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Endo > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

T1DM clinical features

A

Adolescent onset usually but may occur at any age e.g. latent autoimmune diabetes of adults
Insulin deficiency from beta-cell autoimmune destruction
Associated with other autoimmune disorders
Prone to ketoacidosis + weight loss

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2
Q

T2DM clinical features

A

Higher prevalence in old, Asian men
Less insulin secretion ± increased insulin resistance
Stronger genetic influence than T1DM
Associated with sedentary, obese, alcohol excess
MODY is a rare autosomal dominant form of T2DM

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3
Q

Impaired glucose tolerance definition

A

Fasting plasma glucose <7mmol/L and

OGTT 2h glucose ≥7.8mmol/L but <11.1mmol/L

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4
Q

Impaired fasting glucose definition

A

Fasting plasma glucose ≥6.1 but <7mmol/L

OGTT more normal

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5
Q

Causes of DM

A

Steroids, anti-HIV drugs, newer antipsychotics
Pancreas damage (including haemochromatosis + CF)
Cushing’s disease, acromegaly, phaeochromocytoma, hyperthydroidism, pregnancy
Congenital lipodystrophy
Glycogen storage disease

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6
Q

Metabolic syndrome definition

A 
Central obesity (BMI>30 or inc waist circumference)
and two from:

BP≥130/85

Triglycerides ≥1.7mmol/L
HDL ≤1.03(men)/1.29(women)

Fasting glucose ≥5.6
T2DM

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7
Q

DM diagnosis criteria

A

Hyperglycaemia symptoms + raised glucose once (fasting ≥7, random ≥11.1)
Raised venous glucose twice (fasting ≥7, random ≥11.1)
OGTT 2h value ≥11.1
HBA1C ≥48

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8
Q

Hyperglycaemia symptoms

A 
Polyuria
Polydipsia
Unexplained weight loss
Visual blurring
Genital thrush
Lethargy
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9
Q

DM general management

A 
Healthy eating
Assess vascular risk + statin
Review HBA1C every 6mths
Foot/eye care
Pt inform DVLA and not drive if hypoglycaemic spells
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10
Q

T2DM pharm management stages

A

Lifestyle
Metformin monotherapy
HBA1C rises to 58, add DPP-4 inhibitor/ pioglitazone/ sulphonylurea (SU) / SGLT-2I (glifazon)
HBA1C still 58 then add SU to DPP4/pio or SGLT-2I to SU/pio, add insulin at this stage if necessary
Add GLP-1 analogues (exenatide, liraglitide) if still not responding and pt not suitable for insulin (e.g. BMI>35)

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11
Q

Metformin MOA

A

Increase insulin sensitivity + helps weight

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12
Q

DPP4 inhibitor (gliptins) MOA

A

Block DPP-4 action which destroys incretin

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13
Q

Glitazone MOA

A

Increases insulin sensitivity

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14
Q

Metformin CI

A

eGFR ≤36 due to lactic acidosis risk

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15
Q

Glitazone CI

A

CCF past or present due to fluid retention SE
Osteoporosis
Stop if increased weight/oedema

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16
Q

Sulphonylurea MOA

A

Increase insulin secretion

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17
Q

SGLT-2I MOA

A

E.g. empagliflozin

Selective sodium-glucose co-transporter 2 inhibitor blocks glucose reabsorption in kidneys so excreted in urine

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18
Q

Subcut insulin types

A

Ultra-fast before meals (humalog, novorapid)
Isophane (peak at 4-12h)
Pre-mixed (e.g. Novomix 30 (30% short, 70% long acting)
Long-acting e.g. glargine before bed, detemir in overweight T2DM

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19
Q

Insulin during illness

A

Don’t stop taking, illness often increases insulin requirement despite reduced food intake

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20
Q

Complications diabetes

A

Vascular disease
Nephropathy

Retinopathy
Cataracts
Rubeosis iridis (new vessels on iris, may lead to glaucoma)

Metabolic complications

Diabetic feet
Neuropathy

21
Q

Diabetic retinopathy types

A

Background (microaneurysms, haemorrhages and lipid deposits), refer if near macula
Pre-proliferative (infarcts, haemorrhages, venous beading) signs of retinal ischaemia, refer
Proliferative (new vessels form), urgent referral
Maculopathy caused by high retinal blood flow from hyperglycaemia causes vascular leak + hypoxia, can reduce visual acuity

22
Q

BP targets T1DM

A

T1DM treat BP if >135/85

130/80 if albuminuria/2+ features of metabolic syndrome

23
Q

BP targets T2DM

A

<140/80
130/80 if kidney/ eye/ cerebrovascular damage
Anti-RAS unless African/Caribbean, then add diuretic/CCA

24
Q

Testing diabetic neuropathy

A

Glove and stocking loss

Test sensation with 10g monofilament and ankle jerk

25
Q

Testing diabetic foot ischaemia

A

Feel foot pulses (dorsalis pedis + posterior tibial)

Doppler pressure measurements if pulse can’t be felt

26
Q

Foot ulceration in diabetes

A

Painless punched out ulcer in area of thick callus ± infection
Causes cellulitis, abscess ± osteomyelitis

27
Q

What to assess in diabetic foot

A

Neuropathy clinically
Ischaemia clinically, Doppler ± angiography if needed
Bony deformity clinically + Xray
Infection

28
Q

Indications for surgery diabetic foot

A

Abscess/deep infection
Spreading anaerobic infection
Gangrene/rest pain
Infective arthritis

29
Q

Diabetic glove and stocking neuropathy treatment ladder

A

Paracetamol
Tricyclic (amitriptyline)
Duloxetine, gabapentin, pregabalin
Opiates

30
Q

Diabetic mononeuritis multiplex treatment

A

If sudden/severe, immunosuppression may help (corticosteroids, IVIG, Ciclosporin)

31
Q

What is diabetic amyotrophy

A

Painful wasting of quadriceps/ pelvifemoral muscles

32
Q

Diabetic amyotrophy treatment

A

IVIG used sometimes but usually natural improvement

33
Q

Diabetic autonomic neuropathies

A

Postural BP drop
Erectile dysfunction

Gastroparesis
Urine retention

Loss of respiratory sinus arrythmia

34
Q

Diabetic gastroparesis treatment

A

Anti-emetics

Erythromycin

35
Q

Diabetic postural hypotension treatment

A

Fludrocortisone

Midrodine

36
Q

Diabetes in pregnancy

A

Control/reduce weight

Only metformin used as adjunct/alternative to insulin in GDM

37
Q

Diabetes in surgery

A

Optimise blood sugar pre, throughout and post op and T1DM first on list ideally

38
Q

Hypoglycaemia definition

A

plasma glucose ≤3mmol/L

39
Q

Hypoglycaemia symptoms

A

Sweating, anxiety, hunger, tremor
Confusion, drowsiness, visual trouble
May be mistaken for alcohol intoxication

40
Q

Fasting hypoglycaemia causes in diabetics

A

Usually insulin or sulphonylurea treatment

41
Q

Fasting hypoglycaemia causes non-diabetic

A 
EXPLAIN
Exogenous drugs
Pituitary insufficiency
Liver failure
Addison's
Islet cell tumours + immune hypo
Non-pancreatic neoplasms
42
Q

When to investigate hypoglycaemia

A

Whipple’s triad

Signs of hypoglycaemia + decreased plasma glucose + resolution of signs post glucose rise

43
Q

Hypoglycaemic hyperinsulinaemia causes

A

SU
Insulin injection

Insulinoma

Hereditary forms

44
Q

Insulinoma presentation

A

Fasting hypoglycaemia with Whipple’s triad

45
Q

Insulinoma screening test

A

Hypoglycaemia + inc plasma insulin during long fast

46
Q

Insulinoma suppressive tests

A

Give IV insulin and measure C-peptide, normally exogenous insulin suppresses but doesn’t work in insulinoma

47
Q

Insulinoma imaging

A

CT/MRI
Endoscopic Pancreatic US
IACS (intra-arterial calcium infusions)
PET-CT can help guide laproscopic surgery

48
Q

Insulinoma treatment

A

Excision

Endo (6 decks)

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