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Endocrine System > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What is diabetes mellitus?

A

Group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia with disturbances in carbohydrates, fat and protein metabolism from defects in insulin secretion, action or both

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2
Q

What are the symptoms of hyperglycaemia?

A

Polydipsia, polyuria, blurred vision, weight loss and infections

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3
Q

What happens if there is metabolic decompensation in diabetes?

A

Diabetic ketoacidosis
Hyperosmolar hyperglycaemic state

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4
Q

How is diabetes diagnosed?

A

Measure blood glucose or HbA1c
Fasting glucose >7mmol/l and random >11.1 mmol/l
OGTT 2hr after 75g CHO >11.1mmol/l
HbA1c > 48mmol/l

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5
Q

How many tests are needed in diagnosing diabetes?

A

One diagnostic lab glucose or HbA1c plus symptoms
2 without symptoms

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6
Q

What is the criteria for intermediate hyperglycaemia?

A

Impaired fasting glucose 6.1-7mmol/l
Impaired glucose tolerance 2hr glucose > 7.8 and 11mmol/l
HbA1c 42-47 mmol/mol

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7
Q

What is intermediate hyperglycaemia?

A

Group with higher risk of future diabetes and adverse outcomes such as cardiovascular disease

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8
Q

What is normoglycaemia?

A

Glucose levels associated with low risk of developing diabetes and cardiovascular disease

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9
Q

What is HbA1c?

A

Glycated haemoglobin
Gives indication of blood glucose levels over last 8-12 weeks

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10
Q

When can HbA1c not be used for diagnosis?

A

Children and young people
Pregnancy
Short duration of diabetes symptoms
Acutely ill
Patients on medication which could cause rapid rise in glucose
Acute pancreatic disease or surgery
Renal failure
HIV

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11
Q

What is involved in exam and initial assessment?

A

BMI
Ketones
Signs of complication - foot exam and retinal screening

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12
Q

What is type I diabetes characterised by?

A

Insulin deficiency
So there is increased lipolysis, raised glucose production and reduced glucose uptake

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13
Q

How does type I diabetes give diabetic ketoacidosis?

A

Hyperglycaemia
Ketonemia

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14
Q

What are the conterregulatroy hormones?

A

Glucagon
Cortisol
Catecholamines
Growth hormones

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15
Q

What does development of type I diabetes require?

A

Genetic pre-deposition
Plus trigger - viral infection

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16
Q

What are some clinical presentations of type I diabetes?

A

Thirst, tiredness, polyuria, weight loss, blurred vision and abdominal pain
On exam - ketones on breath, dehydration, increased resp. rate, tachycardia, hypotension and low grade infection

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17
Q

What are some key aspects of clinical diagnosis for type I diabetes?

A

Younger age
May be slim
Short duration of hyperglycaemic episodes
Other autoimmune condition
FH of autoimmune condition
Elevated ketones

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18
Q

What tests can be done at a later date to confirm diagnosis of type I diabetes?

A

Autoantibodies GAD, IA2 and ZNT8
C peptide - would expect undetectable c peptide in someone with longstanding t1d and low levels if recently diagnose. High would not have t1d
Genetics t1 genetic risk score

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19
Q

Describe genetics in type II diabetes

A

More inheritable than type I
Polygenic

20
Q

What are the symptoms and signs of type II diabetes mellitus?

A

May have none
Thirst, tiredness, polyuria, weight loss, blurred vision, symptoms of complication
Not ketonic, usually overweight, low grade infections and complications

21
Q

What are key aspects of making a diagnosis of diabetes mellitus?

A

Older age and overweight
FH of t2d
May have no symptoms
No ketones

22
Q

What are risk factors for type II diabetes mellitus?

A

Overweight
FH
Gestational diabetes
Inactive lifestyle
Previous high blood glucose

23
Q

What are some other types of diabetes?

A

Recognised genetic syndrome - MODY
Gestational diabetes
Secondary diabetes

24
Q

What is MODY?

A

Maturity onset diabetes in the young
Autosomal dominant
Impaired beta cell formation
Single gene defect

25
Q

What causes monogenic diabetes?

A

Glucokinase mutations
Transcription factor mutations

26
Q

Describe glucokinase mutations

A

Onset at birth
Stable hyperglycaemia
Diet treatment
Complications are rare

27
Q

Describe transcription factor mutations

A

Young adult onset
Progressive hyperglycaemia
1/3 diet, 1/3 OHA and 1/3 insulin
Complications are frequent
Can respond to tablets

28
Q

Describe secondary diabetes mellitus

A

Drug therapy - corticosteroids
Pancreatic destruction
Recognised genetic syndromes - DIDMOAD
Rare endocrine disorders - Cushing’s, acromegaly and pheochromocytoma

29
Q

Describe gestational diabetes

A

Hyperglycaemia of pregnancy
Increasing insulin resistance in pregnancy
Associated with FH of t2d
Develops 2/3rd trimester
More common if overweight and less active

30
Q

What is the immediate test for type I diabetes?

A

Finger prick capillary glucose test
If result more than 11mmol/l

31
Q

What are the 4 Ts of type I diabetes?

A

Toilet, thirsty, tired and thinner

32
Q

What is important about insulin administration?

A

Needle size, location, rotation, technique and time

33
Q

Describe the insulin therapy regimens

A

Basal bolus
Rapid (short) bolus acting to cover CHO at meals 1 unit per 10g of CHO
Basal long acting insulin in background - twice daily

34
Q

What type of insulin is given twice a day?

A

Rapid acting mixed with intermediate acting
Before breakfast and evening meal

35
Q

What insulin is given 3 times a day?

A

Rapid acting mixed with intermediate acting BB
Rapid acting BT
Intermediate acting at bedtime

36
Q

What is the regime for multiple daily injections?

A

Short acting BB BL and BT
Intermediate before bed or long acting once a day

37
Q

What are the symptoms of diabetic ketoacidosis?

A

Nausea and vomiting
Abdominal pain
Sweet smelling breath
Drowsiness
Rapid breathing and deep sighing
Coma

38
Q

What are the initial investigations for DKA?

A

Rapid A, B, Cs
IV access
Vital signs
Clinical assessment
Urinalysis - ketones
ECG
Glucose and venous blood gas

39
Q

What is the management for DKA?

A

Hour 1 - 1000ml/hr 0.9% saline and reduce to 500ml/hr at hour 3/4 and possible add KCl
Hours rate reduce rate of saline
Hour 1 start actrapid 6 units/hr
Check lab glucose, U+E, and bicarbonate

40
Q

What are the complications of type I diabetes?

A

Hyper and hypokalaemia
Hypoglycaemia
Cerebral oedema
Aspiration pneumonia
Arterial and venous thromboembolism
ARDS

41
Q

Describe hypoglycaemia

A

Blood glucose <4mmol/l
Mild can be self treated
Severe requires assistance
Loss of awareness and autonomic symptoms

42
Q

What are the causes of hypoglycaemia?

A

Too much insulin
Inappropriate timing of insulin
Injection site problem
CHO intake or fasting problem
Exercise and alcohol

43
Q

What are the risk groups for hypoglycaemia?

A

Tight glycaemic control
Impaired awareness
Extremes of age
Malabsorption
Hypoadrenalism
Renal impairment
Pancreatectomy

44
Q

What is the treatment for mild hypoglycaemia?

A

Give 15-20mg of quick acting carbohydrate
Recheck glucose level in 10-15mins

45
Q

What is the treatment for moderate hypoglycaemia?

A

Give 1.5-2 tubes of glucose gel
Recheck after 10-15 mins

46
Q

What is the treatment for severe hypoglycaemia?

A

Stop IV insulin
Give IV glucose over 10-15mins
If low after 10 mins then repeat IV glucose

Endocrine System (23 decks)

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