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Long Case UoA > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the metabolic effects of insulin and glucagon?

A 
Insulin = bind to insulin receptor to increase GLUT4 receptors on cell; powers the Na+/K+ transporter
Glucagon = breakdown glycogen
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2
Q

Where are insulin and glucagon produced?

A

Islets of Langerhans in the pancreas; Insulin (beta cells); glucagon (alpha cells)

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3
Q

What are the defining features of T1DM?

A

10% of DM population; Cell-mediated immune response to beta cells; often associated with HLA dysfunction

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4
Q

What are the symptoms of hyperglycaemia?

A

Weight loss, hungry and thirsty, glycosuria and polyuria; frequent infections, blurry vision, lethargy.

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5
Q

What is the pathophysiology of DKA?

A

Relative starvation causes lipids and ketones to be metabolised. Ketones are active acids; causing acidosis

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6
Q

What are the symptoms of DKA?

A

Kussmaul respiration (deep/laboured breathing; often fruity) + nausea/vomitting + mental status changes + cerebral odema

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7
Q

What are the signs of DKA?

A

Hyperkalemia + high anion gap + dehydration + high BSL

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8
Q

What is the mainstay of treatment for DKA?

A

Fluids + Insulin + K+ supplementation

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9
Q

What is the pathophysiology of T2DM?

A

Insulin resistance; body makes insulin but doesnt respond to it causing beta cell hyperplasia and hypertrophy (unsustainable). Exact pathophysiology not well understood.

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10
Q

What are common risk factors for T2DM?

A
  • Obesity
  • Hypertension
  • Lack of exercise
  • Genetic factors/ FHx
  • Maternal/personal gestational DM
  • Drugs (e.g. steroids)
  • PCOS
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11
Q

Define HHS/HONK

A

Hyperosmolar hyperglycemic state/ hyperosmotic nonketotic coma: increased osmolarity from dehydration due to hyperglycemia (an osmotically active compound)

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12
Q

What are the signs of HHS?

A

Mild ketonemia and acidosis (not to extent of DKA); NO anion gap.

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13
Q

What are the symptoms of HHS?

A

Mental status changes, coma

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14
Q

What are the diagnostic cut offs for diabetes?

A 
2x Fasting glucose >7mmol/L 
2 hour post prandial glucose >11mmol/L
HBA1C 
>50
Urine/plasma ketones
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15
Q

Describe some lifestyle treatments for T2DM

A
  • Losing weight ~5% TBW = VERY LOW CALORIE
  • Healthy diet (less sugary beverages/saturated fats)
  • Exercise at least 30 min a day/5 days a week
  • Quit smoking
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16
Q

What is the generalised treatment pathway for T2DM?

A

Trial lifestyle intervention for at least 3 months + metformin (first line); followed by other oral agents. Consider CVR and manage other cardiac risk factors aggressively. Monitor for complications and ensure adequate follow up and review.

17
Q

What are the foundations for insulin therapy for T2DM?

A
  • Should be considered if HBA1C >75 despite PO meds
  • Risk of hypoglycemia
  • Start with ~10IU isophane (intermediate acting insulin) OD/BD
  • Titrated with effect, need to ensure moving injection site
18
Q

Describe metformin

A
  • Works by increasing peripheral insulin sensitivity
  • Can cause nausea/diarrhoea and LACTIC ACIDOSIS; may reduce B12 absorption
  • Reduce dose if CKD (GFR < 45); avoid if significant (<30)
  • 500mg OD - BD with food; up to 3mg/day
  • Withhold if acutely unwell
19
Q

Describe sulfonylureas

A
  • Glipizide (5mg BD for thin pts), gliclazide (40mg BD obese pts)
  • Works by increasing pancreatic insulin production
  • Can cause HYPOglycemia and weight gain
20
Q

What are the symptoms of hypoglycemia?

A

Weakness, hunger, shaking, sweating, blurred vision, lightheadedness –> LOC, seizures, coma. Typically <4mmol/L

21
Q

What is the treatment of hypoglycemia?

A

Sugar/food (e.g. 7-10 jellybeans) –> IV dextrose –> glucagon. Recheck after 5-10min. Repeat if neccessary.

22
Q

What are the TOP 5 complications of uncontrolled diabetes?

A

Artherosclerosis ++ –> heart attacks, strokes, retinopathy, nephropathy and peripheral neuropathy and vascular disease

23
Q

What are the signs of diabetic retinopathy?

A

Cotton wool spots, flare haemorrhages on fundoscopy, neovascularisation +/- blindness. Should be tested every 2 years.

24
Q

What are the signs of diabetic nephropathy?

A

Initially microalbuminuria or ACR (30mg/day) –> proteinuria on dipstick. Treat with BP control (ACEi)

25
Q

Describe SGLT2 inhibitors

A
  • Dappagliflozin
  • Increase urinary excretion of glucose
  • Newly funded
  • Also known to help with weight loss
  • Risk of UTI
26
Q

What are the glycaemic targets for T2DM?

A

HBA1C 50-55mmol/moL
May be higher if high risk of hypoglycaemia
BSL aim between 6-10mmol/L

27
Q

Describe BP control in T2DM

A

Treatment if >140/90 or >130/80 + proteinuria. Tighter control warranted (aim SBP <120mmHg). Critical to delay diabetic complications. ACEi/ARB first line

28
Q

What to look for on a foot check?

A

Look for peripheral vascular disease AND neuropathy. Encouraged yearly (or ever 3 months if at high risk)

29
Q

What are the causes of hypoglycemia?

A
  • Too much insulin/oral medication
  • Not enough food (e.g. if drinking)
  • Exercising too much
  • Injection errors
30
Q

What are common secondary causes of diabetes?

A
  • Drugs (such as atypical antipsychotics, thiazide diuretics, steroids)
  • Cushings disease
  • Acromegaly
  • Hyperthyroidism
  • Pancreatitis or pancreatic cancer, surgery or destruction (e.g. haemochromatosis)
31
Q

What are appropriate investigations for T2DM?

A

Renal function, lipids, LFTs, TSH, ACR

32
Q

Describe DPP4 inhibitors

A
  • Vildagliptin
  • Can be prescribed as formulation tablet
  • Act by inhibiting degredation of incretin peptides
  • No risk of hypoglyceamia or weight gain
  • Can be used in CKD but can CAUSE liver dysfunction, dizziness
33
Q

Define MODY

A

Maturity Onset Diabetes of the Young - rare autosomal dominant form of T2DM. Associated with hearing loss.

34
Q

Describe neurological complications of diabetes

A
  • Sensory neuropathy (symmetrical, vibration>pain, glove and stocking dist)
  • Painful neuropathy (burning pain that improves with control)
  • Mononeuropathies (e.g. medial nerve –> carpel tunnel, peroneal nerve –> foot drop, CNIII palsy)
  • Autonomic neuropathy (gastroperesis, nocturnal diarrhoea, tachycardia, postural hypotension, atonic bladder, sexual dysfunction)
35
Q

What are the four antibodies associated with T1DM?

A
  • Insulin antibody
  • Islet Cell Antibody
  • Insulinoma Antigen
  • Anti-Gad

Long Case UoA (4 decks)

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