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MB2: Endocrinology > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what is the general resting fasting blood glucose

A

4-7mmol/L

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2
Q

true/false - blood glucose tends to decrease with age

A

false - it increases

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3
Q

cutoff for diabetes - fasting plasma glucose

A

> 7mmol/L

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4
Q

cutoff for diabetes - 2hr plasma glucose tolerance tesrt

A

> 11.1mol/L

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5
Q

cutoff for diabetes - HbA1c

A

> 48mmol/mol

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6
Q

predibetes cutoff for fasting plasma glucose

A

6.1-6.9mol/L

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7
Q

prediabetes cutoff for 2hr glucose tolerance test

A

7.8-11.0mol/L

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8
Q

prediabetes cutoff for HbA1c

A

42-47mmol/mol

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9
Q

cutoff normal glucose fasting tolerance

A

<6.0mol/L

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10
Q

cutoff normal glucose 2hr tolerance test

A

<7.7mol/L

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11
Q

cutoff normal HbA1c

A

<41mmol/mol

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12
Q

what is C peptide a measure of and when may it be useful

A

measures endogenous insulin production as a byproduct of insulin production
measures intrinsic insulin production as s/c or IV insulin do not have C peptide

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13
Q

pancreatic disease leading to diabetes

A 
CF
haemachromatosis 
pancreatic cancer
alcohol/chronic pancreatitis 
acute pancreatitis
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14
Q

what positive blood test must type 1 diabetics have

A

pancreatic autoantibodies

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15
Q

presentation of diabetes

A 
asymptomatic 
polyuria 
high blood glucose 
blurred vision 
genital thrush 
fatigue 
weight loss 
lost vision 
diabetic ketoacidosis 
HHS
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16
Q

microvascular complications hyperglycaemia

A

retiniopathy
nephropathy
neuropathy

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17
Q

macrovascular complications of hyperglycaemia

A

MI/ACS
stroke
peripheral vascular disease
dislipidaemia may help contribute to hypertension

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18
Q

what is HbA1c and why is it of value

A

glycated Hb, absorbed into RBC and binds to Hb and due to 3/4 month lifespan on erythrocyte it estimates diabetic activity over 3/4 months

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19
Q

when is HbA1c not of good use

A

haemolytic anaemia
pregnancy
recent blood loss

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20
Q

target for HbA1c

A

48-58mmol/mol
48 for new diabetics or if possible
53 for all diabetics
58 for those on triple therapy/insulin or if others unachievable

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21
Q

what HbA1c target is high and considered a risk for DKA

A

> 75mmol/mol

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22
Q

at what random glucose would ketones need measured for risk of DKA

A

> 15mol/L

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23
Q

what other treatments may be used in addition to diabetes management to prevent cardiovascular complications

A

antiplatelet therapy
antihypertensives
cholesterol control (statins)

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24
Q

what % weight loss may result in remission for diabetes 2

A

10/15%

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25
Q

what dietary modifications should be made for type 2DM

A

reduce fat intake
increase fruit modestly and veg aggressively
reduce salt
safe alcohol consumption
normal unrefined carbs but less refined carbs
exercise therapy

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26
Q

what HbA1c target is used for the elderly with dementia

A

there isnt, treat symptomatically in line with end of care

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27
Q

what one action is key to global t2dm prevention

A

weight reduction

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28
Q

describe diabetes incidence and prevalence in scotland

A

indicence is stable for 5 years but prevalence is increasing - likely due to increased lifespan

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29
Q

barriers for preventing diabetes

A

health inequality
evaluating if the programme works
obesogenic environment
identifying those at high risk and engaging them

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30
Q

overcoming identifying those at high risk of T2D

A

screen for impaired glucose tolerance and others

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31
Q

overcoming health inequality for those at risk of T2DM

A

no easy fix at all

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32
Q

overcoming obesogenic environment?

A

sugar tax

political agenda, supported by food industry and healthcare professionals

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33
Q

evaluating if the healthcare programme is working

A

high quality data collection

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34
Q

DIRECT clinical trial used what method to try and induce diabetes remission

A

complete diet replacement at 830kcal for 12-20 wks

stepped 400kcal meal introduction every 2-3 weeks and stepping up exercise

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35
Q

findings of DIRECT clinical trial?

A

almost 1/2 came off diabetes meds for >2m and had HbA1c<48mmol/mol
80% of those who lost >10kg remained in remission for >12 months

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36
Q

non modifiable risk factors for type 2 diabetes

A

family history
ethnicity
age

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37
Q

modifiable risk factors for type 2 diabetes

A

sedentary lifestyle
energy dense diet
overweight/obese

38
Q

how much sustained weight loss is recommended in overweight/obese people

A

> 5%

39
Q

nutrition - what should be reduced in type 2 diabetes

A

energy dense foods and drinks
fast foods
alcohol
sedentary behaviour

40
Q

nutrition - what should be encouraged in type 2 diabetes

A

lower energy foods/drinks
moderate/vigorous activity
self weighing

41
Q

describe carb counting in type 1 diabetes

A

identifying foods containing carbohydrate and counting content
calculating insulin dose to cover carbohydrates eaten

42
Q

causes of hypoglycaemia is type 1 diabetes

A 
missed/delayed meal 
alcohol
too much insulin
increased physical activity 
not enough carbohydrate in meal
43
Q

why does alcohol cause hypoglycaemia in type 1 diabetes

A

inhibits gluconeogenesis and enhances effects of insulin

44
Q

reducing risk of hypoglycaemia in type 1 diabetes

A

carry emergency supply of CHO
check blood glucose regularly
dont consume alcohol on empty stomach

45
Q

how much physical activity should an adult have a week

A

150 mins moderate/75 mins vigorous activity a week with 2 days strength training

46
Q

how much physical activity should a child 5-18 have per day

A

1 hour

47
Q

how much physical activity should a child <5 have a day

A

180 mins of being active

48
Q

describe the peak incidence of type 1 diabetes

A

10-15 but can occur from 6m to 70-80s

49
Q

true/false - T1DM is more common in Caribbean populations

A

false - it is more common in white

50
Q

what % of diabetics are type 1

A

around 10%

51
Q

true/false - most of those with diabetes are in wealthy countries and 1/3 are undiagnosed

A

false - most are in middle/low income countries and 1/2 are undiagnosed

52
Q

what factors have influence over health inequalities

A 
socioeconomic status 
education 
rural 
LGBT
gender 
ethnicity 
cultural factors
53
Q

what is the fat storage threshold

A

insulin resistance occurs when fat can no longer be stored in s/c fat and spills over FFA to viscera

54
Q

describe how FFA spilling over to viscera causes insulin resistance

A

fat in muscle, liver, pancreas causes pooer glucose reception so poorer insulin release
in functional beta cells they produce more insulin to counter this
in genetic disposition, there are vulnerable beta cells to cannot cope with higher blood glucose

55
Q

what other conditions other than diabetes is insulin resistance associated with

A

polycystic ovarian syndrome
hypertension
hyperlipidaemia
hyperglycaemia - even in absent diabetes

56
Q

microvascular complications of diabetes

A

neuropathy
nephropathy
retinopathy

57
Q

macrovascular complications of diabetes

A

cardiovascular disease
peripheral vascular disease
cerebrovascular disease

58
Q

solutions to fingerprick glucose monitoring

A

continuous glucose monitoring

flash glucose monitoring

59
Q

what are possible disadvantages of continuous glucose monitoring

A

cost
pt doesnt like having it attached
20 min delay in reading as measures interstitial glucose

60
Q

what are the units used in flash glucose monitoring

A

mg/dl

61
Q

lifestyle activities needing attention for living with diabetes

A 
diet 
previous/upcoming activities 
exercise 
taking insulin 15 mins before meals 
blood glucose monitoring 
hypoglycaemai 
appointments 
blood pressure/ cholesterol management 
work 
pregnancy
62
Q

what is diabetes distress

A

affective state from constant worry and adherence with diet, exercise, blood glucose monitoring, lifestyle adjustment

63
Q

how many patients with diabetes experience poor mental wellbeing/emotional distress

A

40-50%

only roughly 1/3 patients are asked about their wellbeing

64
Q

complication of hypoglycaemia in early onset type 1 diabetes?

A

neurological deficit and impaired cognitive function

65
Q

chronic hyperglycaemia in type 2 diabetes can lead to what psychological factors?

A

poorer mental and physical health
less motivation
poorer relationships
worse learning and memory

66
Q

why is it important to identify emotional distress in diabetics

A

if not, it can lead to poorer glucose control, increased admission, greater mortality and complications due to downward spiral

67
Q

how can doctors reduce psychosocial aspects of diabetes

A

educate the patient
listen to their perspective and refer if needed
tailor the treatment to the patients confidence, goals and support them

68
Q

when should you especially ask a patient about how they feel having diabetes

A

after missing goals, diagnosis and onset of complications

69
Q

what is type 1 diabetes

A

state of absolute insulin deficiency

environmental stimulus in genetically susceptible individual leads to aa pancreatic beta cell destruction

70
Q

what % of those with T1DM are diagnosed before 20

A

85%

71
Q

what % of diabetic type 1 genes are HLA II related and what specific genes does this relate to

A

50%
HLA-DR3-DQ2
HLA DR4-DQ8

72
Q

environmental factors affecting type 1 diabetes?

A 
seasonality 
timing of birth 
genes - 5% HLA +ve
viral infection 
maternal factors 
weight gain 
vitamin D
73
Q

what immune cell mediates the beta cell destruction in T1DM

A

lymphocytes

74
Q

antibodies used in diagnosing T1DM

A 
GAD65Ab
IA-2Ab
IAA
ZnT8Ab
if anti-GAD, IA-2 and ZnT8 are +ve then T1DM can be diagnosed
75
Q

what T1DM Ab is most useful in older patient diagnosis

A

Anti-GAD(65Ab)

76
Q

maternal risk factors for developing T1DM

A 
infection 
age 
ABO mismatch 
stress
birth order
77
Q

autoimmune trigger factors for developing T1DM

A

viral infection
vitamin d deficiency
dietary factors
environmental factors

78
Q

accelerating factors for developing T1DM

A 
puberty
diet/weight 
infection 
stress
insulin resistance
79
Q

true/false - C peptide should be taken at T1DM diagnosis

A

false - it should be taken after months/years to check intrinsic insulin function

80
Q

what is LADA

A

late onset T1DM misdiagnosed as type 2

81
Q

what is idiopathic T1DM

A

permanent insulinopenia and prone to DKA but no evidence of beta cell autoimmunity
african, asian with strong inheritance pattern and not HLA assd

82
Q

clinical presentation demographic for T1DM

A 
pre school and peri puberty 
small peak mid 30s 
lean 
acute onset 
severe symptoms 
severe weight loss 
ketonuria ± metabolic acidosis
83
Q

symptoms of T1DM

A 
thirst 
polyuria 
thrush 
weakness 
weight loss 
fatigue 
blurred vision 
infection
84
Q

what should be done to manage a new T1DM pt

A 
basal bolus insulin
education - DAFNE BERTIE 
dietician contact 
carb count to insulin bolus 
blood glucose + ketone monitor 
annual HbA1c, renal, lipid, weight, BP, foot risk, retinal
85
Q

safety issues in insulin prescription

A

wrong dose
wrong type
insulin omission

86
Q

name 2 soluble insulin preparations, onset time, peak and duration

A

actrapid, humulin S
30-60 mins
2-4hr
5-8 hrs

87
Q

name 2 insulin analogues, onset time, peak and duration

A

humalog, novorapid
15 mins
60-90 mins
4-5hrs

88
Q

why are insulin analogues preferred over soluble insulin

A

faster acting and less chance of hypoglycaemia

89
Q

name 2 basal dose insulin analogues, dosage time, how long they last

A

lantus, levemir
long acting with little peak activity
taken once or twice daily

90
Q

name 2 basal insulin preparations, how long they last

A

insulatard, humulin I
peak 4-6hrs
long acting

MB2: Endocrinology (13 decks)

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