q

What are the targets for the treatment of T2DM?

A

HbA1c of 7%
BP <130/80mmHg
Cholesterol. <5 once statins started
Normal body weight

37
Q

At what age should patients with T2DM be started on statins?

A

> 40 years

38
Q

What is the first line treatment of T2DM?

A

Metformin

39
Q

What drugs can be added to metformin in the second line treatment of T2DM?

A

Sulphonylureas
SGLT-2 inhibitors
DPP-4 inhibitors
Glitazones

40
Q

Another second line agent can be added in the third line management of T2DM, alternatively an injectable medication can be used. Give examples of these injectable medications?

A

Insulin

GLP-1 agonists

41
Q

How does metformin act as a hypoglycaemic agent?

A

Suppresses hepatic gluconeogenesis to reduce glucose output from the liver
Increases peripheral insulin sensitivity
Increases glucose uptake and ultilisation
Increases AMPK activity

42
Q

What effect does metformin have on weight?

A

Reduces weight

43
Q

What are the side effects of metformin?

A

GO side effects

44
Q

Why can metformin not be used if eGFR is <30?

A

Small risk of lactic acidosis

45
Q

What is the efficacy of metformin?

A

Moderate

46
Q

Which hypoglycaemic agents reduce weight?

A

Metformin
SGLT2 inhibitors
GLP-1 receptor agonists

47
Q

Which hypoglycaemic agents result in weight gain?

A

Sulphonylureas
Thiazolidinediones
Insulin

48
Q

Which hypoglycaemic agent is weight neutral?

A

DPP-4 inhibitors

49
Q

Which hypoglycaemic agent should be used at a rescued dose in CLD?

A

DPP-4 inhibitors

50
Q

Which hypoglycaemic agents can’t be used in CKD?

A

Metformin (<30 eGFR)
Caution use of sulphonylurea
SGLT2 inhibitors

51
Q

What is the mechanism of action of sulphonylureas?

A

Bind to SUR1 receptor on cell membrane of pancreatic beta cells which results in closure of ATP-potassium channels which allows an influx of calcium which results in exocytosis of insulin

52
Q

What is the efficacy of sulphonylureas?

A

High efficacy

53
Q

What are the disadvantages of the use of sulphonylureas?

A

No CV benefit
Weight gain
High hypoglycaemic risk
Caution use in CKD

54
Q

What is the mechanism of action of DPP-4 inhibitors?

A

Rapidly inactivate DPP-4 which prolongs the action fo endogenous incretins, enhancing the first phase insulin response.

55
Q

What is the efficacy of DPP-4 inhibitors?

A

Low/moderate efficacy

56
Q

There is a low risk of hypos with DPP-4 inhibitors. T/F?

A

True

57
Q

Which hypoglycaemic agents also have a CV benefit?

A

Metofmrin
Thiazolidinedione (probably)
SGLT-2 inhibitors
GLP-1 receptor agonists

58
Q

What is the mechanism of action of SGLT2 inhibitors?

A

Inhibit SGLT2 glucose transporters in the proximal convoluted tubule of the kidney to decrease the renal reabsorption of glucose

59
Q

What is the efficacy of SGLT2 inhibitors?

A

Moderate efficacy

60
Q

What are the risks associated with the use of SGLT2 inhibitors?

A

GU infections

Small risk of hypovolaemia/DKA

61
Q

What is the mechanism of action of thiazolidinediones?

A

Increased insulin sensitivities by acting as. ligands for the nuclear hormone receptor PPARgamma to regulate its transcription activity. This reduces the availability of fatty acids as an energy source, thereby favouring the utilisation of glucose.

62
Q

What is the efficacy of thiazolidinidiones?

A

Moderate

63
Q

Why are thiazolidinidiones no longer commonly used?

A

Cause fluid retention

Fractures

64
Q

In addition to increasing the endogenous effects of icnretins, what are the effects of GLP-1 receptor agonists?

A

Increases satiety

Suppress appetite

65
Q

What is the efficacy of GLP-1 receptor agonists?

A

High efficacy

66
Q

Which hypoglycaemic agent has the highest hypoglycaemia risk?

A

Insulin

67
Q

What considerations need to be taken when prescribing hypoglycaemic agents in elderly patients?

A

Increased poly pharmacy which increases risk of drug interactions
Increased likelihood of adverse reactions
Likely to have decreased eGFR so some agents not suitable
Increased risk fo hypoglycaemia
Important to individualise therapy

68
Q

Can metofmrin be prescribe in heart failure?

A

It can be used in chronic heart failure but should be withheld with acute episodes of failure

69
Q

Can thiazolidinediones be used in heart failure?

A

No

70
Q

Which hypoglycaemic agent reduces hospitalisations for heart failure, with and without diabetes?

A

SGLT2 inhibitors

Endocrinology (6 decks)

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