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Year Two - Endocrine System > Diabetes Mellitus (Type Two) > Flashcards

Diabetes Mellitus (Type Two) Flashcards

1
Q

What is type two diabetes mellitus?

A

It is defined as chronic condition in which there is abnormally elevated blood glucose levels

This is due to a relative deficiency of insulin, resulting from increased amounts of adipose tissue

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2
Q

What is the pathophysiology of type two diabetes mellitus?

A

In type two diabetes mellitus, there is development of insulin resistance due to repeated exposure to insulin – resulting in peripheral tissues becoming insensitive

Therefore, the body requires hyperinsulinemia to ensure normal uptake of glucose into cells

The beta-pancreatic cells become damaged due to this increased insulin secretion, resulting in the production of decreasing insulin levels

This insulin deficiency results in altered lipolysis in adipose tissue, increased glucose production in liver tissue and reduced glucose uptake in muscle tissue

This is therefore a positive feedback process, which further increases glucose levels and results in hyperglycaemia

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3
Q

What are the four risk factors associated with type two diabetes mellitus?

A

Older Age > 45 Years Old

Black, Chinese & South Asian Ethnicity

Central Obesity

Reduced Physical Activity

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4
Q

What are the five clinical features of type two diabetes mellitus?

A

Polyuria

Polydipsia

Nocturia

Feet Ulcers

Blurred Vision

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5
Q

What is polyuria?

A

It is defined an increased urine frequency, > 3L per day

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6
Q

What is polydyspia?

A

It is defined as increased thirst

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7
Q

What are the four investigations used to diagnose type two diabetes mellitus?

A

Glycated Haemoglobin (HbA1c) Test

Random Blood Glucose Test

Fasting Blood Glucose Test

Oral Glucose Tolerance Test (OGTT)

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8
Q

What is a HbA1c test?

A

It measures the quantity of glucose bound to haemoglobin

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9
Q

What does a HbA1c test indicate? How?

A

It indicates an average glucose level for the past two to three months

This is due to the fact that glucose permanently binds to haemoglobin and haemoglobin cells last up to a period of three months

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10
Q

What HbA1c test result indicates a diagnosis of type two diabetes mellitus?

A

> 48mmol/mol (6.5%)

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11
Q

In which nine circumstances is a HbA1c test contraindicated?

A

Haemoglobinopathies

Haemolytic Anaemia

Untreated Iron Deficiency Anaemia

Children

Pregnant Patients

HIV Patients

Chronic Kidney Disease Patients

Corticosteroid Administration

Patients with A Short Duration of Diabetes Symptoms

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12
Q

When after pregnancy is a HbA1c test no longer contraindicated?

A

> 2 months

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13
Q

What four conditions/treatments can result in a falsely low HbA1c reading?

A

Sickle Cell Anaemia

GP6D Deficiency

Hereditary Spherocytosis

Haemodialysis

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14
Q

What five conditions/treatments can result in a falsely high HbA1c reading?

A

Splenectomy

Iron Deficiency Anaemia

Vitamin B12 Deficiency

Folic Acid Deficiency

Alcoholism

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15
Q

Why are HbA1c tests not deemed as useful for diagnosing type one diabetes?

A

This is due to the fact that is may not accurately reflect a recent rapid rise in serum glucose

Therefore, a HbA1c < 6.5% does not exclude a diagnosis

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16
Q

What is a random blood glucose test?

A

It involves taking a blood sample and a random time, which may be confirmed by repeat testing

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17
Q

What random blood glucose test indicates type two diabetes mellitus?

A

> 11.1 mmol/L

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18
Q

What is the diagnostic criteria for a random blood glucose test for type two diabetes?

A

It should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic

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19
Q

What is a fasting blood glucose test?

A

It involves taking a blood sample after an individual has fasted overnight

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20
Q

What is a normal fasting blood glucose test result?

A

< 5.6mmol/L

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21
Q

What fasting blood glucose test indicates type two diabetes mellitus?

A

> 7mmol/L

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22
Q

What is the diagnostic criteria for a fasting blood glucose test for type two diabetes?

A

It should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic

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23
Q

What is an OGTT?

A

It involves taking a patient’s baseline fasting plasma glucose, giving them a 75g glucose drink and then measuring their plasma glucose two hours later

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24
Q

What OGTT result indicates type two diabetes mellitus?

A

> 11.1mmol/

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25
Q

What is the diagnostic criteria for OGTT for type two diabetes?

A

It should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic

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26
Q

Does an unrecordable blood glucose indicate a DKA or hypogylcaemia?

A

DKA

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27
Q

What are the four conservative management options of type two diabetes mellitus?

A

Dietary Modification

Regular Exercise

Smoking Cessation

Driving Advice

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28
Q

What dietary advice is recommended in type two diabetes?

A

To eat regular meals – which are high in fibre and low in starchy carbohydrates

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29
Q

What is the glycemic index?

A

A rating system for foods containing carbohydrates

It shows how quickly each food affects blood glucose levels when that food is eaten on its own

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30
Q

What is a high glycaemic index?

A

It suggests carbohydrates are broken down quickly during digestion and therefore release their glucose into blood quickly

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31
Q

What is a low glycaemic index?

A

It suggests carbohydrates are broken down slowly during digestion and therefore release their glucose into the blood gradually

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32
Q

Why is it important that diabetic patients are aware of what foods have a high and low glycemic index?

A

It is recommended that individuals have a diet consistent of low glycaemia sources of carbohydrates

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33
Q

Why do we encourage diabetics to exercise regularly?

A

Weight loss

Increases insulin sensitivity

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34
Q

What is the initial target weight loss in type two diabetics who are overweight?

A

5% – 10%

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35
Q

Why do advise type two diabetics to stop smoking?

A

It increases the risk of ischaemic heart disease, which is a common complication of diabetes

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36
Q

Do individuals need to inform the DVLA if they are on insulin?

A

Yes

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37
Q

What are the three criteria type two diabetes require to obtain a group one licence?

A

Hypoglycaemic awareness

They must not an episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months

They have no relevant visual impairments

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38
Q

What are the five criteria type one diabetes require to obtain a group two licence?

A

They should not have a severe hypoglycaemic event in the previous 12 months

They should have full hypoglycaemic awareness

They should show adequate control by regular glucose monitoring

They should demonstrate an understanding of the hypoglycaemia risks

They should have no debarring complications of diabetes

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39
Q

How long prior to driving should individuals check glucose levels?

A

2 hours

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40
Q

How long should patients wait after a hypo to start driving?

A

45 minutes

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41
Q

What is a curative management option of type two diabetics?

A

Conservative lifestyle advice

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42
Q

When is metformin used to manage type two diabetes?

A

It is the first line pharmacological management option

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43
Q

What are the four mechanism actions of metformin?

A

AMP-Activated Protein Kinase (AMPK) Activation

Increased Insulin Sensitivity

Decreased Hepatic Gluconeogenesis

Reduced Carbohydrate Gastrointestinal Absorption

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44
Q

Whar are the three side effects of metformin?

A

Gastrointestinal Upset

Vitamin B12 Malabsorption

Lactic Acidosis

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45
Q

What are the two factors which make type two diabetics susceptible to lactic acidosis when administered metformin?

A

Liver disease

Renal failure

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46
Q

How do we reduce the risk of gastrointestinal side effects associated with metformin?

A

The metformin dose should be started at a low dose and tritiated up slowly

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47
Q

What is the most appropriate management step when individuals develop unacceptable metformin side effects?

A

We switch to modified-release metformin

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48
Q

What are the six contraindications of metformin?

A

Chronic Kidney Disease, eGFR < 30ml/min

Recent Myocardial Infarction

Sepsis

Acute Kidney Injury

Alcohol Abuse

Severe Dehydration

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49
Q

In which condition should metformin be stopped in? Explain

A

Myocardial Infarction

Lactic acidosis risk

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50
Q

What advice should be given to type two diabetics who are administered metformin and are schuled to undergo an iodine-containing x-ray contrast media procedure? Why?

A

They should be advised to discontinue metformin on the day procedure and 48 hours following

This is due to the increased risk of renal impairment due to contrast nephropathy

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51
Q

What advice should be given to diabetics administered metformin who are scheduled for elective surgery?

A

In cases where it is administered once daily or twice daily, it can be continued as normal

In cases where it is administered three times daily, the lunchtime dose should be missed

This assumes only one meal will be missed during surgery, eGFR > 60 and no contrast during procedure

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52
Q

When are sulfonylureas used to manage type two diabetics?

A

They are a second line pharmacological management option

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53
Q

What is the mechanism of action of sulfonylureas?

A

They increase pancreatic insulin secretion, through inhibition of ATP-dependent K+ (KATP) channels on the cell membranes of pancreatic beta cells

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54
Q

Name three sulfonylureas used to manage type two diabetics

A

‘ides’

Glimepiride

Gliclazide

Glipizide

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55
Q

What are the six side effects associated with sulfonylureas?

A

Hypoglycaemic Episodes

Weight Gain

Hyponatraemia (SIADH)

Hepatotoxicity

Peripheral Neuropathy

Bone Marrow Suppression

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56
Q

What are the four contraindications of sulfonylureas?

A

Pregnancy

Breastfeeding

Renal Failure

Hepatic Failure

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57
Q

What advice should be given to diabetics administered sulfonylureas who are scheduled for elective surgery?

A

It should be omitted on the day of surgery

The exception is morning surgery patients who take twice daily, they can have the afternoon dose

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58
Q

What are the two blood test results of gliclazide overdose?

A

Increased Insulin Levels

Increased C-Peptide Levels

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59
Q

When are thiazolidinediones used to manage type two diabetes?

A

It is a second line pharmacological treatment option

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60
Q

What is the mechanism of action of thiazolidinediones?

A

They are agonists to the peroxisome proliferator activated-gamma receptors (PPAR) in adipocytes and reduce peripheral insulin resistance

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61
Q

Name a thiazolidinedione used to manage type two diabetes

A

Pioglitazone

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62
Q

What are the five side effects associated with thiazolidinediones?

A

Weight Gain

Liver Impairment

Fluid Retention

Bone Fractures

Urinary Bladder Cancer

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63
Q

What are the two contraindications of thiazolidinones?

A

Heart Failure

Obesity

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64
Q

When are SGLT-2 inhibitors used to manage type two diabetes?

A

They are a second line pharmacological management option

They should be introduced in all cases where individuals develop cardiovascular disease, have a high risk of cardiovascular disease (QRISK > 10%) or develop heart failure

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65
Q

What is the mechanism of action of SGLT-2 inhibitors?

A

They reversibly inhibit SGLT-2 in the renal proximal convoluted tubule, which reduces glucose reabsorption and increases urinary glucose excretion

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66
Q

Name three SGLT-2 inhibitors used to manage type two diabetes

A

‘glifozin’

Canagliflozin

Dapagliflozin

Empagliflozin

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67
Q

What is an advantage of SLGT-2 inhibitor administration?

A

It reduces cardiovascular disease

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68
Q

What are the five side effects associated with SGLT-2 inhibitors?

A

Weight Loss

Urinary Tract Infection

Thrush

Fournier’s Gangrene

Normoglycaemia Ketoacidosis

Diabetic Foot Disease = Amputation

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69
Q

What is Fournier’s gangrene?

A

It is defined as necrotising fasciitis of the genitalia or perineum

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70
Q

What are the two clinical features of Fournier’s gangrene?

A

A red, swollen patch of skin in the perineal area

Perineal pain

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71
Q

When are DPP-4 inhibitors used to manage type two diabetes?

A

They are a second line pharmacological treatment option

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72
Q

What are incretin mimetics?

A

They are gastrointestinal hormones, which reduce blood glucose through increased insulin secretion, inhibiting glucagon production and reducing gastrointestinal absorption

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73
Q

Name an incretin mimetic

A

GLP-1

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74
Q

What enzyme inhibits incretin mimetics?

A

Dipeptidyl peptidase-4 (DPP-4)

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75
Q

What is the mechanism of action of DPP-4 inhibitors?

A

They reduce the peripheral breakdown of incretin mimetics, increasing their levels

76
Q

Name three DPP-4 inhibitors used to manage type two diabetes

A

‘gliptin’

Saxagliptin

Sitagliptin

Vildagliptin

77
Q

What are the two side effects associated with DPP-4 inhibitors?

A

Nausea & Vomiting

Acute Pancreatitis

78
Q

Why are DPP-4 inhibitors preferable to thiazolidinediones and sulfonylureas?

A

They dont cause weight gain

79
Q

What advice should be given to diabetics administered DPP-4 inhibitors who are scheduled for elective surgery?

A

They can be continued on the day of surgery

80
Q

When are GLP-1 analogues used to manage type two diabetes?

A

They are a fourth line pharmacological treatment option

81
Q

What two other hypoglycaemic drugs are GLP-1 analogues administered with?

A

Metformin

Sulfonylureas

82
Q

In which two circumstances, do we administer GLP-1 analogues?

A

In individuals with a BMI > 35kg/m2, who are of European descent and there are complications associated with their increased weight

In individuals with a BMI < 35kg/m2, on which insulin is unacceptable due to occupational implications or weight loss would benefit their comorbidities

83
Q

What criteria is required for an ongoing administration of GLP-1 analogues?

A

There should be evidence of a HbA1C reduction > 11mmol/mol (1%) and 3% weight loss in 6 months

84
Q

Name three GLP-1 analogues used to manage type two diabetes

A

‘tide’

Exenatide

Liraglutide

Lixisenatide

85
Q

What is the mechanism of action of GLP-1 analogues?

A

They mimic the action of GLP-1, thus increased insulin secretion, inhibiting glucagon secretion and slowing absorption by the gastrointestinal tract

86
Q

What is the administration route of GLP-1 analogues?

A

Subcutaneous injection

87
Q

How is exenatide adminstered to manage type two diabetes?

A

It is administered within 60 minutes before the morning and evening meals.

It should not be administered after a meal

88
Q

How is liraglutide adminstered to manage type two diabetes?

A

It is administered 60 minutes before a meal

It is only administered once daily

89
Q

What are the three side effects of GLP-1 analogues?

A

Weight Loss

Nausea & Vomiting

Acute Pancreatitis

90
Q

What advice should be given to diabetics administered GLP-1 analogues who are scheduled for elective surgery?

A

They can be continued on the day of surgery

91
Q

When is insulin used to manage type two diabetes?

A

It It is a third line pharmacological management option, which should be co-administered with metformin

92
Q

What are the two administration routes of insulin?

A

Subcutaneous injections

Insulin pumps

93
Q

Why can insulin not be prescribed as an oral tablet?

A

It is a polypeptide inactivated by the GI tract

94
Q

What are the three side effects of insulin?

A

Hypoglycaemia

Weight gain

Lipodystrophy

95
Q

What insulin class is used to manage type two diabetes?

A

Intermediate-acting insulin

96
Q

What intermediate-acting insulin is used to manage type two diabetes?

A

Isophane

97
Q

What insulin regimen is used to manage type two diabetes?

A

It is administered at bedtime (BBed)

98
Q

In which three regions of the body is insulin injected?

A

Abdominal region

Thighs

Buttocks

99
Q

Why do we recommend that individuals rotate their insulin injection site?

A

This prevents the development of lipodystrophy

100
Q

What is lipodystrophy?

A

It occurs when the subcutaneous fat hardens, and patients don’t absorb insulin properly from further injections into this spot

101
Q

What is a clinical feature of lipodystrophy?

A

A patient is not responding to insulin as expected

102
Q

What is factitious hypoglycaemia? What does it indicate?

A

It is defined as high insulin levels in the absence of elevated c-peptide levels

It indicates that individuals are injecting too much insulin

103
Q

What is insulinoma? What does it indicate?

A

It is defined as high insulin and c-peptide levels

It indicates an insulin secreting tumour

104
Q

What are the five sick day rules of insulin?

A

They should increase the frequency of blood glucose and ketone monitoring

In cases where individuals have elevated blood glucose and ketone levels, they should administer a corrective dose of insulin

They should encourage fluid intake aiming for at least 3L in 24 hours

In cases where they are struggling to eat, they should intake sugary drinks to maintain carbohydrate levels

They should never stop their insulin, even if they are struggling to eat

105
Q

How often should individuals monitor blood glucose and ketone levels when unwell?

A

Up to four hourly

106
Q

How can individuals work out the corrective dose of insulin - when unwell and high glucose/ketone levels?

A

The total daily insulin dose divided by 6 – with a maximum of 15 units

107
Q

Why should individuals never stop their insulin - even when ill?

A

To prevent a DKA

108
Q

What should all individuals treated with insulin recieve?

A

Glucagon Kit

109
Q

What is the step one pharmacological management option of type two diabetes?

A

Metformin

110
Q

Which hypoglycaemic drug can be administered first line with metformin?

A

SGLT-2 inhibitors

111
Q

In which three circumstances, do we administer SGLT-2 inhibitors first line with metformin?

A

High Cardiovascular Risk, QRISK > 10%

Established Cardiovascular Disease

Chronic Heart Failure

112
Q

How do we administer SGLT-2 inhibitors with metformin first line?

A

Metformin should be established and titrated up before the introduction of a SGLT-2 inhibitor

SGLT-2 inhibitors should be started regardless of whether glycemic control is achieved with metformin

113
Q

What is the maximum dose metformin can be titrated up to?

A

500mg three times daily

114
Q

What are the four hypoglycaemic agents which can be administered first line when metformin is contraindicated?

A

SLGT-2 Inhibitors

Sulfonylureas

Thiazolidines

DPP-4 Inhibitors

115
Q

When are SGLT-2 inhibitors recommended to manage type two diabetes first line?

A

When metformin is contraindicated

It is recommended in cases where individuals are at high risk of cardiovascular disease, have established cardiovascular disease or have chronic heart failure

116
Q

When are sulfonylureas, thiazolidines or DPP-4 inhibitors recommended to manage type two diabetes first line?

A

When metformin is contraindicated

In cases where individuals are at low risk of cardiovascular disease, don’t have established cardiovascular disease and don’t have chronic heart failure

117
Q

When is step two management of type two diabetes recommended?

A

In cases where glycaemic control is not established on monotherapy, with HbA1c > 58mmol/mol (7.5%)

118
Q

What is the step two pharmacological management option of type two diabetes melitus?

A

It involves dual therapy, with metformin and the addition of one of the following pharmacological options to metformin…

  • Sulfonylurea
  • Thiazolidinedione
  • DPP-4 Inhibitor
  • SGLT-2 Inhibitor
119
Q

When is step three management of type two diabetes recommended?

A

In cases where glycaemic control is not established on dual therapy, with HbA1c > 58mmol/mol (7.5%)

120
Q

What is the step three pharmacological management option of type two diabetes melitus?

A

It involves triple therapy, with administration of the following…

  • Metformin, DPP-4 Inhibitor & Sulfonylurea
  • Metformin, Thiazolidine & Sulfonylurea
  • Metformin, SGLT-2 & Thiazolidine OR Sulfonylurea OR DPP-4 Inhibitor
  • Metformin & Insulin Treatment
121
Q

When is step four management of type two diabetes recommended?

A

In cases where glycaemic control is not established on triple therapy, with HbA1c > 58mmol/mol (7.5%)

122
Q

What is the step four pharmacological management option of type two diabetes?

A

It involves switching a second line pharmacological management option with a GLP-1 analogue

123
Q

Which oral hypoglycaemic drug is safe to continue during breastfeeding?

A

Metformin

124
Q

How often do we conduct a HbA1c test in type two diabetics?

A

Every 3 to 6 months, until stable

Following stability, they should be conducted six monthly

125
Q

What is the target HbA1c level in type two diabetics who are managed with lifestyle advice only?

A

48mmol/L (6.5%)

126
Q

What is the target HbA1c level in type two diabetics who are managed with lifestyle advice and metformin?

A

48mmol/L (6.5%)

127
Q

What is the target HbA1c level in type two diabetics who are managed with lifestyle advice and a sulfylnourea?

A

53mmol/L (7%)

128
Q

What is the target HbA1c level in type two diabetics who are managed with dual-therapy, triple-therapy and fourth line management?

A

53mmol/L (7%)

129
Q

How often should digital retinal screening be conducted in type one diabetics? What is an exception to this?

A

Annually

In pregnancy, this should be more frequent

130
Q

Why do we conduct digital retinal screening in type one diabetics?

A

To monitor the development of diabetic retinopathy

131
Q

How often should foot screening be conducted in type one diabetics?

A

15 months

132
Q

Why do we conduct foot screening in type one diabetics?

A

To monitor the development of diabetic foot complications

133
Q

How do we manage diabetic patients who develop foot problems, other than simple calluses?

A

A referral to the local diabetic foot clinic

134
Q

How often should a urine test be conducted in type one diabetics?

A

Annually

135
Q

Why do we conduct a urine test in type one diabetics?

A

To check for microalbuminuria and neuropathy development

136
Q

What urine test is used to monitor type one diabetes?

A

Albumin: creatinine ratio (ACR)

137
Q

What ACR urine test result indicates microalbuminuria development?

A

Increased ACR > 2.5

138
Q

What are the three short term complications of type two diabetes?

A

Hypoglycaemia

Hyperglycaemia

Potassium Imbalance

139
Q

What is hypoglycaemia?

A

It is defined as a low blood glucose level, specifically below 4mmol/L

140
Q

What are the five reasons for hypoglycaemia in type two diabetics?

A

Skipping a meal

Injecting too much insulin

Lipodystrophy

Physical activity

Alcohol intake

141
Q

What are the five clinical signs of hypoglycaemia?

A

Tremor

Sweating

Hunger

Dizziness

Blurred Vision

142
Q

What is the first line management option of hypoglycaemia in a community setting?

A

Oral glucose 10 - 20g should be given in liquid, gel or tablet form

OR

A quick acting carbohydrate may be given - glycogen or dextrogel

143
Q

What is the first line management option of hypoglycaemia in a hospital setting - when the patient is alert?

A

A quick acting carbohydrate may be given - glycogen or dextrogel

144
Q

What is the first line management option of hypoglycaemia in a hospital setting - when the patient is unconscious or unable to swallow?

A

SC or IM glucagon

145
Q

What is the second line management option of hypoglycaemia in a hospital setting - when the patient is unconscious or unable to swallow?

A

IV 20% glucose

146
Q

What are the four reasons for hyperglycaemia in type two diabetics?

A

Eating too much

Eating the wrong types of foods

Not injecting enough insulin

Illness

147
Q

How do we treat mild hyperglycaemia?

A

Patients can treat themselves by administrating an additional dose of insulin that should bring their glucose levels back to normal

Diabetic patients should be aware that it can take several hours to take effect and repeated doses could lead to hypoglycaemia

148
Q

What glucose level indicates DKA?

A

> 40mmol/l

149
Q

What are the five clinical features of DKA?

A

Nausea

Vomiting

Abdominal pain

Kaussmal breathing

Ketone breath

150
Q

What six blood test results indicate DKAs?

A

Decreased Na levels

Increased K levels

Increased urea levels

Increased creatinine levels

Increased glucose levels

Decreased bicarbonate levels

151
Q

What are the four macrovascular complications of type two diabetes?

A

Coronary Artery Disease

Peripheral Ischaemia

Stroke

Hypertension

152
Q

When is a statin administered as secondary prevention in type two diabetics?

A

QRISK score > 10%

153
Q

What is the first line antihypertensive used to manage hypertension in type two diabetes?

A

ACEI/ARBs

In Afro-Carribean patients, ARBS are preferred

In those with renovascular disease, we administer CCBs

154
Q

What is the clinic blood pressure target in type two diabetics with hypertension?

A

< 140/90mmHg

155
Q

What is the home/ABPM blood pressure target in type two diabetics with hypertension?

A

< 135/85mmHg

156
Q

How does type two diabetes result in macrovascular complications?

A

Diabetes accelerates the process of atherosclerosis

This is due to the fact that when glucose binds to LDL, it inhibits its ability to binds to liver cell receptors

This means that LDL continues to circulate within the bloodstream, resulting in hyperlipidaemia and thus atherosclerosis

157
Q

What are the three management options after developing macrovascular complication development in type two diabetics?

A

We review the patient’s diabetic treatment

We can consider prescribing statins

We encourage patients to adopt healthier lifestyle choices, such as smoking cessation, diet modifications, etc

158
Q

What is the most common cause of death in diabetic patients?

A

Myocardial Infarction

159
Q

What are the four microvascular complications of type two diabetes?

A

Diabetic Retinopathy

Diabetic Neuropathy

Gastrointestinal Autonomic Neuropathy

Diabetic Nephropathy

160
Q

What is diabetic retinopathy?

A

It is defined as damage to the blood vessels supplying the retina of the eye

161
Q

What are the four clinical features of diabetic retinopathy?

A

Retinal infarction

Exudate formation

Haemorrhage

Cataract formation

162
Q

What is diabetic neuropathy?

A

It is defined as nerve damage, which results in sensory loss to the bodies’ extremities – hands, feet and arms

163
Q

What are the three clinical features of diabetic neuropathy?

A

Paraesthesia

Burning Neuropathic Pain

Neuropathic Ulcers

164
Q

What is the characteristic feature of diabetic neuropathy?

A

‘Glove and stocking’ distribution’

165
Q

What is a glove and stocking’ distribution’?

A

It describes a distribution in which the lower legs are affected first

166
Q

What are the two main contributing factors of diabetic foot disease?

A

Peripheral Arterial Disease

Loos of Sensation

167
Q

What are the four pharmacological management options of diabetes neuropathy?

A

Amitriptyline

Duloxetine

Gabapentin

Pregabalin

168
Q

What is the second line management option of diabetic neuropathy?

A

We trial one of the other three pharmacological management options

169
Q

What is the management option of resistant diabetic neuropathy?

A

We can refer individuals to pain management clinics

170
Q

What is gastrointestinal autonomic neuropathy?

A

It is defined as nerve damage involving those that control autonomic body functions of the gastrointestinal system

171
Q

What are the three clinical features of gastrointestinal autonomic neuropathy?

A

Gastroparesis

Chronic diarrhoea

Gastro-oesophageal reflux disease

172
Q

What is gastroparesis?

A

It is defined as bloating and vomiting associated with erratic blood glucose control

173
Q

What are the three pharmacological management options of gastrointestinal autonomic neuropathy?

A

Metoclopramide

Domperidone

Erythromycin

174
Q

What is diabetic nephropathy?

A

It is is defined as damage to the renal blood vessels

175
Q

What are the three complications of diabetic nephropathy, if untreated?

A

Microalbuminuria

End-stage renal disease

Renal failure

176
Q

What is a feature of diabetic retinopathy on US?

A

Enlarged Kidneys

177
Q

What are the four management options of diabetic nephropathy?

A

Dietary Protein Restriction

Glycaemic Control

ACE Inhibitor/Angiotensin-II Receptor Antagonist

Atorvastatin Administration

178
Q

When are ACEI/ARBs recommended to manage diabetic nephropathy?

A

ACR > 3

179
Q

How do microvascular complications develop in diabetic patients?

A

In arterioles and capillaries, there is a subendothelial space located between the endothelial cells and the basal lamina layers. This subendothelial space allows the movement of molecules into and out of the vessel lumen.

In diabetes, molecules are unable to move out of this subendothelial space. This results in a build-up of trapped molecules, which thickens the basal lamina layer and narrows the vessel lumen. Overtime, this lumen narrowing can result in ischemia – which tends to affect the nerve and arteries of the kidney, foot and eyes.

There are two reasons as to which molecules are unable to move out of the subendothelial space in diabetic patients…

Albumin is a protein which freely moves in and out of the subendothelial space. However, in diabetic patients, albumin binds to glycosylated collagen fibres in the outermost layer of the vessel – thus trapping it in the subendothelial space.

In normal circumstances, basal lamina proteins don’t cross link and can therefore be removed from the subendothelial space. However, in diabetes, the glycosylated proteins bind to their neighbouring proteins (cross link) and therefore cannot be easily removed.

180
Q

How is diabetes associated with the development of infections?

A

It causes suppression of the immune system

181
Q

What are the four infections associated with type one diabetics?

A

Urinary Tract Infections

Pneumonia

Fungal Infections

Skin & Soft Tissue Infections

182
Q

What fungal infection is associated with type one diabetes?

A

Candidiasis

183
Q

What skin and soft tissue infection is associated with type one diabetes?

A

Feet

184
Q

What organism is most commonly associated with diabetic foot infections?

A

Pseudomonas Aeruginosa

185
Q

What drugs induce type one diabetes?

A

Thiaziade diuretics

186
Q

What drug reduces hypoglycaemic awareness?

A

Beta-blockers

187
Q

What are the differences between type one and type two diabetes?

A

Type one = onset < 20, more acute onset, recent weight loss, DKA features, ketonuria common

Type two = onset > 40, onset slower, obesity strong risk factor, milder symptoms, ketonuria rare

Year Two - Endocrine System (17 decks)

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