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Endocrinology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diagnostic criteria for DKA

A

Hyperglycaemia (blood glucose >11)
Acidosis (pH <7.3)
Ketosis (blood ketones > 3mmol/l)

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2
Q

Insulin therapy and potassium

A

Insulin drives potassium into cells

Serum potassium can be high or normal without insulin - kidneys work to balance this (overall potassium low)

Insulin treatment can cause hypokalaemia, can lead to fatal arrythmias

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3
Q

Presentation of DKA

A 
Hyperglycaemia
Dehydration
Ketosis
Metabolic acidosis (with a low bicarbonate)
Potassium imbalance
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4
Q

Management of DKA

A

FIGPICK

F - Fluids - resuscitation
I - Insulin - Actrapid
G - Glucose - monitor (dextrose infusion if falls below certain level
P - Potassium - monitor
I - Infection - treat potential underlying figures
C - Chart - fluid balance
K - Ketones - monitor

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5
Q

Dangers of not cycling injection sites

A

Lipodystrophy

Subcat fat hardens, insulin not properly absorbed

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6
Q

Symptoms of hypoglycaemia

A 
Tremor
Sweating
Irritability
Dizziness
Pallor
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7
Q

Treatment of hypoglycaemia

A

IM glucagon

IV dextrose

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8
Q

Macrovascular Complications of diabetes

A

Coronary artery disease is a major cause of death in diabetics
Peripheral ischaemia causes poor healing, ulcers and “diabetic foot”
Stroke
Hypertension

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9
Q

Microvascular Complications of diabetes

A

Peripheral neuropathy
Retinopathy
Kidney disease, particularly glomerulosclerosis

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10
Q

Infection Related Complications

A

Urinary Tract Infections
Pneumonia
Skin and soft tissue infections, particularly in the feet
Fungal infections, particularly oral and vaginal candidiasis

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11
Q

Risk Factors in T2DM

A

Non-Modifiable
Older age
Ethnicity (Black, Chinese, South Asian)
Family history

Modifiable
Obesity
Sedentary lifestyles
High carbohydrate (particularly refined carbohydrate) diet

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12
Q

Glucose levels in pre-diabetes

A

HbA1c – 42-47 mmol/mol
Impaired fasting glucose – fasting glucose 6.1 – 6.9 mmol/l
Impaired glucose tolerance – plasma glucose at 2 hours 7.8 – 11.1 mmol/l on an OGTT

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13
Q

Diagnosis of T2DM

A

HbA1c > 48 mmol/mol
Random Glucose > 11 mmol/l
Fasting Glucose > 7 mmol/l
OGTT 2 hour result > 11 mmol/l

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14
Q

Management of T2DM

A

Dietary Modification
Optimise Other Risk Factors
Monitoring for Complications

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15
Q

What does metformin do?

A

Increases sensitivity to insulin

Decreases liver production of glucose

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16
Q

Second line treatment of T2DM

A

Sulfonylurea
Pioglitazone
DPP-4 inhibitor
SGLT-2 inhibitor

17
Q

Side effects of metformin?

A

Diarrhoea and abdominal pain. This is dose dependent and reducing the dose often resolves the symptoms
Lactic acidosis
Does NOT typically cause hypoglycaemia

18
Q

What is Pioglitazone?

A

Thiazolidinedione

Increases insulin sensitivity and decreases liver production of glucose

19
Q

Side effects of Pioglitazone

A 
Weight gain
Fluid retention
Anaemia
Heart failure
Extended use may increase the risk of bladder cancer
Does NOT typically cause hypoglycaemia
20
Q

Most common sulfonylurea

A

Gliclazide

Stimulate insulin release from the pancreas

21
Q

Side effects of sulfonyluria

A

Weight gain
Hypoglycaemia
Increased risk of cardiovascular disease and myocardial infarction when used as monotherapy

22
Q

What is the function of incretins?

A

Increase insulin secretions
Inhibit glucagon production
Slow absorption by the GI tract

Main incretin - GLP-1
Incretins inhibited by DPP-4

23
Q

Most common DPP-4 inhibitor

A

Sitagliptin

Inhibits DPP-4 enzyme and therefore increases GLP-1 activity

24
Q

SIde effects of sitagliptin

A

GI tract upset
Symptoms of upper respiratory tract infection
Pancreatitis

25
Q

Examples of SGLT-2 inhibitors

A

Empagliflozin
Canagliflozin
Dapagliflozin

26
Q

How do SGLT-2 inhibitors work

A

Block the SGLT-2 glucose reuptake channels in the proximal tubules

27
Q

Side effects of SGLT-2 inhibitors

A

Glucoseuria (glucose in the urine)
Increased rate of urinary tract infections
Weight loss
Diabetic ketoacidosis, notably with only moderately raised glucose. This is a rare complication
Lower limb amputation appears to be more common in patients on canagliflozin. It is not clear if this applies to other SGLT-2 inhibitors

28
Q

Rapid Acting Insulins

A

Start working after around 10 minutes and last around 4 hours

Novorapid
Humalog
Apidra

29
Q

Short-acting Insulins

A

Start working in around 30 minutes and last around 8 hours

Actrapid
Humulin S
Insuman Rapid

30
Q

Intermediate-acting Insulins

A

Start working in around 1 hour and last around 16 hours

Insulatard
Humulin I
Insuman Basal

31
Q

Long-acting Insulins

A

Start working in around 1 hour and lasts around 24 hours

Lantus
Levemir
Degludec (lasts over 40 hours)

32
Q

What do combination insulins contain?

A

Rapid acting and Intermediate acting insulin

Endocrinology (5 decks)

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