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Diploma exam > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

Adult T1DM target fasting (on waking) BMs

A

5-7mmol/l

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2
Q

Adult T1DM target pre-prandial BMs

A

4-7mmol/L

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3
Q

Adult T1DM target post-prandial BMs

A

5-9mmol/L

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4
Q

Target HbA1c in diabetes

A

<48mmol/mol

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5
Q

Adult T2DM target pre-prandial BMs

A

4-7mmol/L

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6
Q

Adult T2DM target post-prandial BMs

A

<8.5mmol/L

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7
Q

Adult T2DM target bedtime BMs

A

6-10mmol/L

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8
Q

Target blood pressure in T1DM

A

<135/85mmHg

Albuminuria or >2 features of metabolic syndrome <130/80mmHg

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9
Q

Target blood pressure in T2DM

A

<140/80mmHg

Kidney, eye or cerebrovascular damage <130/80mmHg

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10
Q

Examples of factors which increase insulin requirements

A

Infection, accident, trauma, obesity, drug therapy, puberty and pregnancy

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11
Q

Examples of factors which decrease insulin requirements

A

Renal, hepatic impairment, endocrine disorders or coeliac disease

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12
Q

What types of insulin are Novorapid (insulin apart) and Humalog (insulin lispro)

A

Rapid-acting insulins
Onset of action = 10-20mins
Duration is 3-5 hours

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13
Q

What types of insulins are Humulin S, act rapid and Insuman?

A

Short-acting insulins
Onset of action is 30mins -1 hour, should be injected before meals
Duration of action = 6-8 hours

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14
Q

What type of insulins are Humulin I, insulatard?

A

Intermediate acting examples
Usually administered OD or BD
Onset of action is 1.5hours
Duration of action is 8-14 hours

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15
Q

Causes of DKA

A

Undiagnosed diabetes, interruption to insulin therapy, acute illness, trauma, infection,

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16
Q

Clinical features of DKA

A

Polyuria, polydipsia, polyphasic, lethargy, nausea and vomiting, SOB & Kussmaul breathing, abdominal pain, confusion, coma
Dehydration, tachycardia, hypotension, hyperventilation, drowsiness

17
Q

DKA - acute management

A

Rehydrate - 0.9% saline
Replace electrolytes lost
Commence high rate IV insulin 0.1 unit/kg/hour
Once BMs <14 prescribe glucose containing fluids

18
Q

What do NICE advise as the gold standard insulin regimen in T1DM?

A

Offer multiple daily injections basal-bolus insulin regimens

19
Q

HONK precipitating factors

A 
Undiagnosed T2DM
Glucose drinks
thiazides/steroids 
Illness
Non-compliance with anti-diabetic medications
20
Q

How do sulphonylureas work?

A

Increased pancreatic beta cell sensitivity to glucose

Long term use increases tissue sensitivity to insulin

21
Q

Pioglitazone counselling

A

Weight gain

Haematuria, dysuria and urinary urgency - signs of bladder cancer

22
Q

Pioglitazone MHRA alert

A

European review found increased incidence of heart failure when pioglitazone was used in combination with insulin
Observe for signs and symptoms of HF, weight gain and oedema
Pioglitazone should be discontinued in any deterioration in cardiac status occurs

23
Q

What class of medications is sitagliptin?

A

DPP-4 inhibitor

24
Q

NICE algorithm for treatment of T2DM

A

1st line - metformin
2nd line - metformin and SU
3rd line - metformin, SU and intermediate insulin

25
Q

When should patients with T1DM be offered a statin?

A

Offer atorvastatin 20mg ON to adults with T1DM who are older than 40 years OR have had diabetes fore more than 10 years, have established nephropathy or have other CVD risk factors

26
Q

When should patients with T2DM be offered a statin?

A

Estimate risk using QRISK2 - offer if risk >10%

27
Q

What general advice would you provide a patient regarding the storage of insulin?

A

Before opening - store in fridge at 2-8’C
During use store below 25’C for up to 4 weeks
Protect vial/cartridge from light
On holiday store in a cool bag. Never lean in airplane hold as can freeze

28
Q

How many units should insulin be adjusted by at a time?

A

Usually insulin doses are adjusted by 2 units each time or 10%

29
Q

Why does DKA occur?

A

DKA results from absolute deficiency of insulin. Lack of insulin means the body cannot use glucose for energy, and the body starts to breakdown fats as energy source. Ketones are the by-product of this process. Ketones have a low pKa therefore turn the blood acidic

Diploma exam (3 decks)

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