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endocrine > diabetes > Flashcards

diabetes Flashcards

1
Q

What is Type I diabetes?

A

The autoimmune destruction of insulin secreting β pancreatic cells

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2
Q

What is the normal age of onset of Type I diabetes?

A

Normally adolescence but can happen at any age

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3
Q

What are the two most likely complications of TI diabetes?

A

Ketoacidosis and weight loss

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4
Q

What is Type II diabetes?

A

Decreased insulin secretion, increased insulin resistance

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5
Q

When is the normal age of onset for Type II diabetes?

A

Normally in later age as it is due to lifestyle and diet rather than genetic factors

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6
Q

In what demographic is the highest prevalence of TII diabetes?

A

Asians, the elderly, men

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7
Q

What are factors that influence development of TII diabetes?

A

Obesity, lack of exercise, calorie excess, alcohol excess

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8
Q

What is the preliminary phase of TII diabetes?

A

Impaired fasting glucose or impaired glucose tolerance

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9
Q

What is MODY?

A

Maturity Onset Diabetes of the Young - rare autosomal dominant TII diabetes affecting young people

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10
Q

What is normal range for impaired glucose tolerance?

A

Fasting plasma glucose < 7mmol/L

Oral glucose after 2hr 7.8 - 11.1mmol/L

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11
Q

What is normal range for impaired fasting glucose?

A

Fasting plasma glucose 6.1 - 7mmol/L

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12
Q

What is the management for impaired fasting glucose or glucose tolerance?

A

Lifestyle advice, OGTT to exclude diabetes mellitus

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13
Q

Primary causes of diabetes mellitus

A

Steroids, anti-HIV drugs, new antipsychotics

Congenital lipodystrophy, glycogen storage diseases

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14
Q

What are pancreatic causes of diabetes?

A

pancreatitis, pancreatectomy, trauma, destruction of pancreas, pancreatic Ca

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15
Q

What are endocrine causes of diabetes?

A

Cushing’s, acromegaly, phaechromocytoma, hypERthyroidism, pregnancy

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16
Q

What is metabolic syndrome?

A

Central obesity: BMI > 30 and

BP > 130/85 OR 3glycerides >1.7mmol/L OR HDL < 1.29mmol/L OR fasting glucose > 5.6mmol/L OR TII DM

17
Q

What are some risk factors for metabolic syndrome?

A

Weight, genetics, insulin resistance

18
Q

What is the management for metabolic syndrome?

A

Exercise, weight loss, treatment of individual components and symptoms

19
Q

What are the criteria to diagnose DM?

A

Symptoms of hyperglycaemia: polydipsia, polyuria, weight loss, visual blurring, genital thrush, lethargy AND
Raised venous glucose ONCE: fasting > 7mmol/L, random > 11.1mmol/L OR TWICE fasting, random or OGTT 2h > 11.1mmol/L
HbA1c > 48mmol/mol - not for pregnant, children, T1DM, haemoglobinopathies

20
Q

What are the characteristic features of T1 DM?

A

Unintentional weight loss, persistent hyperglycaemia despite diet, presence of autoantibodies - islet cell and GAD, ketonuria

21
Q

What is an epidemiological difference between T1 and T2 DM?

A

T1: often starts before puberty
T2: usually older patients

22
Q

What is a genetic difference between T1 and T2 DM?

A

T1: HLA D3, D4 linked
T2: no HLA association

23
Q

What is a causal difference between T1 and T2 DM?

A

T1: autoimmune β pancreatic cell destruction
T2: insulin resistance and β cell dysfunction

24
Q

What is a difference in presentation between T1 and T2 DM?

A

T1: polydipsia, polyuria, weight loss, ketosis
T2: asymptomatic or complications eg MI

25
Q

What are the long and short term blood test for glucose?

A

Short: random, fasting, venous
Long: HbA1c - 8 weeks of glucose control

26
Q

What is general management for diabetes?

A

Education: exercise to increase insulin sensitivity
Lifestyle: healthy eating - less sat fats, sugar, more starch carbohydrates, moderate proteins
Set HbA1c targets for every 3-6 months
Start high intensity statin eg atorvastatin
Assess global vascular risk
Give foot care
DVLA for driving

27
Q

What is the management for T2 DM?

A

Lifestyle: diet, weight control, exercise
Monotherapy: standard release metformin 1st line
IF HbA1c rises > 58mmol/mol, ?dual therapy:
Metformin + sitagliptin
Metformin + pioglitazone (PG)
Metformin + sulfonylurea (SU)
Metformin + glifazon
IF HbA1c rises > 58mmol/mol, ?triple therapy:
Met + DPP4 inhibitor + SU
Met + PG + SU
Met + SU/PG + SLGT-2i
Insulin-based therapy

28
Q

What are the complications of diabetes?

A 
Injection site infection/lipohypertrophy
Vascular disease, macro and microscopic
Nephropathy
Retinopathy - cataracts 
Rubeosis iridis
Metabolic complications
Diabetic feet 
Neuropathy
29
Q

What types of insulin are there?

A

Short, medium and fast acting, in strengths of 100 units/ml

30
Q

What are fast acting insulins and when are they used?

A

Humalog, Novorapid, ultra fast acting, injection at start of meal to match what is eaten/planned

endocrine (2 decks)

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