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Year 3 Exams: Endocrine > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

How does Hyperglycemia present? (5)

A 
Polydipsia
Polyuria
Blurred Vision
Weight Loss
Infection
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2
Q

How to Diagnose Diabetes? (4)

A

Venous Plasma Fasting >7
Random Plasma Fasting >11.1
OGTT >11.1
HBA1C >48

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3
Q

What is Hba1c?

A

Glycated Haemoglobin

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4
Q

Hba1c provides indication of what?

A

Blood Glucose over last 8-12 Weeks

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5
Q

Hba1c cannot be used to diagnose diabetes in who? (8)

A 
Children
Pregnant or <2 Months Pregnant
Short Duration Symptoms
Acutely Ill
Meds that increase glucose eg corticosteroids, antipyschotics
Pancreatic Surgery
Renal Failure
HIV
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6
Q

What is the only hormone to lower blood glucose?

A

Insulin

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7
Q

What hormone dominates absorptive state?

A

Insulin

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8
Q

Pancreatic A cells act on?

A

Glucagon

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9
Q

Pancreatic B Cells act on?

A

Insulin

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10
Q

What happens to Lipolysis in Type 1 Diabetes?

A

Increased

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11
Q

What happens to Glucose in Type 1 Diabetes?

A

Increased

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12
Q

What happens to Glucose Uptake in Type 1 Diabetes?

A

Decreased

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13
Q

Monozygotic Twins Genetics of Type 1 Diabetes percentage?

A

30-50%

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14
Q

Father Genetics of Type 1 Diabetes percentage?

A

6%

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15
Q

Mother Genetics of Type 1 Diabetes percentage?

A

1%

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16
Q

Siblings Genetics of Type 1 Diabetes percentage?

A

8%

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17
Q

Non Identical Twin Genetics of Type 1 Diabetes percentage?

A

10%

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18
Q

Both Parents Genetics of Type 1 Diabetes percentage?

A

30%

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19
Q

identical twin Genetics of Type 2 Diabetes percentage?

A

90-100%

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20
Q

1 parent Genetics of Type 2 Diabetes percentage?

A

15%

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21
Q

both parents Genetics of Type 2 Diabetes percentage?

A

75%

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22
Q

Siblings Genetics of Type 2 Diabetes percentage?

A

10%

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23
Q

Non Identical twin Genetics of Type 2 Diabetes percentage?

A

10%

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24
Q

Type 2 Diabetes can present with what infections (3)?

A

Low Grade Infection
Thrush
Balantitis

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25
Q

A big baby >4kg can make mother at risk of what type of Diabetes?

A

Type 2

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26
Q

What type of diabetes is genetic?

A

MODY

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27
Q

MODY in Diabetes is what genes?

A

Autosomal Dominant

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28
Q

What is impaired in MODY Diabetes? (3)

A

Beta Cell Function
Glucokinase Mutations
Transcription Factor mutations

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29
Q

Glucokinase Mutations in MODY are what? (3)

A

Onset at Birth
Stable Hyperglycemia
Treat through Diet

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30
Q

Transcription Factor Mutations in MODY are what?

A

HNF1a, 1b or 4a

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31
Q

Transcription Factor Mutations in MODY happen when?

A

Adolescence/Young Adult

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32
Q

What is Haemochromotosis?

A

Excess Iron

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33
Q

Secondary Diabetes can present when? (4)

A

Haemochromotosis
Pancreatic Destruction
Cystic FIbrosis
Pancreactomy

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34
Q

Gestational Diabetes does what to insulin?

A

Increased Insulin Resistance

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35
Q

Gestational Diabetes risks?

A

Family History of Type 2 Diabetes

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36
Q

Gestational Diabetes presents particularly when?

A

2nd/3rd Trimester

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37
Q

What neonatal problems does gestational diabetes bring? (3)

A

Neonatal Hypoglycemia
Respiratory Distress
Macrosomia

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38
Q

How long should someone wait to drive after a hypo?

A

45 minutes

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39
Q

What can a diabetic not eat?

A

Simple Carbs

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40
Q

Alcohol does what to Glycogenolysis?

A

Decreases

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41
Q

How many units of alcohol does it take to increase hypo risk?

A

2-3 Units

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42
Q

If HBA1C is high in Type 1 diabetes what does that increase risk of?

A

DKA

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43
Q

How to early diagnose Type 1 Diabetes?

A

Finger Prick Capillary Glucose >11

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44
Q

Insulin Features? (3)

A

Polypeptide
Inactivated by GI Tract
Hexamer into Monomer

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45
Q

Increased Risk of Absolute Insulin Deficiency with? (4)

A

Cortisol
GH
Glucagon
Catecholamines

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46
Q

Insulin deficiency does what to Free Fatty Acids in Liver?

A

Increased

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47
Q

Insulin deficiency does what to Gluconeogenesis?

A

Increased

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48
Q

DKA presents with? (4)

A

Ketonuria
Ketonaemia
Metabolic Acidosis
Hyperglycemia

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49
Q

Sick Day Rules of Type 1 Diabetes?

A

Ketones +3 = Hospital

50
Q

How to Treat DKA? (3)

A

Actrarapid
0.9% Saline
10% Dextrose

51
Q

Complications of DKA? (8)

A 
Hypo/Hyper Kalaemia
Hypoglycemia
Rebound Ketosis 
Arrythmia
Cerebral Oedema (Kids in Particular)
Aspiration Pneumonia
Thromboembolism
ARDS
52
Q

Hypoglycemia: Blood glucose is what?

A

<4

53
Q

Causes of Hypoglycemia (3)

A

Too much Insulin
Exercise
Alcohol

54
Q

How to treat Mild Hypoglycemia?

A

Dextrosol or 200ml Fruit Juice

55
Q

How to treat Severe Hypoglycemia?

A

IV Glucose

56
Q

Which four drugs can be used to treat Insulin Release?

A

Sulphanylureas
Metiglinides
Incretin
DDDIV Inhibitors

57
Q

What drug can increase excretion of glucose?

A

SGLT1 Inhibitors

58
Q

What drugs can increase insulin action? (4)

A

Biguamides
Thiazidones
Reduce Weight
Exercise

59
Q

1st Line Diabetes Treatment?

A

Lifestyle then Metformin

60
Q

2nd and 3rd Line Diabetes Treatment when have CV Disease? (2)

A

GLP1 Agonist

SGLT2 Inhibitor

61
Q

Name 2 GLP1 Agonists?

A

Liraglutido

Semaglutide

62
Q

Name a SGLT 2 Inhibitor?

A

Empagliflozin

63
Q

What diabetes drugs should not use together? (2)

A

DPPIV inhibitor and GLP1 Agonist

64
Q

Metformin acts on? (2)

A

Liver and Muscle

65
Q

SGLT2 Inhibitor acts on?

A

Kidney

66
Q

Glitazone acts on?

A

Adipose, Muscle and Liver

67
Q

Metformin is what type of drug?

A

Biguanide

68
Q

Action of Metformin?

A

Increase Insulin Sensitivity and Decrease FA Synthesis

69
Q

Risks of Metformin (3)

A

Renal and Liver Failure
Malabsorption
Don’t use with EGFR <30

70
Q

Name 3 Sulphonylureas?

A

Glimepiride, Glicazide and Glipzide

71
Q

When are Sulphonylureas first choice? (3)

A

Osmotic Symptoms or Hba1c Increases

Peeing More/More Thrush

72
Q

Sulphonylureas binds to?

A

SUR1 Receptors or Beta Cells

73
Q

Sulphonylureas does what to potassium?

A

Decreased Potassium Influx Depol of Beta Cell Membrane

74
Q

Sulphonylureas are metabolised where?

A

Liver

75
Q

Sulphonylureas have risk of?

A

Hypos

76
Q

Sulphonylureas should not be used when? (4)

A

Renal or Liver Issues

Pregnant/Breast Feeding

77
Q

Pioglitzaone stimulates?

A

PPAR-Gamma

78
Q

Pioglitozone does what to insulin?

A

Decreases Insulin resistance

79
Q

Pioglitozone does what to Hba1c?

A

Decreased Hba1c in Blood, Glucose and Insulin

80
Q

Pioglitozone increases risk of? (3)

A

Bladder Cancer, Fluid Retention and Fractures in Females

81
Q

Name 3 DPPIV Inhibitors?

A

Saxagliptin, Sitagliptin and Vildagliptin

82
Q

Action of DPPIV Inhibitors? (4)

A

Decreased breakdown of Incretins
Increased Insulin from Peripheral Glucose
Increased GLIP1 and GLP Gut Hormones
Decreased Glucagon from Alpha Cells

83
Q

What drug in diabetes has no hypo risk?

A

Pioglitozone

84
Q

When can Pioglitozone not be used?

A

Pregnant/Breastfeeding

85
Q

GLP1 Analogue are what drugs?

A

Tides

86
Q

Actions of GLP1 Analogue? (2)

A

Decreased Glucagon

Increased Insulin

87
Q

GLP1 Analogue can be used with BMI of?

A

> 35

88
Q

GLP1 Analogues should be avoided when?

A

Low EGFR

89
Q

GLP1 Analogues should not be used when?

A

Pregnant/Breastfeeding

90
Q

Normally renal glucose is reabsorbed by?

A

SGLT2 at Proximal Tubule

91
Q

Which diabetic drug selectively inhibits SGTL2?

A

Glioflozin

92
Q

Which diabetic drug increases glucose excretion at renal proximal tubule?

A

Glioflozin

93
Q

What side effects of Glioflozin? (3)

A

Postural Hypotension
Decreased Systolic BP
Increased Risk of Infection

94
Q

Gliflozin carries what major risk?

A

Amputation

95
Q

Gliflozin contraindicated in? (4)

A

Pregnancy/Breastfeeding
Renal Impairment
Ever DKA/Ketones or Low BMI

96
Q

Sulphonureas side effects?

A

Hypos and Increased Weight Gain

97
Q

SGLT2 Inhibitor side effects?

A

Thrush/UTI Worse

98
Q

Thiozidones risks? (3)

A

Bladder Cancer
Congenital Heart Failure
Thigh Bone Fracture

99
Q

HBA1C target if taking drugs associated with Hypos?

A

53

100
Q

HBA1C target?

A

48

101
Q

Microvascular complications of diabetes (3)

A

Retinopathy
Nephropathy
Neuropathy

102
Q

Physiology of Atherosclerosis? (4)

A

Foam Cells
Low HDL Cholesterol
High Trigylycerides
LDL causing Oxidation

103
Q

How to treat Retinopathy?

A

Laser Photocogulation

104
Q

Nephropathy does what to albumin?

A

Microalbuminia

105
Q

What is the single biggest cause of End Stage Renal DIsease needing Dialysis?

A

Diabetes

106
Q

How to prevent Nephropathy?

A

Screen Urine for Albumin

107
Q

How to treat Nephropathy?

A

Ace Inhibitors or ARB’s

108
Q

Neuropathy risks?

A

Silent MI

109
Q

Obesity Surgery when?

A

BMI >35

110
Q

2/3 of Pancreatic Islet cells are?

A

B Cells

111
Q

Insulin into blood in capillaries drive glucose into?

A

Adipocytes

112
Q

Increased Glucose does what to Insulin?

A

Increases Insulin and Glucose Uptake by Cells which Decreases Glucose in Serum

113
Q

Type 1 Diabetes is affected by what genetic molecule?

A

HLA

114
Q

What happens to Beta Cells in Type 1 diabetes?

A

Decreased

115
Q

Decreased Islets and Insulin in Type 1 Diabetes does what to glucose?

A

Increased

116
Q

What happens to tissue sensitivity in insulin in Type 2 Diabetes?

A

Decreased

117
Q

What happens to fatty acids in blood in Type 2 Diabetes?

A

Increased

118
Q

Commonest cause of Death in Type 2 Diabetes?

A

MI

119
Q

Arteriolar Disease causes what physiology changes?

A

Increased Hyaline

120
Q

Small Vessel Disease in Diabetes causes what physiology changes?

A

Increased Connective Tissue around Capillaries
Glycosylation
Covalent Bonds

121
Q

Glycosylation physiology changes?

A

Stuck in Subendothelial Space
Cross Linked Basal Lamina Protein
Proteins in Arteriole Wall

Year 3 Exams: Endocrine (34 decks)

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