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Pass Medicine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is type 1 diabetes?

A

This is where autoimmune beta cell destruction occurs in the islets of Langerhan in the pancreas.

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2
Q

Clinical features of T1DM?

A 
Polyuria
Polydipsia
Weight loss
Fatigue
Infections
DKA
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3
Q

What is T2DM caused by?

A

Resistance to the peripheral action of insulin

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4
Q

Is there a genetic component in T2DM?

A

Yes, if one genetically identical twin has it there is a 90% chance the other twin gets it

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5
Q

What are the clinical features of diabetes?

A

80% overweight
Polyuria
Polydipsia
20% present with complications of T2DM e.g. ischaemic heart disease, CVD, foot ulcers of visual changes)

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6
Q

How do we manage T1DM?

A

Insulin to control

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7
Q

What are side effects of insulin?

A

Hypoglycaemia
Weight gain
Lipodystrophy

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8
Q

What is the first line drug in T2DM?

A

Metformin in the majority of cases

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9
Q

What drugs can be used if metformin is not appropriate/enough?

A

Sulfonylureas
Gliptins
Pioglitazone

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10
Q

How do sulfonylureas work?

A

Stimulate pancreatic beta cells to secrete insulin

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11
Q

Examples of sulfonylureas?

A

Gliclazide

Glimepiride

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12
Q

Side effects of sulfonylureas?

A

Hypoglycaemia
Weight gain
Hyponatraemia

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13
Q

MOA of gliptins (DPP-4 inhibitors)?

A

Increases incretin which inhibits glucagon secretion

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14
Q

How does pioglitazone work?

A

Increases fatty acid uptake and adipogenesis - thiazolidinedione

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15
Q

Side effects of pioglitazone?

A

Weight gain

Fluid retention

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16
Q

How do we diagnose diabetes?

A

Fasting glucose >7
Random glucose >11.1
^ provided they’re symptomatic

If patients are asymptomatic, those readings must be found twice

Also glucose tolerance test:
Give 75g oral glucose
See if glucose is about 11.1 after 2 hours, (7.8+ indicates impaired tolerance)

> 6.5% HbA1c can also be used to diagnose diabetes

17
Q

What is a HbA1c?

A

A way of monitoring diabetes control. It measures the percentage of glycosylated haemoglobin in the blood over the past 2-3 months.

18
Q

How do we differentiate complications of DM?

A

Microvascular vs macrovascular

19
Q

What are the microvascular complications of DM?

A

Retinopathy
Nephropathy
Neuropathy

20
Q

What are the sick day rules in diabetes?

A

Don’t stop medications even if you’re not eating too much - cortisol from illness increases glucose levels in the blood, just monitor more closely your blood sugar levels.
Only exception is maybe metformin (which you may potentially need to stop if becoming dehydrated because of AKI)

21
Q

Features of diabetic retinopathy

A

1/3 people with diabetes get diabetic retinopathy
5% are blind within 30 years

The pathology is that you get thickening of the basement capillary membrane which results in:
Haemorrhage
Hard exudates
Occluded vessels
Macular oedema
22
Q

How can we treat diabetic retinopathy?

A

Yearly eye checks (before developing the condition) - manage glycaemia/BP
Laser retinal photocoagulation in later stages

23
Q

What is diabetic nephropathy?

A

This is where you get thickening of the glomerular basement membrane eventually leading to reduced eGFR

24
Q

What are indicators of diabetic nephropathy?

A

Albuminuria

25
Q

Symptoms of diabetic nephropathy?

A

Oedema
HTN
Uraemia

26
Q

How do we manage diabetic nephropathy?

A

ACEi
Good glycaemic control
Aspirin

27
Q

What are the characteristics of diabetic neuropathy?

A

Sensory loss NOT motor loss
Glove and stocking
Loss of vibration sense (first)

28
Q

How do we treat painful diabetic neuropathy?

A

First-line:

Amitryptlline, duloxetine, pregabalin or gabapentin

29
Q

Cataracts and diabetes?

A

Usually get cataracts 10-15 years earlier

30
Q

Macrovascular diabetes complications?

A

Cerebrovascular risk - 2x
Coronary artery disease - 3x
PVD - 40x

31
Q

What is diabetic foot a result of?

A

PAD

Peripheral neuropathy

32
Q

Features of diabetic foot

A

Loss of sensation
Absent foot pulses
Reduced ABPI
Intermittent claudication

Complications:
Calluses, ulceration, Charcot’s arthropathy, cellulitis, osteomyelitis, gangrene

33
Q

How do we manage diabetic foot?

A

Screen for it on an annual basis:
Palpate the pulses
10g monofilament used on the sole of foot to check for neuropathy

Pass Medicine (24 decks)

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