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Human Disease Y3 > Diabetes and Treatment > Flashcards

Diabetes and Treatment Flashcards

1
Q

what is fasting blood glucose?

A

4.0-5.9 mmol/L

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2
Q

what is fasting blood glucose?

A

4.0-5.9 mmol/L

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3
Q

what is the blood glucose level after a meal ?

A
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4
Q

what is the difference between type 1 and type 2 diabetes ?

A

in type 1 diabetes insulin is not produced in sufficient amounts
in type 2 diabetes the cells do not respond to insulin

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5
Q

what are the symptoms of type 1 diabetes ?

A 
frequent urination, 
excessive thirst, 
extreme hunger, 
dramatic weight loss, 
irritability,
weakness and fatigue,
nausea and vomiting
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6
Q

what are the symptoms of type 2 diabetes ?

A 
increased thirst,
frequent or night time urination,
blurry vision,
unusual fatigue, 
dark skin around neck or armpits (acanthosis nigricans)
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7
Q

how is diabetes diagnosed ?

A
  1. diabetes symptoms and random plasma glucose >11.1 mol/L OR fasting plasma glucose > 7 mmol/L OR 2 hour oral glucose tolerance test > 11.1 mmol/L
  2. no diabetes symptoms - any 2 positive tests
  3. HbA1c > 48 mmol/mol
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8
Q

what are the major risk factors for microvascular complications in patients with diabetes ?

A

hypertension, hypercholesterolaemia, smoking, obesity

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9
Q

what is the blood glucose level after a meal ?

A
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10
Q

what is the difference between type 1 and type 2 diabetes ?

A

in type 1 diabetes insulin is not produced in sufficient amounts
in type 2 diabetes the cells do not respond to insulin

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11
Q

what are the symptoms of type 1 diabetes ?

A 
frequent urination, 
excessive thirst, 
extreme hunger, 
dramatic weight loss, 
irritability,
weakness and fatigue,
nausea and vomiting
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12
Q

what are the symptoms of type 2 diabetes ?

A 
increased thirst,
frequent or night time urination,
blurry vision,
unusual fatigue, 
dark skin around neck or armpits (acanthosis nigricans)
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13
Q

how is diabetes diagnosed ?

A
  1. diabetes symptoms and random plasma glucose >11.1 mol/L OR fasting plasma glucose > 7 mmol/L OR 2 hour oral glucose tolerance test > 11.1 mmol/L
  2. no diabetes symptoms - any 2 positive tests
  3. HbA1c > 48 mmol/mol
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14
Q

what are the major risk factors for microvascular complications in patients with diabetes ?

A

hypertension, hypercholesterolaemia, smoking, obesity

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15
Q

what are the major complications form diabetes ?

A

wounds which won’t heal leading to amputation, heart disease, stroke, kidney failure, retinopathy leading to blindness

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16
Q

what therapy is given for type 1 diabetes ?

A

injectable insulin via pen or pump devices

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17
Q

what therapy is given for type 2 diabetes ?

A

oral - metformin, sulphonylureas, glitazones, DPP4 inhibitor, SGLT2 inhibitor
injectable - GLP-1 agonist, insulin via pen devices

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18
Q

what is the first line treatment for type 2 diabetes ?

A

metformin

19
Q

what are the advantages of metformin ?

A

prevents cardiovascular complications, does not cause hypoglycaemia, aids weight loss

20
Q

what are the side effects of metformin ?

A

GI changes - diarrhoea, vomiting, loss of appetite,

lactic acidosis, B12 deficiency

21
Q

what is the dosage and timing of metformin ?

A

max 2g per day with or after meals

22
Q

in what event should diabetes controlling drugs be stopped ?

A

if eGFR

23
Q

what is the action of sulphonylureas ?

A

stimulate pancreatic beta cells to produce insulin

24
Q

what are the side effects of sulphonylureas ?

A

hypoglycaemia, weight gain

25
Q

what is the dosage and timing for sulphonylureas ?

A

max 160mg twice daily before meals

26
Q

what is the action of glitazones ?

A

improve insulin resistance

27
Q

what are the side effects of glitazones ?

A

fluid retention, haematuria (bladder cancer), increased risk of bone fracture, weight gain, hepatotoxicity

28
Q

what is the dosage and timing for sulphonylureas ?

A

45 mg once daily taken any time

29
Q

what are the advantages of incretin hormones (GLP) ?

A

reduce appetite and promote satiety, delay gastric emptying, reduce hepatic gluconeogenesis, stimulates release of insulin only in the presence of glucose

30
Q

which enzyme is GLP inactivated by ?

A

DPP4

31
Q

what is the action of SGLT2 inhibitors ?

A

removal of glucose and its associated calories via the kidney

32
Q

what are the side effects of SGLT2 inhibitors ?

A

increased frequency of UTI, increased frequency of thrush, modest diuretic effect

33
Q

what is the definition of hypoglycaemia?

A

any episode of low blood glucose i.e.

34
Q

who is at risk of hypoglycaemia ?

A

individuals taking insulin or sulphonylureas

35
Q

what are the symptoms of hypoglycaemia ?

A

autonomic - due to inactivation of autonomic nervous system, sweating, tremor, anxiety, palpitations
neuroglycopaenic - due to reduced glucose delivery to the brain, poor concentration, odd behaviour, dizziness, blurred vision
coma, death

36
Q

what are the treatment options for hypoglycaemia ?

A
  1. dextrose, fruit juice, coke etc.
  2. hypostop, honey on inside of cheeks
  3. IM glucagon, IV glucose
37
Q

what are the consequecnes of hypoglycaemia ?

A

falls, prolonged QT interval leading to arrythmia and death, repeat hypoglycaemia leading to cognitive impairment and unawareness, driving consequences

38
Q

how does hypoglycaemia affect driving a car or motorcycle ?

A

must have awareness, no more than 1 hypo needing third party assistance in last 12 months, appropriate blood glucose monitoring

39
Q

how does hypoglycaemia affect driving a lorry or bus ?

A

must have awareness, no hypo needing assistance in last 12 months, appropriate blood glucose monitoring, 3 monthly blood glucose readings

40
Q

what type of diabetes does diabetic ketoacidosis (DKA) occur in ?

A

type 1

41
Q

what are the criteria for diagnosis of DKA ?

A

all three of:
capillary blood glucose > 11 mol/L,
capillary ketones > 3 mmol/L,
venous pH

42
Q

what are the precipitating factors for DKA ?

A

infection, new diagnosis, non compliance

43
Q

what is the pathophysiology of DKA ?

A

acute insulin deficiency, lipolysis leading to formation of fatty acids, fatty acid metabolism leads to ketone formation, ketoacidosis, nausea and vomiting, respiratory compensation

44
Q

how is DKA managed ?

A

fluid resuscitation, insulin infusion, screen and treat underlying infection, DVT prophylaxis

Human Disease Y3 (24 decks)

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