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Diabetes and Endocrine > Diabetes - Clinical > Flashcards

Diabetes - Clinical Flashcards

1
Q

What symptoms may present in hyperglycaemia?

A 
Polyuria
Polydipsia
Blurred vision
Difficulty concentrating
Fatigue
Weight loss (due to insulin deficiency/insensitivity)
Infections
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2
Q

What symptoms may present in hypoglycaemia?

A 
Anxiety, sweating, chilld, clamminess
Irritability, impatience
Confusion (may become delirium)
Rapid heartbeat
Lightheadedness, dizziness
Hunger, nausea
Fatigue, weakness, shakiness
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3
Q

How is diabetes diagnosed?

A 
Lab glucose
 - 1 diagnostic test plus symptoms
 - 2 diagnostic tests without symptoms
Oral glucose tolerance test (OGTT)
HbA1c (glycated haemoglobin)
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4
Q

What blood glucose levels are diagnostic for diabetes?

A

Fasted glucose > 7.0mmol/L

Random glucose > 11.1mmol/L

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5
Q

Describe how an OGTT can be used to diagnose diabetes

A

Venous plasma glucose is measured 2 hours after taking 75g of anhydrous glucose (dextrose)
Blood glucose > 11.1mmol/L is diagnostic of diabetes

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6
Q

How can HbA1c be used to diagnose diabetes? What else can it be used for?

A

HbA1c > 48mmol/mol (6.5%) is diagnostic of diabetes
- the normal range in 4-6%
Can also be used to monitor long term control as it can indicate blood glucose levels over the last 8-12 weeks

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7
Q

Describe the role of urine dipstick in diagnosing diabetes

A

Dipstick is a very useful screening test but is not sufficient for a diagnosis

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8
Q

What are the normal ranges for blood glucose and blood ketones?

A

Blood glucose: 4.2 - 6.3 mmol/L

Ketones: < 0.6

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9
Q

What is the threshold for hypoglycaemia?

A

Blood glucose < 3 mmol/L

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10
Q

What are the indications for a patient with newly diagnosed diabetes to be admitted to hospital?

A

If they are clearly unwell (or present with DKA)
Ketones are present in urine
Blood glucose is greater than 25 mmol/L
All children should be admitted

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11
Q

Describe the initial investigations that should be done in a patient with suspected diabetes

A

Height, weight, BMI
Urinalysis - test for ketones, protein, glucose
CVS examination; smoking status, BP, ECG, lipids
Diabetic foot examination
ACR (albumin:creatinine ration) to test for microalbuminuria
Renal function tests
U&E, LFTs

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12
Q

What are the options for long term management of type 1 diabetes?

A

All will need insulin
Basal-bolus regimens vs continuous subcutaneous insulin infusion (insulin pump)

Basal bolus regimen options:

  • twice daily
  • three times daily
  • four times daily
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13
Q

Give two types of rapid acting insulin

A

Humalog (lispro)

Novorapid (aspart)

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14
Q

Give two types of short-acting insulin

A

Actrapid
Humulin S
(both are human soluble insulins)

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15
Q

Give three types of intermediate acting insulin

A

Insulatard
Hypurin isophane
Humulin I
(all are isophane insulins)

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16
Q

Give three types of long-acting insulin

A

Lantus (glargine)
Levemir (determir)
Tresiba (degludec)

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17
Q

How long do rapid acting insulins take to kick in? How long do they last for?

A

Onset: 10-20 minutes

Duration 2-5 hours

18
Q

How long do short acting insulins take to kick in? How long do they last for?

A

Onset: 30-60 minutes
Duration: 8 hours

19
Q

How long do intermediate acting insulins take to kick in? How long do they last for?

A

Onset: 2 hours
Duration: 8-14 hours

20
Q

How long do long acting insulins take to kick in? How long do they last for?

A

Onset: 1 hour
Duration: 18-24 hours

21
Q

Describe the general measures that should be taken in the long term management of diabetes

A

Optimise blood glucose control (measure HbA1c)
Optimise blood pressure control
Manage cardiovascular risk factors (stop smoking, control cholesterol)
Screen for early detection of complications (feet, eyes, kidneys)

22
Q

Describe the initial investigation of a patient with suspected diabetic ketoacidosis

A 
Rapid ABCDE assessment
 - IV access, vital signs, clinical assessment, full exam
Investigations
 - Blood glucose, ketones
 - Venous blood gas
 - Urinalysis
 - U&amp;E, FBC
 - Blood/urine culture
 - ECG
 - Consider CXR
23
Q

What are the three main signs of DKA?

A

Hyperglycaemia: [BG] > 11mmol/L
Ketonaemia: blood ketones > 3mmol/L
Acidosis: pH < 7.3 (venous) OR bicarbonate < 15mmol/L

24
Q

What are the symptoms of DKA?

A 
Polyuria, polydipsia
Weight loss
Weakness
Nausea, vomiting
Abdominal pain
Breathlessness
25
Q

What are the signs of DKA?

A 
Dry mucous membranes
Sunken eyes
Hypotension and tachycardia
Ketotic breath
Kussmaul respiration
Altered mental state
Hypothermia
26
Q

Describe the potential complications of DKA

A 
Cerebral oedema (and raised ICP)
Pulmonary oedema
Hyperkalaemia
Hypernatraemia
Cardiac dysarhuthmia
Venous thromboembolism
Aspiration pneumonia
Acute Respiratory Distress Syndrome (ARDS)
Iatrogenic hypoglycaemia
27
Q

Describe the management of DKA

A 
Give IV saline; 5 litres over 24 hours
Give IV insulin; drives glucose AND potassium into cells (monitor carefully for hypokalaemia)
Give IV potassium in saline
May need antibiotics
Consider heparin
Consider NG tube
28
Q

What should be included in the initial management of a patient with newly diagnosed diabetes?

A

If patient is acutely unwell, presents with DKA and/or is a child, they should be admitted to hospital
Patient education
Dietary advice
Blood pressure management
Blood glucose monitoring and targets (HbA1c)

29
Q

What lifestyle measures should be recommended to a patient with diabetes?

A

Quit smoking
Lipid control
Blood pressure control
Diet and exercise

30
Q

What is the first line treatment for type 2 diabetes?

A

Metformin

or Sulfonylurea

31
Q

How often should HbA1c be reviewed?

A

Every 3 - 6 months

32
Q

Give three examples of sulfonylureas

A

Glimepiride
Glicalazide
Glipizide

33
Q

What class of drugs does metformin belong to? How does this drug work?

A

Biguanide
Improves insulin action on muscle and liver by improving receptor function.
Inhibits gluconeogenesis and decreases fatty acid synthesis in the liver.
Decreases glucose absorption from intestine.

34
Q

How do sulfonylureas work?

A

Increase insulin secretion from beta-cells in the pancreas.

35
Q

List some second/third line glucose-lowering drugs

A

(Sulfonylureas)
Thiazidolidinediones - e.g. Pioglitazone
DPP IV inhibitors - sitaglyptin, saxaglyptin
GLP-1 analogues - lixisenatide, liraglutide, exenatide
SGLT2 inhibitors - canagliflozin, empagliflozin, dopagliflozin
(Insulin)

36
Q

Why might sulfonylurea be used as a first line diabetes treatment instead of metformin?

A

Metformin is contraindicated in renal impairment (eGFR<30), but sulfonylureas are not.

37
Q

Which glucose-lowering drugs can also contribute to weight loss:?

A

GLP-1 analogues

SGLT2 inhibitors

38
Q

What is MODY?

A

Maturity Onset Diabetes in the Young

  • autosomal dominant, single gene defect
  • causes problems with glucokinase which impairs beta-cell function
  • level of glucose at which cells are stimulated to produce insulin is higher
  • glucose level stays relatively constant but is just above the normal range
39
Q

What are the potential causes of secondary diabetes?

A 
Pancreatic disease (CF, pancreatitis, cancer)
Endocrine causes (Cushing's, acromegaly, thyrotoxicosis, phaeochromocytoma, glucagonoma)
Drug-induced (thiazide diuretics, corticosteroids others)
Genetics conditions (Wel fram's, Friedreich's ataxia, Haemachromatosis)
40
Q

Which diabetes drugs work by influencing the incretin pathway?

A

GLP-1 analogues - are agonists of the incretin hormone GLP-1 so act directly on pancreas and liver.
DPP4 inhibitors - inhibit DPP4 enzymes. DPP4 enzymes inhibit GLP-1, therefore DPP4 inhibitors increase the action of GLP-1 so act indirectly on the pancreas and liver.

41
Q

Which drugs increase the risk of hypoglycaemia?

A

Those which act on the pancreas to increase insulin secretion:

  • sulfonureas
  • GLP-1 agonists
  • DPP4-inhibitors

Diabetes and Endocrine (10 decks)

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