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DM Flashcards

1
Q

what antibodies are present in T1DM?

A

anti islet

ant GAD

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2
Q

what is the pathophysiology of T2DM?

A

insulin resistance and beta cell dysfunction

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3
Q

what are the fasting and random venous glucose levels ?

A

fasting >7

random >11.1

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4
Q

how is asymptomatic DM diagnosed?

A

increased venous glucose on 2 occasions
or
2hr OGTT (oral glucose tolerance test) >11.1

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5
Q

what does IFG and IGF mean in relation to DM?

A

IFG (impaired fasting glucose)

IGF (impaired glucose tolerance)

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6
Q

what test is used to diagnose IFG?

A

fasting glucose (6.1-6.9)

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7
Q

what is the test used to diagnose IGT?

A

OGTT (7.8-11)

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8
Q

what is metabolic syndrome?

A

central obesity and two of:

  • increased triglycerides
  • decreased HDL
  • HTN
  • hyperglycaemia (DM, IGT, IFG)
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9
Q

state some secondary causes of DM?

A

steroids, anti-HIV drugs, thiazides, atypical neuroletics

CF, chronic pancreatitis, HH, pancreatic cancer

phaemochromocytoma, cushings, acromegaly, hyperthryoidism

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10
Q

what are the 4Cs of DM management?

A

control glycaemia
complications (macro, micro)
competency (insulin injections, injection sites, BM monitoring)
coping (psychological)

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11
Q

what three things are monitored in order to control glycaemia?

A

capillary blood glucose
HbA1c
BP, lipids

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12
Q

what should fasting glucose be?

A

4.5-6.5mM

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13
Q

what should the HbA1c aim be?

A

<45-50mM (7.5-8%)

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14
Q

what lifestyle modifications can be done for DM? DELAYS

A 
diet 
exercise
lipids 
ABP
aspirin 
yearly checkups 
smoking cessation
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15
Q

what is 1st line for DM?

A

metformin

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16
Q

what are SEs of metformin?

A

Nausea/diarrhoea, abdo pain, lactic acidosis

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17
Q

when is metformin taken?

A

500mg after evening meal

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18
Q

what are CIs for metformin?

A

GFR<30
sepsis, MI
iodinated contrast media

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19
Q

what is 2nd line for Dm and give an example?

A

sulfonylurea

- gliclazide

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20
Q

when is sulfonylurea taken?

A

with breakfast

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21
Q

what are SEs of sulfonylureas?

A

weight gain, hypoglycaemia

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22
Q

does sulfonylureas need to be stopped before surgery?

A

stop on morning of surgery

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23
Q

what are three SEs of insulin treatment?

A

hypoglycaemia risk
lipohypertrophy
weight gain in T2DM

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24
Q

what BM informs you on the long acting insulin dose?

A

fasting BM before meals

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25
Q

what BM informs you on the short acting insulin dose?

A

finger prick BM after meals

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26
Q

state 3 common insulin regimes?

A

BD biphasic regime
basal bolus regime
OD long acting before bed

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27
Q

what is the BM biphasic regime?

A

BD insulin mixture 30min before breakfast and dinner
 Rapid-acting: e.g. actrapid
 Intermediate- / long-acting: e.g. insulatard

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28
Q

what is the basal bolus regime?

A

Bedtime long-acting (e.g. glargine) + short acting
before each meal (e.g. lispro)
 Adjust dose according to meal size
 ~50% of insulin given as long-acting

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29
Q

what is the OD long acting regime?

A

 Initial regime when switching from tablets in T2DM

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30
Q

what insulin regime is best for T1DM?

A

basal bolus regime

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31
Q

what are the 4 sick rules for insulin use?

A 
Insulin requirements usually ↑ (even if food intake ↓)
Maintain calories (e.g. milk)
Check BMs ≥4hrly and test for ketonuria
↑ insulin dose if glucose rising
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32
Q

what screening should be done in DM?

A

fundoscopy, albumin/creatinine ratio, foot checks

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33
Q

what are two type of ulcers DM pts can get on their feet?

A

ischaemic

neuropathic

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34
Q

what deformities can occur with DM neuropathy?

A 
charcots joints 
pes cavus (high arch)
claw toes
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35
Q

are iscahemic ulcers sore?

A

yes

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36
Q

are neuropathic ulcers sore?

37
Q

what are indictions for surgery for DM complications?

A

abscesses, spreading celllulitis, gangrene, suppurative arthritis (septic arthritis)

38
Q

what changes can occur in the kidney to hyperglycaemia?

A

nephron less and glomerulosclerosis

39
Q

what is the treatment for microalbuminuria in DM?

40
Q

over what level is ACR for microalbuminuria a problem?

41
Q

what does ACR stand for?

A

urine albumin:creatinine ratio

42
Q

what is rubeosis iris ?

A

new vessels on the iris due to increase VEGF due to retinal ischaemia

43
Q

what is a complication of rubeosis iris?

44
Q

what investigation should be done for diabetic retinopathy ?

A

fluorescein angiography

45
Q

what is the treatment for diabetic retinopathy ?

A

laser photocoagulation

46
Q

what structure does DM affect to cause ischaemic neuropathy ?

A

loss of vasa nervorum

- small arteries that provide blood supply to peripheral nerves

47
Q

accumulation of what 3 metabolic features increases the risk of DM neuropathy complications?

A

increased glycosylation
ROS (role of reactive oxygen species)
sorbitol accummulation

48
Q

what 4 neuropathy conditions can occur in DM?

A

symmetric sensory polyneuropathy

mononeuropathy (CN3/6 palsy)

femoral nueropathy

autonomic neuropathy

49
Q

what are some featurs of autonomic neuropathy?

A 
postural hypotension 
gastroparaesis 
diarrhoea 
urinary retention 
ED (erectile dysfunction)
50
Q

what is the presentation of symmetric sensory polyneuropathy?

A

glove and stocking
absent of ankle jerks
numbness, tingling, pain (worse at night)

51
Q

what medication can be given for symmetric sensory polyneuropathy ?

A 
paracetamol
amitriptyline 
gabapentin 
SSRI
baclofen 
capsaicin cream
52
Q

what is femoral neuropathy ?

A

 Painful asymmetric weakness and wasting of quads c¯

loss of knee jerks

53
Q

how is a diagnosis of femoral neuropathy made?

A

nerve conduction and electromyography

54
Q

what is postural hypotension treated with?

A

fludrocortisone

55
Q

what is autonomic diarrhoea treated with?

A

codeine phosphate

56
Q

state the presentation of DKA?

A 
Abdo pain + vomiting
 Gradual drowsiness
 Sighing “Kussmaul” hyperventilation
 Dehydration
 Ketotic breath
57
Q

what is myasthenia gravis associated with?

A

thymus problems (hyperplasia, adenocarcinoma)

58
Q

what are the levels of ketones in serum and urine for DKA?

A

> 3mM in serum

>2+ on dipstik

59
Q

will HCO3 be high or low for DKA?

60
Q

what investigations should be done for DKA?

A 
Urine: ketones and glucose, MCS
 Cap glucose and ketones
 VBG: acidosis + ↑K
 Bloods: U+E, FBC, glucose, cultures
 CXR: evidence of infection
61
Q

are people with DM usually hypo/hypernatreamic?

A

hypo

- since Osmolar compensation for hyperglycaemia

62
Q

what is a complication after treatment of DKA?

A

hyperchloraemic metabolic acidosis

- since loss of bicarbonate with the excretion of ketones

63
Q

state some complications of DKA?

A

Cerebral oedema: excess fluid administration
 Commonest cause of mortality
 Aspiration pneumonia
 Hypokalaemia
 Hypophosphataemia → resp and skeletal muscle
weakness
 Thromboembolism

64
Q

what are the 4 managements for DKA in HDU? GRIP

A

Gastric aspiration
 Rehydrate
 Insulin infusion
 Potassium replacement

65
Q

what is hyperosmolar non ketotic coma?

A

marked dehydration and glucose >35mM but with no acidosis

66
Q

state the presentation of someone with hyperosmolar non ketotic coma?

A

Usually T2DM, often new presentation
 Usually older
 Long hx (1 week)

67
Q

what medication should be given to a hyperosmolar non ketotic coma pt to prevent occlusion events?

68
Q

what is the osmolality of someone with hyperosmolar non ketotic coma?

A

> 340mosmol/kg

69
Q

what is the management of hyperosmolar non ketotic coma?

A

rehydrate with 0.9% over 48hrs

wait 1 hr before starting insulin to avoid rapid changes in osmolality

70
Q

what is the triad called for hypoglycaemia presentation?

A

Whipples triad

71
Q

what is whipples triad?

A

low plasma glucose <3
hypoglycaemia symptoms
relief of symptoms by glucose administration

72
Q

what two classifications of hypoglycaemia symptoms are there?

A

autonomic

neuroglycopenic

73
Q

state some autonomic hypoglyaemia symptoms?

A 
Sweating
 Anxiety
 Hunger
 Tremor
 Palpitations
74
Q

state some neurglycopenic hypoglyaemia symptoms?

A 
Confusion
 Drowsiness
 Seizures
 Personality change
 Focal neurology (e.g. CN3)
 Coma (<2.2)
75
Q

what 4 things in the blood should be measured during a hypoglycaemic attack?

A

Glucose, insulin, C-peptide, ketones

76
Q

what is the management of hypoglycaemia in an alert pt?

A

oral carbs

77
Q

what is the management of hypoglycaemia in a drowsy pt?

A

buccal carb

- glucogel

78
Q

what is the management of hypoglycaemia in an unconscious pt?

A

100ml 20% glucose

79
Q

what is the management of hypoglycaemia in a deteriorating pt?

A

1mg glucagon IM/SC

80
Q

what are some causes of Hyperinsulinaemic hypoglycaemia

A

drugs

insulinoma

81
Q

what medication could cause increased C peptide with Hyperinsulinaemic hypoglycaemia?

A

sulfonylurea

82
Q

what medication could cause normal C peptide with Hyperinsulinaemic hypoglycaemia?

83
Q

what could cause ↓ insulin, no ketones ?

A

Non-pancreatic neoplasms

Insulin receptor Abs

84
Q

what could cause ↓ insulin, ↑ ketones ?

A

 Alcohol binge c¯ no food
 Pituitary insufficiency
 Addison’s

85
Q

is an insulinoma benign or malignant?

86
Q

what condition is insulinoma associated with?

87
Q

what can trigger hypoglycaemia with insulinoma?

A

fasting

exercise

88
Q

what is the management of insulinoma?

89
Q

what is post prandial hypoglycaemia ?

A

Dumping post-gastric bypass

Y4 Endo (5 decks)

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