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#passmed 2022 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

How do you differentiate between Type 1 and 2 diabetes?

A

History
Physical examination
Simple lab tests

(Type 2 usually obese)

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2
Q

What are the criteria for prediabetes?

A

Fasting BG of 100-125 mg/dL

OR

Post-OGTT glucose of 140-200 mg/dL

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3
Q

What is prediabetes often confused with?

A

Metabolic syndrome

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4
Q

What are the criteria for metabolic syndrome?

A

3 out of 5 of

  1. Abd obesity
  2. High triglyceride level
  3. Low HDL cholesterol
  4. High BP
  5. Fasting glucose 100+
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5
Q

What are the investigations of diabetes?

A

One of these

HbA1c : 48+
Fasting plasma glucose (FPG) : 126+
2 hour PG in OGTT: 200+
Random PG: 200+

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6
Q

What is the general management of diabetes?

A
  • Education + lifestyle advice
    - reduce sat. fat + sugars
    - increase starch + carbs
    - moderate prot.
  • Negotiate HbA1c target + assess every 3-6 months
  • High intensity statin (e.g atorvastatin)
  • Control BP
  • Foot care
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7
Q

What are the two ways of insulin administration in Type 1 diabetes?

A

Subcut

Insulin pump

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8
Q

What are the 4 types of insulin for SUBCUT?

A
  1. Ultrafast acting (Novorapid)
    - @ start of meal
    - matches what is acc eaten (instead of what is planned)
  2. Isophane insulin (peaks @ 4-12 hours)
    - favoured by NICE (cheap!)
  3. Pre-mixed insulin (NovoMix) = 30% short + 70% long acting
  4. Long acting recombinant human insulin (glargine)
    - @ bed time
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9
Q

What are the different regimens of insulin?

A
  • BD Biphasic regimen
    • 2x a day NovoMix pen
    • type 2 or 1 w regular life style

QDS regimen

- before meals ultrafast
- bed time long acting
- type 1 for flexible lifestyle

Once daily long acting before bed

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10
Q

When should insulin pumps be used? (2 things)

A
  1. Can’t reach HbA1c target

2. Trying to reach HbA1c w daily injections –> disabling hypoglycaemia

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11
Q

What is DM? (2 things)

A
  1. Disorder of carbs met

2. Inadeq insulin prod / resistance to insulin action on pancreas

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12
Q

What is the cause of Type 1 DM? (2 things)

A
  1. AI destruction (T cell mediated) of pancreatic B cells –> insulin deficiency
  2. Assoc w other AI conditions
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13
Q

What is the cause of Type 2 DM? (2 things)

A
  1. Insulin resistance

2. Strong FHx / genetix

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14
Q

What are the antibodies that clart the pancreas in Type 1 DM?

A

Glutamic Acid Decarboxylase (GAD)

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15
Q

What is the pathophysiological steps of Type 1 DM including GAD antibodies? (4 steps)

A
  1. GAD target insulin producing pancreatic B cells
  2. AI destruction of 80-90% of B cells
  3. Insulin deficiency
  4. Hyperglycaemia
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16
Q

What do patients with Type 1 DM require?

A

Continuous insulin replacement to treat hyperglycaemia

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17
Q

What happens if you fail to give insulin in Type 1 DM?

A

DKA

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18
Q

We said Type 2 DM is caused by insulin resistance, but does it also have insulin secretion problems?

A

Yh in obese n fatty diet niggas

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19
Q

What is the pathophysiology of Defective Insulin Secretion in Type 2 DM?

A
  1. Insulin secretion by B cells req glucose to be transported into cell
  2. This is done by Glucose Transporter 2 (GLUT-2)
  3. Obesity + fatty diet = affect GLUT-2 –> decreased insulin secretion
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20
Q

What is the pathophysiology of Peripheral Insulin Resistance in Type 2 DM?

A
  1. High intake of glucose (sugary diet) –> constant high demand for insulin
  2. Always got insulin circulating in body
  3. Hyperinsulinaemia –> decreased sensitivity of insulin receptors in Liver + Muscle + Adipose Cells
  4. Downreg. of insulin receptors –> constant cycle of high insulin levels (bc neg feedback)
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21
Q

What are the clinical features of Type 1 DM? (2 things)

A
  1. DKA symptoms

2. Hyperglycaemia symptoms

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22
Q

What are the DKA symptoms of Type 1 DM? (4 things)

A
  1. Depressed mental status
  2. Vomiting
  3. Fruity acetone breath
  4. Abd pain
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23
Q

When do the DKA symptoms of Type 1 DM usually come about? (3 things)

A

After an event dat tips dem over da edge

  1. Viral illness
  2. Trauma
  3. Emotional stress
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24
Q

What are the Hyperglycaemia symptoms of Type 1 and 2 DM? (4 things)

A
  1. Polydipsia
  2. Polyuria
  3. Blurred vision
  4. Weight loss
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25
Q

What is special about Type 2 DM and its symptoms?

A

It has a gradual onset, so remains asymptomatic for years

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26
Q

What are the clinical features of Type 1 DM? (2 things)

A
  1. Hyperglycaemia symptoms

2. Skin manifestations

27
Q

What are the Skin manifestation symptoms of Type 2 DM? (4 things)

A
  1. Recurrent cellulitis / fungal infections
  2. Poor / delayed wound healing
  3. Pruritis (itchy skin)
  4. Acanthosis nigricans (hyperpigmented plaques on skin of axilla / neck / between digits)
28
Q

How should a diagnosis of Type 1 DM be made? (NICE) (2 things)

A
  1. Clinical grounds
  2. Presenting w hyperglycaemia (random plasma glucose 11+ mmol/L)
    Both together
29
Q

When trying to diagnose Type 1 DM, what typical things should you look out for in patients to help w diagnosis? (5 things) (NICE)

A
  1. Ketosis
  2. Rapid weight loss
  3. Younger than 50 yrs
  4. BMI below 25
  5. Hx / FHx of AI diseases
30
Q

How should a diagnosis of Type 2 DM be made? (NICE) (2 things)

A
  1. Persistent hyperglycaemia
  2. Clinical features
    Both together = definite diagnosis (only need 1 blood test)
    If no CF (asymptomatic) = repeat blood tests to confirm diagnosis
31
Q

What is Persistent Hyperglycaemia classified as in Type 2 DM diagnosis? (3 things)

A
  1. 48+ mmol/mol HbA1c
  2. 7+ mmol/L FASTING plasma glucose
  3. 11.1+ mmol/L RANDOM plasma glucose
32
Q

What is the aim of management of diabetes? (4 things)

A
  1. Correcting high BG w insulin (Type 1)
  2. Oral medication (Type 2)
  3. Avoiding low BG
  4. Treating CF of chronic hyperglycaemia
33
Q

What is the initial management of diabetes?

A
  1. Lifestyle (diet / exercise / weight loss)
  2. Smoking cessation
  3. Stress management
34
Q

What is the First Line Oral medication given for Type 2 DM?

A

Metformin (titrated from initially 500mg OD as tolerated)

35
Q

What are the Second Line medications given for Type 2 DM?

A
  1. Sulfonylurea
  2. Pioglitazone
  3. DPP-4 Inhibitor
  4. SGLT-2 Inhibitor
    Second line = add one of these
36
Q

What is the Third Line management plan for Type 2 DM?

A
  1. Triple therapy (Metformin + TWO second line drugs)

2. Metformin + insulin

37
Q

What drug class if Metformin?

A

Biguanide

38
Q

What is the action of Metformin? (2 things)

A
  1. Increases insulin sensitivity

2. Decreases liver prod of glucose

39
Q

What are the Side fx of Metformin? (3 things)

A
  1. Diarrhoea
  2. Abd pain
  3. Lactic acidosis
40
Q

What is the most common Sulfonylurea used in Type 2 DM?

A

Gliclazide

41
Q

What is the action of Gliclazide (Sulfonylurea)?

A

Stimulates insulin release from pancreas

42
Q

What are the Side fx of Gliclazide (Sulfonylurea)? (3 things)

A
  1. Weight gain
  2. Hypoglycaemia
  3. Increased risk of CVS disease / MI if used alone
43
Q

What drug class if Pioglitazone?

A

Thiazolidinedione

44
Q

What is the action of Pioglitazone? (2 things)

A
  1. Increases insulin sensitivity
  2. Decreases liver prod of glucose
    (same as metformin)
45
Q

What are the Side fx of Pioglitazone? (5 things)

A
  1. Weight gain
  2. Fluid retention
  3. Anaemia
  4. HF
  5. Increased bladder cancer risk (chronic use)
46
Q

What is the most common DPP-4 Inhibitor?

A

Sitagliptin

47
Q

What is the action of DPP-4 Inhibitors? (3 things)

A
  1. Increase insulin secretion
  2. Inhibits glucagon prod
  3. Slows absorption by GI tract
48
Q

What are the Side Fx of DPP-4 Inhibitors? (3 things)

A
  1. GI tract upset
  2. URTI symptoms
  3. Pancreatitis
49
Q

What suffix do SGLT-2 Inhibitors end with?

A
  • glifozin

e. g Canaglifozin

50
Q

What is the action of SGLT-2 Inhibitors?

A

Cause glucose to be excreted in urine (by stopping reabsorp in PCT of kidney)

51
Q

What are the Side fx of SGLT-2 Inhibitors? (5 things)

A
  1. Glucoseuria (glucose in urine) (obv fam)
  2. UTI
  3. Weight loss
  4. DKA (rare)
  5. Lower limb amputation (Canaglifozin)
52
Q

When is Insulin Therapy used in diabetes? (2 things)

A
  1. All Type 1

2. Sometimes Type 2 if Oral meds not enough

53
Q

What are the timings of RAPID acting insulin?

A

Starts working within 15 mins

54
Q

What is an example of RAPID acting insulin?

A

Aspart

Like Asphalt racing game on iPad lol

55
Q

What are the timings of SHORT acting insulin? (2 things)

A
  1. Starts working within 30 mins

2. Peaks at 2-3 hours

56
Q

What is an example of SHORT acting insulin?

A

Hypurin Porcine/Bovine Neutral insulin

khanzeer / beef

57
Q

What are the timings of LONG acting insulin?

A

Lasts 12-24 hours

58
Q

What is an example of LONG acting insulin?

A

Glargine

Galoot taks a LONG time lol

59
Q

What 2 things should you consider with insulin use?

A
  1. The dawn phenomenon

2. The Somogyi effect

60
Q

What is The Dawn Phenomenon with insulin use? (3 things)

A
  1. Early morning, FX of exogenous insulin inj day before disappear
  2. Insulin antagonistic hormones increase physiologically in morning
  3. Both these cause morning hyperglycaemia
61
Q

What is The Somogyi Effect with insulin use? (2 things)

A
  1. Hypoglycaemia @ night caused by too much exogenous insulin inj evening before
  2. Causes Rebound morning hyperglycaemia
62
Q

What are the MACROvascular complications of Chronic Hyperglycaemia? (4 things)

A
  1. CAD
  2. Peripheral ischaemia –> poor healing + ulcers + diabetic foot
  3. Stroke
  4. HTN
63
Q

What are the MICROvascular complications of Chronic Hyperglycaemia? (3 things)

A
  1. Neuropathy (peripheral)
  2. Nephropathy (e.g glomerulosclerosis)
  3. Retinopathy
64
Q

What are some INFECTION related complications of Chronic Hyperglycaemia? (4 things)

A
  1. UTIs
  2. Pneumonia
  3. Skin + soft tissue inf (esp feet)
  4. Fungal inf (esp oral + vaginal candidiasis)

#passmed 2022 (27 decks)

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