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2 Endocrine > Diabetes Module > Flashcards

Diabetes Module Flashcards

1
Q

differentials for T1DM?

A

T2DM
diabetes insipidus
hypercalcaemia
UTI

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2
Q

presentation of diabetes insipidus?

A

unquenchable thirst

excessive urination

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3
Q

prevalence of diabetes insipidus?

A

very rare

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4
Q

what test is done to look for diabetes insipidus? what result is a positive test?

A

fluid deprivation test

if fluid output did not decrease it’s DI

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5
Q

UTI clinical presentation?

A

frequent urination
painful urination
foul smelling urine

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6
Q

why is hypercalcaemia on the differential for T1DM?

A

can get increased urine frequency and is very dangerous so should exclude

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7
Q

clinical presentation for hypercalcaemia?

A

groans (constipation)
moans (depression/fatigue)
bones (sore)
stones (kidney)

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8
Q

how is glucose normally absorbed in the body and where?

A

it is first passively secreted and then is actively reabsorbed in the kidney

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9
Q

what happens to normal glucose absorption mechanisms when there is too much?

A

not all of it will be reabsorbed in the kidney so it will be excreted in the urine

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10
Q

when would a random blood glucose be sufficient for diagnosis if the patient has no symptoms?

A

if they get over 11.1mmol/l twice

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11
Q

main role of HbA1c in diabetes?

A

to measure long term blood glucose control in known diabetics

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12
Q

name 2 diabetes investigations that arent essential for diagnosis?

A

HbA1c

islet antibodies

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13
Q

what are the normal glucose concentration ranges?

A

3.6-5.8mmol/l

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14
Q

how many hormones regulate blood glucose?

A

5

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15
Q

why is hyperglycaemia more common than hypoglycaemia?

A

4 hormones increase plasma glucose concentration whereas only 1 (insulin) decreases it

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16
Q

what biochemical process does insulin stimulate?

A

glycogenesis

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17
Q

what biochemical processes does insulin inhibit?

A

glycogenolysis
gluconeogenesis
lipolysis

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18
Q

what does insulin do to fatty acids?

A

encourages entry of fatty acids into adipose tissues of the body
promotes chemical reactions that use fatty acids

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19
Q

what does a feedback loop mean?

A

controlled through its own action

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20
Q

where is insulin made?

A

beta cells

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21
Q

what happens once insulin is secreted?

A

stimulates uptake of glucose in peripheral tissues = less glucose in the blood = insulin stops secreting

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22
Q

what things other than the feedback loop stop insulin from being released?

A

sympathetic nervous system eg during exercise

adrenaline

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23
Q

name the 4 hormones that increase blood glucose levels

A

glucagon
adrenaline
cortisol
GH

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24
Q

why are diabetic patients tired alot?

A

poor glycaemic control

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25
Q

why do alot of T1D’s experience weight loss?

A

increased lipolysis

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26
Q

why do diabetic patients get visual blurring?

A

glucose can be absorbed by the lens of the eye causing it to change shape

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27
Q

infections in which areas are most common to diabetics?

A

soft tissue
GU (thrush)
chest

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28
Q

what is kussmaul breathing?

A

hyperventilation as a result of excessive ketones in blood

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29
Q

what diabetes is kussmaul breathing foudn in?

A

T1

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30
Q

can you use oral glucose lowering drugs in T1 patients?

A

no

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31
Q

how should diabetic patients inject their insulin?

A

into the fatty tissue of their abdomen; rotate the needle as they inject

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32
Q

is an insulin pump first or second line?

A

second

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33
Q

what birth defect are children with diabetic mothers most liekly to get?

A

spina bifida and other CNS deformities

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34
Q

do babies with diabetic mothers differ in size from normal babies?

A

tend to be bigger

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35
Q

when is diabetes the most teratogenic during pregnancy?

A

8 weeks

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36
Q

can glucose or insulin cross the placenta?

A

glucose

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37
Q

why are babies with diabetic mothers bigger?

A

glucose crosses the placenta and if the mother has bad diabetic control it will give the baby too many nutrients

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38
Q

why are babies of diabetic mums at a higher risk of hypo?

A

used to a high amount of insulin so are producing lots of insulin and when this is stopped they may get hypo

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39
Q

is the risk to monozygotic twins having a concordance higher in T1DM or T2DM?

A

T2DM

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40
Q

is metformin safe during pregnancy?

A

yes

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41
Q

what birth risks should be made to a diabetic?

A

higher risk of stillbirth, preeclampsia, maternal death

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42
Q

is there a correlation between age of diagnosis and decreased life expectancy?

A

yes

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43
Q

clinical requirements for a metabolic syndrome diagnosis?

A 
impaired glucose regulation/diabetes
insulin resistance
hypertension
triglycerides >1.7mmol/l
glucose intolerance
obese
44
Q

what is the risk of a woman with gestational diabetes getting type 2?

A

30%

45
Q

what is acromegaly?

A

excess GH

46
Q

what is the link between acromegaly patients and diabetes?

A

1/3rd get it

47
Q

what test is usually done to check for both acromegaly and diabetes in acromegaly patients?

A

GTT

48
Q

what is cushings?

A

excess cortisol

49
Q

can diabetes associated with acromegaly and cushings be reversed?

A

yes potentially if the diseases are controlled well

50
Q

why should a patient with T2DM’s protein intake be assessed?

A

too much protein can overload the kidneys

51
Q

how could you encourgae someone in tayside to exercise?

A

free membership

diabetic exercise classes

52
Q

what route are sulfonylureas taken?

A

orally

53
Q

why can’t T1DM patients have sulfonylureas?

A

must be functioning beta cells

54
Q

main risk of sulfonylurea drugs?

A

hypoglycaemia

55
Q

what other drugs can interfere with the effectiveness of sulfonylurea drugs?

A

corticosteorids
thiazides
anti-psychotics

56
Q

what type of drug is metformin?

A

biguanide

57
Q

why is metformin good for type 2 diabetics?

A

suppresses appetite and T2’s are usually overweight
prevents absorption and production of glucose
initiates glycolysis

58
Q

side effects of metformin?

A 
lactic acidosis
nausea
vomiting
diarrhoea
metallic taste
59
Q

what comorbidities should you avoid giving metformin in?

A 
renal failure
alcoholism
cirrhosis
chronic lung disease
cardiac failure
60
Q

what do thiaxolidinediones do?

A

bind to receptors in the nucleus and prevent gene expression

61
Q

name the only TZD licensed in the uk?

A

pioglitazone

62
Q

when should you give insulin in T2DM?

A

as a last resort

63
Q

why is insulin dose decreased if the patient has renal failure?

A

insulin is excreted by the kidneys

64
Q

the somogyi effect can occur when a patient is on what antidiabetic medication?

A

insulin

65
Q

what is the somogyi effect?

A

hyperglycaemia prouced by the body in response to hypo straight after insulin injection

66
Q

what tissues are particularly insulin independent?

A

retina
nerves
blood vessel walls

67
Q

what does insulin independent mean?

A

cannot regulate glucose influx so cant control their BGL

68
Q

what is the poyol pathway?

A

biochemical pathway used by insulin indeoendent tissues to decrease their BGL

69
Q

when will the poyol pathway be activated?

A

presence of raised intracellular glucose

70
Q

does glucokinase or aldose reductase have the higher KM?

A

aldose reductase

71
Q

what does aldose reductase do?

A

converts glucose into sorbitol in the poyol pathway

72
Q

what are you looking for from taking blood in a T2DM patient?

A

HbA1C

73
Q

what should you look for in a patient’s urine who has T2DM?

A

creatinine

albumin

74
Q

what would proteinuria indicate in a diabetic patient?

A

kidney damage

75
Q

what could kidney damage in T2DM be from?

A

diabetic nephropathy

hypertension

76
Q

is glomerular filtration increased or decreased in diabetes?

A

increased

77
Q

what increases intraglomerular pressure in the kidneys? what is its consequence?

A

hypertrophic, overworked kidneys
afferent arteriole of the kidneys dilates
= glomerular sclerosis

78
Q

what are the effects of glomerular sclerosis on the kidneys?

A

thickening of basement membrane

disruption of normal protein cross links so large molecules can get through = worse filter

79
Q

leading cause of chronic renal failure?

A

diabetic nephropathy

80
Q

what would increased creatinine indicate?

A

ACUTE renal failure

81
Q

how often is creatinine measured?

A

annually

82
Q

what pathway is responsible for the vascular complications in T2DM?

A

poyol pathway

83
Q

what does hypertension do to the kidneys?

A

damages glomeruli causing proteinuria

84
Q

what is the BP target for most diabetics?

A

less than 140/80mmHg

85
Q

what is the BP target for diabetic patients at risk?

A

less than 130/80mmHg

86
Q

which vascular change is characteristic of diabetes?

A

capillary microangiopathy

87
Q

what is the effect of capillary microangiography on the body?

A

thickened, permeable and dilated small blood vessels causing microaneurysms and increased passive diffusion of proteins

88
Q

what vascular complication causes retinpathy, nephropathy and peripheral neuropathy?

A

capillary microangiopathy

89
Q

good screening questions to ask at review?

A

snacking between meals

compliance

90
Q

what condition could be causing dry feet and calluses from diabetes?

A

peripheral nueropathy

91
Q

cause of distended veins at the foot in someone with diabetes?

A

peripheal neuropathy

92
Q

name the 3 types of neuropathy that can occur in diabetic patients?

A

hyperglycaemic
acute painful diabetic
distal symmetrical

93
Q

which neuropathy tends to occur in diabetics with poor glycaemic control?

A

hyperglycaemic neuropathy

94
Q

clinical presentation of hyperglycaemic neuropathy

A

discomfort in lower legs

95
Q

when is a patient most likely to get acute painful diabetic neuropathy?

A

when they have weight loss and bad glycaemic control

96
Q

most common neuropathy?

A

distal symmetrical

97
Q

which neuropathy presents with the glove and stocking sensation?

A

distal symmetrical

98
Q

what si the glove and stocking sensation

A

sensation reduced over extremities of limbs

99
Q

what would you find on the feet of someone with DSN?

A

warm, dry feet
foot ulceration
oedema

100
Q

why does diabetic retiniopathy happen?

A

capillary microangiopathy

101
Q

why do you get dry feet in neuropathy?

A

nerve damage stops sweating

102
Q

why do you get foot ischaemia in diabetes?

A

damage to the nerves can lead to arteriovenous shunting which means blood blood bypasses the capillary vessels of the feet

103
Q

where do neuropathic foot ulcers present?

A

high pressure areas eg metatarsal heads or big toe

104
Q

where do ischemic foot ulcers present?

A

margins of the feet

105
Q

foot complication of severe neuropathy?

A

charcot foot

106
Q

which condition has a bag of bone appearance on x ray?

A

charcot foot

2 Endocrine (35 decks)

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