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CCTs Year 3 > Diabetes Mx in Primary care (1) > Flashcards

Diabetes Mx in Primary care (1) Flashcards

1
Q

Physiology review - cells of the pancreas:

  • cells that secrete glucagon
  • cells that secrete insulin
  • cells that secrete somatostatin
  • which areas do contain endocrine tissue within the pancreas?
A
  • Glucagon -> alpha cells
  • Insulin -> beta cells
  • Samatostatin -> delta cells
  • Endocrine tissue within the pancreas -> Islets of Langerhans
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2
Q

WHO type 1 DM diagnostic criteria

(symptoms and bloods)

A

Diabetes Mellitus

symptoms ( Polyuria, Polydipsia and unexplained weight loss) plus

  • Random venous plasma glucose concentration of ≥ [11.1] mmol/l or
  • Fasting venous plasma glucose concentration of ≥ [7.0] mmol/l or
  • Plasma glucose concentration ≥ 11.1 mmol/l [two] hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT)
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3
Q

What’s diagnostic (apart from symptoms) of T1DM in terms of random venous plasma glucose concentration?

A

Random venous plasma glucose concentration of ≥ [11.1] mmol/l

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4
Q

What’s diagnostic (apart from symptoms) of T1DM in terms of fasting venous plasma glucose concentration?

A

Fasting venous plasma glucose concentration of ≥ [7.0] mmol/l

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5
Q

How many hours do we check plasma glucose concentration in oral tolerance test?

A

Plasma glucose concentration ≥ 11.1 mmol/l two hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT)

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6
Q

If no symptoms, can we make a diagnosis of DM based on a single glucose reading?

A
  • with no symptoms, diagnosis should not be based on a a single glucose determination
  • requires confirmatory plasma venous determination -> At least one additional glucose test result on another day (with a value in the diabetic range )
  • either fasting, from a random sample or from the two hour post glucose load
  • if the fasting random values are not diagnostic the two-hour value should be used
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7
Q

What medication is the 1st line in Rx of T2DM?

A

Metformin

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8
Q

Are statins used in all T2DM in order to lower the risks of CVD?

A

No, it depends on a patient’s QRISK assessmnet

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9
Q

What’s the commonest reason why the patients would stop taking Metformin?

A

diarrhoea and GI disturbance

*these are common side effects -> to reduce their likelihood introduce metformin gradually

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10
Q

What pattern of neurological damage does diabetic neuropathy usually present with?

A

Glove and stocking distribution

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11
Q

What is the most common cause of death in patients with T2DM?

A

CVD: stroke, MI etc.

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12
Q

What’s:

  • glycogenesis
  • gluconeogenesis
  • glycogenolysis
A
  • glycogenesis = glucose ->glycogen (liver store)
  • gluconeogenesis = non-carbohydrate sources -> glucose
  • glycogenolysis = glycogen (liver store) *-> glucose-6- phosphate

*this process is induced by glucagon from the pancreas

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13
Q

Symptoms of hypoglycaemia

A

Hypoglycaemia symptoms

  • fatigue
  • faint
  • seizures
  • tachycardia
  • neurological damage (may be permanent if hypoglycaemia is not treated for long time)
  • LOC -> injury/trauma
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14
Q

Symptoms of hyperglycaemia

A

Hyperglycaemia symptoms

  • polyuria
  • polydipsia

*leading to dehydration

  • vascular retinopathy/ nephropathy/ neuropathy
  • increased CVD risk
  • confusion
  • DKA (high blood glucose, but low insulin -> so cannot get into the cells)
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15
Q

What’s the classical presentation of T1DM?

A

T1DM classical presentation

  • young patient
  • fairly rapid onset of thirst, polyuria and polydipsia
  • sometimes may present as acutely unwell, with DKA
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16
Q

What is the most common presentation of T2DM?

A

Asymptomatic

17
Q

What other conditions may an otherwise asymptomatic person with T2DM present with?

A
  • lightheadedness
  • clumsiness/ weakness/tingling -> diabetic neuropathy
  • recurrent cellulitis
  • recurrent candidiasis or balanitis (in men)
  • cramps -> due to polydipsia and polyuria leading to dehydration = electrolyte imbalance
  • visual disturbance -> due to retinopathy
  • CKD/AKI -> due to nephropathy
  • stroke/MI/ PVD
  • erectile dysfunction
  • increased BP (nephropathy)
18
Q

What does HbA1C tell us?

A

HbA1C = glycosylated haemoglobin -> how much glucose attach to RBCs

*considers period of 2-3 months

19
Q

Ranges for HbA1C

  • normal
  • impaired glucose tolerance (pre-diabetic)
  • diabetes
A

Hb1Ac ranges

  • Normal:<42
  • Impaired glucose tolerance: 42-47
  • Diabetes: >/= 48
20
Q

Ranges for fasting glucose

  • normal
  • impaired glucose tolerance (pre-diabetic)
  • diabetes
A

Fasting glucose

  • normal:<5.5
  • impaired glucose tolerance (pre-diabetic):5.5 - 6.9 mmol/L
  • diabetes: >/= 7,0 mmol/L
21
Q

Ranges for random glucose

  • diabetes (*just that criteria is provided)
A

Ranges for random glucose

  • diabetes: >/= 11.1 mmol/L
22
Q

Ranges for 2-hour glucose in OGTT

  • normal
  • impaired glucose tolerance (pre-diabetic)
  • diabetes
A

Ranges for 2-hour glucose in OGTT

  • normal: <7.8 mmol/L
  • impaired glucose tolerance (pre-diabetic): 7.8-11.0 mmol/L
  • diabetes: >/= 11.1 mmol/L
23
Q

What to do if the initial testing is within the diabetic range and patient is asymptomatic?

A

Repeat the same test 2 weeks later (to confirm the diagnosis)

24
Q

How long before the ‘fasting glucose’ test does a patient need to fast?

A

6 hours before

25
Q

How many tests are needed to confirm the diagnosis of diabetes in:

  • asymptomatic patient
  • symptomatic patient
A

Asymptomatic -> two tests needed

Symptomatic -> one test is enough

26
Q

What conditions may alter the results of HbA1C? (in general)

A

Anything that affects haemoglobin level (as glycosylated haemoglobin tested)

27
Q

Examples of conditions that may make the HbA1c result too low

A

Conditions that will cause low RBCs (so fewer RBCs for glucose to be attached - maybe false low result)

  • anaemia and haemolytic anaemia
  • sickle cell
  • leukaemia
  • myelodysplastic syndrome
  • thalassemia
28
Q

Examples of conditions and (2) types of medications that may make the HbA1c result too high

A

More RBCs -> more glucose can attach to it

  • splenectomy (no spleen so less old RBCs will be destroyed)

Drugs that increase glucose levels:

  • steroids
  • anti psychotics
29
Q

What (3) groups of patients would be taking HbA1c reading not be reliable?

A
  • if blood transfusion -> as someone else’s blood
  • pregnancy -> as more foetal Hb
  • children -> more foetal haem
30
Q

What tests to do in patients who would have not reliable HbA1 readings? (e.g. pregnancy, anaemia etc)

A
  • Fasting glucose test
  • 2 hours glucose tolerance (18-28 weeks pregnant women)

CCTs Year 3 (14 decks)

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