Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > Diabetes mellitus > Flashcards

Diabetes mellitus Flashcards

1
Q

What is Type 2 diabetes mellitus?

A

Chronic metabolic condition characterised.

Inadequate insulin production from pancreatic beta cells, resulting in insulin resistance.

Leads to increase in blood glucose levels, causing hyperglycaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes Type 2 diabetes mellitus?

A

Genetics:
- FHx

Environmental:
- Poor dietary habits
- Lack of physical activity
- Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors for Type 2 diabetes mellitus?

A

Non-modifiable risk factors:
- Older age
- Ethnicity (Black African or Caribbean and South Asian)
- Family history

Modifiable risk factors:
- Obesity
- Sedentary lifestyle
- High carbohydrate (particularly sugar) diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Presentation of Type 2 diabetes mellitus?

A

Initially asymptomatic

Polyuria
Polydipsia (excessive thirst)
Unexplained wt loss
Blurry vision
Fatigue
Opportunistic infections (e.g., oral thrush)
Glucose in urine (on a dipstick)
Acanthosis nigricans (thickening and darkening of the skin in the neck, axilla, or groin region)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Investigations for Type 2 diabetes mellitus?

A

Symptomatic:
- Random blood glucose ≥ 11.1mmol/l

  • Fasting plasma glucose ≥ 7mmol/l
  • 2-hour glucose tolerance ≥ 11.1mmol/l
  • HbA1C ≥ 48mmol/mol (6.5%)

Asymptomatic:
- two results are required from different days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the blood glucose range for pre-diabetes?

A

42-47 mmol/mol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the blood glucose range for diabetes?

A

≥ 48 mmol/mol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is Type 2 diabetes mellitus managed?

A

Education
- DESMOND
- DAFNE
- XPERT

Lifestyle modifications:
- Low-glycaemic-index, high-fibre diet
- Exercise
- Weight loss (if overweight)
- Smoking cessation

Medication:
- assess HbA1c, QRISK2, and kidney function

Not at high risk CVD risk:
- metformin (500mg OD, then increase dose to BD before breakfast and dinner)

  • if contraindicated, consider Pioglitazone, DPP‑4 inhibitors, sulphonylureas, or SGLT-2 inhibitor.

Chronic heart failure/atherosclerotic CVD”
- metformin, once tolerated offer SGLT2 inhibitor

High risk of CVD:
- metformin, once tolerated offer SGLT2 inhibitor

If metformin is contraindicated for any of the above, offer SGLT2 inhibitor alone.

If dual therapy has not controlled the blood sugar, consider triple therapy (metformin and 2 second-line durgs) or start insulin.

Monitor HbA1c levels at 3-6 month intervals.

If pt is on insulin or at risk of hypoglycaemia, self-monitoring at home is necessary.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Complications of Type 2 diabetes mellitus?

A

Macrovascular
- CVD
- ischaemic heart disease
- stroke disease
- peripheral arterial disease

Microvascular
- diabetic kidney disease
- retinopathy
- peripheral
- autonomic neuropathy

Foot problems
- ulcer
- deformity
- infection
- Charcot arthropathy

Metabolic
- diabetic ketoacidosis
- hyperosmolar hyperglycaemic state
- dyslipidaemia

Psychological impact
- anxiety, depression, eating disorder, sexual dysfunction

Reduced life expectancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is hyperosmolar hyperglycaemic state (HHS)?

A

Refers to a rare but potentially fatal complication of type 2 diabetes and is an emergency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does hyperosmolar hyperglycaemic state (HHS) present?

A
  • hyperosmolality(water loss leads to very concentrated blood)
  • hyperglycaemia
  • absence of ketones, distinguishing it from ketoacidosis.
  • polyuria
  • polydipsia
  • weight loss
  • dehydration
  • tachycardia
  • hypotension
  • confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is hyperosmolar hyperglycaemic state (HHS) treated?

A
  • IV fluids
  • close montoring by specialists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is type 1 diabetes mellitus?

A

Autoimmune condition

Beta cells (produce insulin) within the pancreas are destructed, hence insulin deficiency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes type 1 diabetes mellitus?

A

Genetics
- human leukocyte antigen (HLA)

Environmental
- viral infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does type 1 diabetes mellitus present?

A

Polyuria
Polydipsia (excessive thirst)
Weight loss - a distinguishing factor between T1DM and T2DM

Severe cases:
diabetic ketoacidosis (DKA)
- hyperglycemia
- metabolic acidosis
- ketonemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is type 1 diabetes mellitus diagnosed?

A

If symptomatic, one of the following is needed:
Random blood glucose ≥ 11.1mmol/l or Fasting plasma glucose ≥ 7mmol/l
2-hour glucose tolerance ≥ 11.1mmol/l
HbA1C ≥ 48mmol/mol (6.5%)

If asymptomatic, two results from the above are required from different days.

Antibodies:
- anti-GAD
- anti-ICA
- anti-IAA

C-peptide levels

Urine ketone testing
- presence of ketones = diabetic ketoacidosis (DKA)

17
Q

How is type 1 diabetes mellitus managed?

A

Education:
- DAFNE

Lifestyle:
- healthy and balanced diet
- reduce alcohol
- smoking cessation
- regular exercise

Insulin therapy

Glycemic control:
- maintain blood glucose within target ranges

Pre-meal blood glucose: 4-7 mmol/L (72-126 mg/dL)
Bedtime blood glucose: 6-10 mmol/L (108-180 mg/dL)
HbA1c: Less than 7% (53 mmol/mol)

Blood glucose monitoring throughout the day, especially at each meal and before bedtime.

Psychosocial support

Regular screening for complications.
- retinopathy
- neuropathy
- nephropathy
- CVD

Blood pressure control
- <135/85 mmHg
- <130/80 mmHg if end-organ damage present
(ACEi or ARB -1st line tx)

18
Q

What is type 1 diabetes mellitus associated with?

A

Growth and pubertal development (delay in puberty and obesity)

Thyroid disease (most associated; screening recommended)

Coeliac disease

19
Q

What is diabetic ketoacidosis?

A

Medical emergency

Refers to severe lack of insulin and the cells are unable to use glucose so it uses fat instead.

Triad:
- Hyperglycemia (blood sugars >11 mmol/L)
- Ketonemia (blood ketones >3 mmol/L)
- Acidosis (pH <7.3 or bicarbonate <15 mmol/L)

20
Q

Presentation of diabetic ketoacidosis?

A

Nausea
Vomiting
Abdominal pain
Dehydration
Hypovolaemic shock
Drowsiness
Coma
Tachypnoea (Kussmaul’s respiration: a deep, sighing pattern of respiration, compensating for a metabolic acidosis by blowing off CO2)
‘Fruity’ ketotic breath

21
Q

What investigations would you do if you suspect diabetic ketoacidosis?

A

Blood glucose (>11.1mmol/L)
Blood ketones (>3mmol/L)
Urea and electrolytes
Blood gas analysis (expecting hyperglycaemic, hypokalaemic metabolic acidosis, low bicarb)
Urinary glucose and ketones
Blood cultures (if evidence of infection)
ECG (ischaemic changes)

22
Q

Management of diabetic ketoacidosis?

A

Suspect DKA →admit to hospital and emergency tx with IV insulin and fluids

FIGPICK
Fluids – IV fluid resuscitation with normal saline
Insulin – fixed rate insulin infusion
Glucose – closely monitor blood glucose and add a glucose infusion when it is less than 14 mmol/L
Potassium – add potassium to IV fluids and monitor closely
Infection – treat underlying triggers such as infection
Chart fluid balance
Ketones – monitor blood ketones, pH and bicarbonate

(aims to correct dehydration, electrolyte disturbance and acidosis)

23
Q

What are sick day rules in diabetes?

A

Refers to temporary medication adjustment during acute illness.
Certain drugs may need to be stopped until the person is eating and drinking normally for 24-48 hours.

ACEi, diuretics, NSAIDs →stop tx if risk of dehydration, prevent AKI

Adjust dose of insulin therapy (do not stop tx)

Monitor blood glucose regularly and ketone levels.

Maintain normal meal pattern.

If you can’t eat or vomiting, replace meals with carbohydrate-containing drinks.

24
Q

How do you distinguish Type 1 diabetes mellitus and diabetes insipidus?

A

Both present with polyuria and polydipsia.

Diabetes insipidus does not present hyperglycemia or glucosuria.

25
Q

What is hypoglycaemia?

A

Low blood glucose level

< 3.5 mmol/L

26
Q

Causes of hypoglycaemia?

A

Drugs: Insulin, Sulphonylureas, GLP-1 analogues, DPP-4 inhibitors, Beta-blockers
Alcohol
Acute liver failure
Sepsis
Adrenal insufficiency
Insulinoma
Glycogen storage disease

27
Q

Presentation of hypoglycaemia?

A

Adrenergic Symptoms (Blood glucose concentrations <3.3 mmol/L):
- Trembling
- Sweating
- Palpitations
- Hunger
- Headache

Neuroglycopenic Symptoms (Blood glucose concentrations below <2.8 mmol/L):
- Double vision
- Difficulty concentrating
- Slurred speech
- Confusion
- Coma

28
Q

Investigations for hypoglycaemia?

A
  • prolonged fasting (for insulinoma -tumours in the pancreas)
  • HBA1c
  • LFTs
  • TFTs
29
Q

How is hypoglycaemia diagnosed?

A

High insulin and low glucose (<3.5 mmol/L)

30
Q

How is hypoglycaemia managed?

A

Mild hypoglycaemia
- pt is conscious
- ABCDE approach
- 15-20g fast-acting carbohydrate (e.g. sweets, glucose tablets, fruit juice)
- avoid chocolate (slow absorption)
- follow up with slower-acting carbohydrates (e.g. toast)

Severe hypoglycaemia
- seizure, unconsciousness
- ABCDE approach
- 200ml 10% dextrose IV
- 1mg glucagon IM if no IV access
- manage seizures

Endocrine (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions