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Endocrinology > Diabetes Modules > Flashcards

Diabetes Modules Flashcards

1
Q

What is the definition of hypoglycaemia in diabetics

A

Blood glucose below 4 mmol/l

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2
Q

What are the symptoms of hypoglycaemia

A 
Trembling 
Anxiety 
Palpitation 
Numbness/tingling around lips and fingers 
Pale and sweaty 
Then (when brain deprived) 
Weakness 
Concentration and coordination issues 
Vision problems 
Slurred speech 
Loss of consciousness 
Seizures
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3
Q

When is the release of glucose from stores in the liver impaired

A

Where glycogen levels are low

Common in malnourished, repeated hypoglycaemia, excess alcohol consumption and liver disease

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4
Q

You should always check blood glucose in an unconscious patient - true or false

A

TRUE

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5
Q

What treatment should be given for hypoglycaemia in patients who can swallow

A

15-20g of fast acting carbs

Glucojuice, glucotabs, fruit juice etc

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6
Q

What treatment should be given for hypoglycaemia in patients who are drowsy or confused

A

1.5-2 tubes of a glucose gel

Squeeze into the mouth between teeth and gums

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7
Q

What treatment should be given for hypoglycaemia in patients who are unconscious

A

Check ABC
Call senior Dr
Stop IV insulin if on this

IV glucose - infuse over 10-15 mins
SC or IM glucagon

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8
Q

How long after treatment for hypoglycaemia should you recheck the blood glucose

A

15 mins

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9
Q

What is the most common route of administration for insulin

A

subcutaneous

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10
Q

What are the main sites of insulin injection

A

Abdomen
Upper outer thigh
upper outer arm
Some patients use buttocks

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11
Q

What are the key principles of SC insulin injection

A

Rotate the injection site with each injection
Use same general location at same time of day
Change insulin pen needle or syringe for each injection

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12
Q

What are the potential problems that occur at injection sites

A

Lipohypertrophy - occurs if repeated injections at same site and means insulin absorption will be poor
Can lead to hypo or hyper

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13
Q

What is the normal concentration of insulin used in hopsitals

A

100 units per millilitre

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14
Q

Do all insulin pens need to be stored in the fridge

A

Spare ones should be

The one in use will be stable for around 1 month at room temperature

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15
Q

What is the target blood glucose range for diabetics in hospital

A

6-12 mmol/L

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16
Q

What is post-prandial insulin

A

The insulin released in response to high glucose after meals
Will peak after meals to cope with this

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17
Q

Quick acting insulin must always be given with carbohydrates - true or false

A

True
These forms are given with meals
e.g. novorapid, Humalog

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18
Q

What is meant by a basal bolus regimen

A

Patients take a basal (background) dose of long lasting insulin and quick acting with meals

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19
Q

When would you use IV insulin in diabetic patients

A 
Acute illness 
DKA 
HHS
Fasting patients 
Those that cannot take orally 
Some antenatal patients on high dose steroids
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20
Q

In patients with T1DM what can insulin omission lead to

A

diabetic ketoacidosis (DKA)

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21
Q

Describe glucose monitoring during IV insulin treatment

A

Check blood glucose hourly Use results to adjust as needed

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22
Q

What is co-administered with IV insulin

A

IV fluids

Different fluid may me needed by different patients e.g. DKA or HHS

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23
Q

When should transfer from IV to SC insulin occur

A

When patient is clinically stable and tolerating fluid and foods
Done at mealtime:
If long acting has been continued then stop IV 30-60 mins after quick acting has been given with meal
If long acting hasn’t been continued then stop IV 30-60 mins after both quick and long acting have been given

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24
Q

How often should you check blood glucose after stopping IV insulin

A

A minimum of 4 times per day

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25
Q

How high must a random blood glucose be in order to diagnose diabetes

A

Over 11.1 mmol/L with symptoms

If no other symptoms then 2 random measurements over 11.1 on separate occasions is enough

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26
Q

What is the ideal plasma concentration for glucose

A

Between 3.6 and 5.8 mmol/L

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27
Q

What are the roles of insulin in reducing blood glucose

A

Facilitates transport of glucose into cells - recruits GLUT4 transporter
Stimulates glycogenesis
Inhibits glycogenolysis (breakdown of glycogen to glucose)
Inhibits gluconeogenesis

28
Q

What effects does insulin have on fatty acids

A

Encourages entry of fatty acids into adipose tissues
Promotes chemical reactions that use fatty acids
Inhibits lipolysis

29
Q

How does insulin effect amino acid levels in the blood

A

Promotes uptake of amino acids into muscles and other tissues
Stimulates protein synthesis
Inhibits degradation of protein

30
Q

What can stimulate insulin release

A

Increase in blood glucose
GI hormones - during digestion to prepare for nutrient absorption
Elevated blood amino acid levels

31
Q

Which hormones can increase blood glucose

A

Glucagon
Adrenalin
Cortisol
Growth hormone

32
Q

Why do diabetics lose weight

A

Increased lipolysis so they lose their fat stores

33
Q

Why can diabetes cause visual blurring

A

Short term - excess glucose can be absorbed by the lens of the eye changing it’s shape
Long term: retinopathy and increased cataract risk

34
Q

Which infections are diabetics particularly prone to

A

Respiratory and urinary tracts
Soft tissue
Thrush in women

35
Q

What is Kussmaul breathing

A

Deep, laboured breathing that occurs when there is an excess of ketones - diabetic ketoacidosis
Seen in T1 only

36
Q

What damage can diabetes cause to the foetus in pregnancy

A

High risk of CNS deformities - e.g. spina bifida
Abnormalities of great vessels
Larger birth weight
Can go hypo after birth as baby develops high insulin levels due to high glucose from mother

37
Q

Does diabetes affect life expectancy

A

Yes

Lowers it

38
Q

Which investigations would you do to diagnose T2DM

A

Urine glucose
Random plasma glucose
Fasting glucose test
HbA1c test

39
Q

What is gestational diabetes

A

Form of diabetes first recognised in pregnancy

40
Q

What does gestational diabetes increase your risk of

A

developing type 2 DM later in life

41
Q

Which condition related to growth hormones is associated with diabetes

A

Acromegaly - excess of growth hormone

Thought that hormones induce insulin resistance

42
Q

How is Cushing’s syndrome related to diabetes

A

Excess cortisol in the syndrome inhibits the uptake of glucose by muscles
Leads to hyperglycaemia and insulin resistance

43
Q

How long should a T2 patient try lifestyle changes before drugs are added as treatment

A

At least one month on lifestyle changes alone

Must be continued alongside drugs

44
Q

List examples of sulphonylureas

A

Tolbutamide
Glicazide
Glibenclamide

45
Q

How do sulphonylureas work

A

Need functioning beta cells - only used in T2

They depolarise the beta cells to stimulate insulin release

46
Q

What is the major risk with sulphonylureas

A

Hypoglycaemia

Keep working even if glucose is low

47
Q

What drug class is metformin in

A

Biguanides

48
Q

What are the side effects of metformin

A

Lactic acidosis
Nausea and vomiting
Diarrhoea

49
Q

In which patients should metformin be avoided

A 
Those with: 
renal failure 
alcoholism 
cirrhosis 
chronic lung disease 
cardiac failure
50
Q

How do TZD’s work

A

Bind to receptors within the cell nucleus and affect gene expression
This decreases insulin resistance

51
Q

Give an example of a TZD

A

Glitazone

52
Q

How do GLP-1 analogues work

A

Mimic the action of GLP-1 to increase secretion of insulin and decrease glucagon secretion
Also increase insulin sensitivity

53
Q

List examples of GLP-1 analogues

A

Exenatide

Liraglutide

54
Q

How do DPP-4 inhibitors work

A

Stop inhibition of GLP-1 so increase action of GLP-1 (increase insulin etc)

55
Q

List examples of DPP-4 inhibitors

A

Sitagliptin

Vildagliptin

56
Q

What is the Somogyi effect

A

Side effect of insulin

Hyperglycaemia through overcompensation of hypo

57
Q

List the side effects of insulin

A 
Hypoglycaemia 
Hyperglycaemia - Somogyi 
Local reaction at injection site 
Loss of fatty tissue at injection site 
Insulin resistance
58
Q

What is HbA1c

A

Glycated haemoglobin

Evaluates glucose control over the past 2-3 months

59
Q

What is proteinuria a sign of in diabetics

A

Kidney damage - may be a sign of nephropathy

60
Q

Are diabetics more prone to hypertension

A

YES

Up to 2x as common in diabetics

61
Q

What is capillary microangiopathy

A

Thickened, permeable and dilated small blood vessels
Leads to micro-aneurysms and increased passive diffusion of proteins
This causes retinopathy, nephropathy and neuropathy

62
Q

What are the key points in diabetic foot care

A

Inspect feet daily
Seek early advice for any damage
Check shoes for sharp foreign bodies etc before wearing
Keep feet clean and dry

63
Q

What causes retinopathy

A

Capillary microangiopathy
Vessel walls get abnormally glycosylated which thickens the basement membrane and becomes more permeable
proteins can pass across and react with retina - damages neural network
Small vessels dilate
May get thrombosis and ischaemia - damage

64
Q

What is charcot foot

A

Complication of severe neuropathy
Initiated by injury
As the injuries get worse, the bone density decreases and joints are destroyed

65
Q

What constitutes an Annual Diabetic Screening?

A
  • Foot screening
  • HbA1c test (measure of glycaemic control)
  • Retinal screening
  • Protein test
  • Blood Pressure
  • Renal function
  • Cholesterol
  • Weight
  • Smoking history
66
Q

What are the risks of drinking alcohol if diabetic

A

Risk of hypoglycaemia
Alcohol blocks the release of glucose from liver
Tell friends that you are out with that you are diabetic as a safety net
Symptoms of a hypo are similar to being drunk

Endocrinology (13 decks)

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