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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
What is special about Type 2 DM and its symptoms?
It has a gradual onset, so remains asymptomatic for years
26
What are the clinical features of Type 1 DM? (2 things)
1. Hyperglycaemia symptoms | 2. Skin manifestations
27
What are the Skin manifestation symptoms of Type 2 DM? (4 things)
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
How should a diagnosis of Type 1 DM be made? (NICE) (2 things)
1. Clinical grounds 2. Presenting w hyperglycaemia (random plasma glucose 11+ mmol/L) Both together
29
When trying to diagnose Type 1 DM, what typical things should you look out for in patients to help w diagnosis? (5 things) (NICE)
1. Ketosis 2. Rapid weight loss 3. Younger than 50 yrs 4. BMI below 25 5. Hx / FHx of AI diseases
30
How should a diagnosis of Type 2 DM be made? (NICE) (2 things)
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
What is Persistent Hyperglycaemia classified as in Type 2 DM diagnosis? (3 things)
1. 48+ mmol/mol HbA1c 2. 7+ mmol/L FASTING plasma glucose 3. 11.1+ mmol/L RANDOM plasma glucose
32
What is the aim of management of diabetes? (4 things)
1. Correcting high BG w insulin (Type 1) 2. Oral medication (Type 2) 3. Avoiding low BG 4. Treating CF of chronic hyperglycaemia
33
What is the initial management of diabetes?
1. Lifestyle (diet / exercise / weight loss) 2. Smoking cessation 3. Stress management
34
What is the First Line Oral medication given for Type 2 DM?
Metformin (titrated from initially 500mg OD as tolerated)
35
What are the Second Line medications given for Type 2 DM?
1. Sulfonylurea 2. Pioglitazone 3. DPP-4 Inhibitor 4. SGLT-2 Inhibitor Second line = add one of these
36
What is the Third Line management plan for Type 2 DM?
1. Triple therapy (Metformin + TWO second line drugs) | 2. Metformin + insulin
37
What drug class if Metformin?
Biguanide
38
What is the action of Metformin? (2 things)
1. Increases insulin sensitivity | 2. Decreases liver prod of glucose
39
What are the Side fx of Metformin? (3 things)
1. Diarrhoea 2. Abd pain 3. Lactic acidosis
40
What is the most common Sulfonylurea used in Type 2 DM?
Gliclazide
41
What is the action of Gliclazide (Sulfonylurea)?
Stimulates insulin release from pancreas
42
What are the Side fx of Gliclazide (Sulfonylurea)? (3 things)
1. Weight gain 2. Hypoglycaemia 3. Increased risk of CVS disease / MI if used alone
43
What drug class if Pioglitazone?
Thiazolidinedione
44
What is the action of Pioglitazone? (2 things)
1. Increases insulin sensitivity 2. Decreases liver prod of glucose (same as metformin)
45
What are the Side fx of Pioglitazone? (5 things)
1. Weight gain 2. Fluid retention 3. Anaemia 4. HF 5. Increased bladder cancer risk (chronic use)
46
What is the most common DPP-4 Inhibitor?
Sitagliptin
47
What is the action of DPP-4 Inhibitors? (3 things)
1. Increase insulin secretion 2. Inhibits glucagon prod 3. Slows absorption by GI tract
48
What are the Side Fx of DPP-4 Inhibitors? (3 things)
1. GI tract upset 2. URTI symptoms 3. Pancreatitis
49
What suffix do SGLT-2 Inhibitors end with?
- glifozin | e. g Canaglifozin
50
What is the action of SGLT-2 Inhibitors?
Cause glucose to be excreted in urine (by stopping reabsorp in PCT of kidney)
51
What are the Side fx of SGLT-2 Inhibitors? (5 things)
1. Glucoseuria (glucose in urine) (obv fam) 2. UTI 3. Weight loss 4. DKA (rare) 5. Lower limb amputation (Canaglifozin)
52
When is Insulin Therapy used in diabetes? (2 things)
1. All Type 1 | 2. Sometimes Type 2 if Oral meds not enough
53
What are the timings of RAPID acting insulin?
Starts working within 15 mins
54
What is an example of RAPID acting insulin?
Aspart | Like Asphalt racing game on iPad lol
55
What are the timings of SHORT acting insulin? (2 things)
1. Starts working within 30 mins | 2. Peaks at 2-3 hours
56
What is an example of SHORT acting insulin?
Hypurin Porcine/Bovine Neutral insulin | khanzeer / beef
57
What are the timings of LONG acting insulin?
Lasts 12-24 hours
58
What is an example of LONG acting insulin?
Glargine | Galoot taks a LONG time lol
59
What 2 things should you consider with insulin use?
1. The dawn phenomenon | 2. The Somogyi effect
60
What is The Dawn Phenomenon with insulin use? (3 things)
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
What is The Somogyi Effect with insulin use? (2 things)
1. Hypoglycaemia @ night caused by too much exogenous insulin inj evening before 2. Causes Rebound morning hyperglycaemia
62
What are the MACROvascular complications of Chronic Hyperglycaemia? (4 things)
1. CAD 2. Peripheral ischaemia --> poor healing + ulcers + diabetic foot 3. Stroke 4. HTN
63
What are the MICROvascular complications of Chronic Hyperglycaemia? (3 things)
1. Neuropathy (peripheral) 2. Nephropathy (e.g glomerulosclerosis) 3. Retinopathy
64
What are some INFECTION related complications of Chronic Hyperglycaemia? (4 things)
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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