Diabetes Mellitus Flashcards
What is involved in a glucose tolerance test?
A fasting blood glucose is taken, then patient is given a 75g glucose load. A second blood glucose reading is taken 2 hours after
How does increased red cell turnover affect HbA1C?
HbA1C value will appear lower than true value
What values for fasting and random blood glucose levels are diagnostic for diabetes?
Fasting >7mmol/l
Random >11.1mmol/l
What HbA1C value would be suggestive of diabetes mellitus?
> 6.5% (48mmol/mol)
What are the main side-effects with insulin?
Hypoglycaemia, weight gain, lipodystrophy
What are the main side effects with Metformin?
GI upset, lactic acidosis
Which drug used in the management of diabetes mellitus shouldn’t be used in patient with a GFR <30
Metformin
Through which route should GLP-1 agonists be given?
Subcutaneous
How do GLP-1 agonists help to manage diabetes?
Incretin mimetic which Inhibits glucagon secretion
Which diabetic medications increase risk of pancreatitis?
GLP-1 agonists, DPP-4 inhibitors
What suffix do GLP-1 agonists have?
-tides
Which diabetic medications can cause weight gain?
Sulfonylureas, glitazones, insulin
Which diabetic medications are typically associated with weight loss?
SGLT-2 inhibitors, GLP-1 agonists
-gliflozins, -tides
What are the three diagnostic criteria for DKA?
Hyperglycaemia >11mmol
Capillary ketones >3mmol or Ketonuria 2++ or more
pH <7.3
What are the first steps in DKA management?
Give fluids (according to local policy) Commence fixed rate intravenous infusion insulin 50 units at a rate of 0.1 unit/kg/hour Regularly reassess patient obs
How is resolution of DKA defined?
Ketones <0.6 mmol, venous pH >7.3
During management of DKA what would you do if a patient’s blood glucose drops below 14mmol?
Add 10% dextrose at rate of 125mls/hr to avoid hypoglycaemia
During DKA management a patient has a potassium of 4.2, how would manage their potassium level?
Give 40mmol/l KCl (as potassium range is less than 5.5)
What would make you consider insulin infusion in a patient presenting with HHS?
If there is significant ketonaemia/ketonuria
What HHS stand for?
Hyperglycaemic hyperosmolar state
How will common presentation DKA and HHS differ?
onset: DKA (hours), HHS (days)
HHS- hypovolaemia, high osmolality, often in older patients more common in type 2
What would you give to a patient who is unconscious to correct their hypoglycaemia?
IM glucagon 1mg
IV 20% glucose 75ml over 10 mins
How can we reduce GI side effects of metformin?
Slowly titrate up their dose
Change to modified release rather than standard release
What is first line therapy for T2DM if metformin contraindicated in patients with and without CVD?
With CVD: SGLT-2 inhibitor mono therapy
Without CVD: sulfonylureas / DPP-4 inhibitor / pioglitazone
What are other types of diabetes mellitus other than type 1 and 2?
LADA- late autoimmune diabetes of adulthood
MODY- maturity onset diabetes of the young
Gestational diabetes
What are other types of diabetes mellitus other than type 1 and 2?
LADA- late autoimmune diabetes of adulthood
MODY- maturity onset diabetes of the young
What is the diagnosis in a patient with a high serum glucagon and a crusting red vesicular rash spreading across various parts of the body?
Glucogonoma- treated by surgical resection
What are cutaneous manifestations in diabetes mellitus?
Acanthosis nigracans, fungal infections and necrobiosis lipoidica (Necrobiosis lipoidica begins as a dull red papule or plaque on the shin which slowly enlarges into one or more yellowish-brown patches with a red rim)
What are the effects of insulin in the body?
Triggers cells to take up glucose
Inhibits gluconeogenesis
Inhibits glycogenolysis
Which cells of the pancreas produce glucagon?
Alpha cells
When can HbA1c be inaccurate?
Haemoglobinopathies like sickle cell
What kind of drug is metformin?
Biguanide
How does metformin work?
It increases insulin sensitivity
What is a contraindication to metformin?
Impaired renal function
How do sulfonylureas work?
They stimulate islet cells
What is an example of a sulfonylurea?
Gliclazide
What are the two main side effects with sulfonylureas?
Weight gain and hypoglycaemia
What are ‘gliptins’ how does this work?
DPP-4 inhibitors, works by improving insulin secretion and inhibit glucagon
What type of drug is exenatide?
GLP-1 agonist
What are diabetic complications associated with the eyes?
Diabetic retinopathy, maculopapular, rubeosis iridis-> glaucoma, cataracts
What is diabetic amyotrophy?
Painful wasting and weakness of proximal lower limb muscles
What symptoms might a patient with HHS present with?
Muscle cramps, confusion. In the time leading up to admission likely to have profound weakness, weight loss, polydipsia, polyuria
What is the stepwise management of hypoglycaemia?
If patient alert- oral or liquid source of glucose
If patient drowsy- oral glucogel (swallow still intact)
If patient unconscious- 125ml of 20% dextrose or 1mg glucagon IM injection
What are some complications of T2DM?
Microvascular- retinopathy, nephropathy, neuropathy
Microvascular- stroke, MI, peripheral vascular disease
Diabetic foot, ulcers, charcot joints, poor wound healing, UTIs,
What should be assessed with diabetic feet?
Level of ischaemia, level of neuropathy, bony deformity, degree of infection
What are surgical indications for a diabetic foot?
Abscess, deep infection, anaerobic infection, gangrene, rest pain
What advice should be given to patient taking insulin when they get ill?
Don’t stop taking your insulin! (Often need more with ilness despite reduced food intake)
Try to maintain calorie intake
Check blood glucose QDS and check for ketonuria
What is the stepwise approach to managing neuropathic pain in diabetes?
Paracetamol -> amitriptyline -> gabapentin/pregabalin/duloxetine -> opiates
What are some symptoms of autonomic dysfunction in diabetes?
Postural hypotension, erectile dysfunction, gastroparesis
At what HbA1c levels should monotherapy, dual therapy and triple therapy be considered?
Mono therapy considered at >48mmol
Dual therapy considered >
Triple therapy when >58 on dual therapy
When is fast acting insulin given in relation to food?
Just before a meal as takes 10-20 minutes to reach its peak. If having hypos around meal time take it after
