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Finals > Diabetes > Flashcards

Diabetes Flashcards

1
Q

what is normal BG levels?

A

3.5 - 8 mmol/L

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2
Q

what is T1DM?

A

autoimmune destruction of the pancreatic B cells. Occurs in genetically susceptible individuals/triggered by an environmental antigen.

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3
Q

Features of T1DM? what causes these?

A

thirst - due to electrolyte losses
polyuria - osmotic diuresis with high glucose
weight loss - fluid depleted
DKA

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4
Q

what is the diagnostic criteria for DM?

A

fasting glucose >7

random glucose >11.0

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5
Q

How do you manage T1DM?

A

EDUCATE - foot care/healthy weight/stop smoking
DIET - low in sugar/high in starchy carbs/low fat
BG MONITORING
INSULIN - long acting morning and night and short acting before food

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6
Q

what are some complications of insulin treatment?

A

hypoglycaemia, lipohypertrophy, local allergic reaction, insulin resistance, weight gain

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7
Q

what are the features of hypoglycaemia?

A

symptoms <3.0mmol/L glucose

hunger, sweating, pallor, tachycardia, unconscious, fit

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8
Q

Mx for hypoglycaemia?

A

glucogel, IV dextrose

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9
Q

what is T2DM?

A

polygenic disorder, linked with central obesity. B cell mass is reduced by 50% and there is peripheral insulin resistance

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10
Q

features of chronic T2DM presentation?

A

reduced energy, visual problems, recurrent candida infections

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11
Q

what is the treatment pathway for a patient with T2DM?

A
  1. Dietary/lifestyle advice
  2. Metformin (biguanide)
  3. Metformin + Sulfonyluria
  4. Add in insulin therapy (increasing doses)
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12
Q

how does Metformin work? what are the side effects?

A

Reduces glucose production by the liver & sensitises tissues to insulin
SE = anorexia and diarrhoea

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13
Q

name a sulfonylurea, how do they work and SE?

A

Glibenclamide - they increase insulin secretion

SE = hypoglycaemia

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14
Q

what is DKA?

A

uncontrolled catabolism and insulin deficiency. Absent insulin causes increased hepatic gluconeogenesis and osmotic diureses by the kidneys –> dehydration
- peripheral lipolysis –> increased circulating free fatty acids –> liver –> ketosis –> metabolic acidosis

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15
Q

features of DKA?

A

profound dehydration and vomiting
eyes sunken/reduced tissue turgor/dry tongue/low BP
kussmauls resp
abdo pain

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16
Q

what are Ix findings for DKA?

A 
BG > 11
blood ketones > 3
acidosis < 7.3
urine stix - glycosuria/ketonuria
UE - raised creatinine
17
Q

How do you manage DKA?

A
  1. 0.9% NaCL 500mL over 15 mins to rehydrate
  2. Insulin + fluids (including potassium)
    - once BG has gone down - give fluids + K + dextrose and start an insulin regime
18
Q

what are the features of hyperosomolar hyperglycaemic state?

A

uncontrolled DM
hyperglycaemia, hyperosmolality, no ketones
dehydration, osmotic diuresis

19
Q

what are the macrovascular complications of diabetes? how do you manage this?

A

major risk factor for atherosclerosis, increased risk of stroke/IHD/hyperlipidaemia
Mx: control BP/stop smoking/statin

20
Q

name some microvascular complications of diabetes?

A

retinopathy, neuropathy, nephropathy

21
Q

what are the two types of diabetic retinopathy?

A

proliferative

non-proliferative

22
Q

name some features of diabetic eye disease on fundoscopy?

A

dot and blot haemorrhages
new leaking vessels
exudates
cotton wool spots

23
Q

how can you manage diabetic retinopathy?

A

laser photocoagulation of new vessels
stop smoking
good glycaemic control

24
Q

how does diabetes damage the kidneys?

A

glomerular disease
ischaemic lesions
ascending UTIs

25
Q

what are the signs of diabetic neuropathy

A

symmetrical sensory neuropathy
loss of vibration and pain first
“walking on cotton wool”

26
Q

what are the complications of diabetic neuropathy?

A

unrecognised trauma
ulcers
neuropathic arthropathy (Charcot’s joint)

27
Q

some findings O/E of vascular disease

A 
thin skin
absent hair
bluish discolouration
reduced skin temp
absent pulses

Finals (21 decks)

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