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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
How high must a random blood glucose be in order to diagnose diabetes
Over 11.1 mmol/L with symptoms If no other symptoms then 2 random measurements over 11.1 on separate occasions is enough
26
What is the ideal plasma concentration for glucose
Between 3.6 and 5.8 mmol/L
27
What are the roles of insulin in reducing blood glucose
Facilitates transport of glucose into cells - recruits GLUT4 transporter Stimulates glycogenesis Inhibits glycogenolysis (breakdown of glycogen to glucose) Inhibits gluconeogenesis
28
What effects does insulin have on fatty acids
Encourages entry of fatty acids into adipose tissues Promotes chemical reactions that use fatty acids Inhibits lipolysis
29
How does insulin effect amino acid levels in the blood
Promotes uptake of amino acids into muscles and other tissues Stimulates protein synthesis Inhibits degradation of protein
30
What can stimulate insulin release
Increase in blood glucose GI hormones - during digestion to prepare for nutrient absorption Elevated blood amino acid levels
31
Which hormones can increase blood glucose
Glucagon Adrenalin Cortisol Growth hormone
32
Why do diabetics lose weight
Increased lipolysis so they lose their fat stores
33
Why can diabetes cause visual blurring
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
Which infections are diabetics particularly prone to
Respiratory and urinary tracts Soft tissue Thrush in women
35
What is Kussmaul breathing
Deep, laboured breathing that occurs when there is an excess of ketones - diabetic ketoacidosis Seen in T1 only
36
What damage can diabetes cause to the foetus in pregnancy
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
Does diabetes affect life expectancy
Yes | Lowers it
38
Which investigations would you do to diagnose T2DM
Urine glucose Random plasma glucose Fasting glucose test HbA1c test
39
What is gestational diabetes
Form of diabetes first recognised in pregnancy
40
What does gestational diabetes increase your risk of
developing type 2 DM later in life
41
Which condition related to growth hormones is associated with diabetes
Acromegaly - excess of growth hormone | Thought that hormones induce insulin resistance
42
How is Cushing's syndrome related to diabetes
Excess cortisol in the syndrome inhibits the uptake of glucose by muscles Leads to hyperglycaemia and insulin resistance
43
How long should a T2 patient try lifestyle changes before drugs are added as treatment
At least one month on lifestyle changes alone | Must be continued alongside drugs
44
List examples of sulphonylureas
Tolbutamide Glicazide Glibenclamide
45
How do sulphonylureas work
Need functioning beta cells - only used in T2 | They depolarise the beta cells to stimulate insulin release
46
What is the major risk with sulphonylureas
Hypoglycaemia | Keep working even if glucose is low
47
What drug class is metformin in
Biguanides
48
What are the side effects of metformin
Lactic acidosis Nausea and vomiting Diarrhoea
49
In which patients should metformin be avoided
``` Those with: renal failure alcoholism cirrhosis chronic lung disease cardiac failure ```
50
How do TZD's work
Bind to receptors within the cell nucleus and affect gene expression This decreases insulin resistance
51
Give an example of a TZD
Glitazone
52
How do GLP-1 analogues work
Mimic the action of GLP-1 to increase secretion of insulin and decrease glucagon secretion Also increase insulin sensitivity
53
List examples of GLP-1 analogues
Exenatide | Liraglutide
54
How do DPP-4 inhibitors work
Stop inhibition of GLP-1 so increase action of GLP-1 (increase insulin etc)
55
List examples of DPP-4 inhibitors
Sitagliptin | Vildagliptin
56
What is the Somogyi effect
Side effect of insulin | Hyperglycaemia through overcompensation of hypo
57
List the side effects of insulin
``` Hypoglycaemia Hyperglycaemia - Somogyi Local reaction at injection site Loss of fatty tissue at injection site Insulin resistance ```
58
What is HbA1c
Glycated haemoglobin | Evaluates glucose control over the past 2-3 months
59
What is proteinuria a sign of in diabetics
Kidney damage - may be a sign of nephropathy
60
Are diabetics more prone to hypertension
YES | Up to 2x as common in diabetics
61
What is capillary microangiopathy
Thickened, permeable and dilated small blood vessels Leads to micro-aneurysms and increased passive diffusion of proteins This causes retinopathy, nephropathy and neuropathy
62
What are the key points in diabetic foot care
Inspect feet daily Seek early advice for any damage Check shoes for sharp foreign bodies etc before wearing Keep feet clean and dry
63
What causes retinopathy
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
What is charcot foot
Complication of severe neuropathy Initiated by injury As the injuries get worse, the bone density decreases and joints are destroyed
65
What constitutes an Annual Diabetic Screening?
- Foot screening - HbA1c test (measure of glycaemic control) - Retinal screening - Protein test - Blood Pressure - Renal function - Cholesterol - Weight - Smoking history
66
What are the risks of drinking alcohol if diabetic
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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