Endocrine Flashcards
Signs of diabetes mellitus
Polyuria
Polydipsia
weight loss
What are the types of diabetes?
T1DM = an absolute insulin deficiency causes persistent hyperglycaemia. (autoimmune)
T2DM = a combination of insulin resistance/insensitivity and insulin deficiency
Diagnostic criteria for diabetes
Symptomatic:
1. fasting glucose > 7.0 mmol/l
- random glucose > 11.1 mmol/l (or after 75g oral glucose tolerance test)
HbA1c > 48 mmol/mol
4 main ways to check blood glucose
- a finger-prick bedside glucose monitor
- a one-off blood glucose.
- a HbA1c.
- a glucose tolerance test.
Management of T1DM
Insulin
Management of T2DM
- Metformin
- Sulfonylureas, gliptins + pioglitazone
- Insulin
Signs and symptoms of DKA
Common in new diagnosis T1DM:
- abdominal pain
- polyuria, polydipsia, dehydration
- deep hyperventilation
- acetone-smelling breath (‘pear drops’ smell)
When should HbA1c be monitoried for T1DM?
Every 3-6 months
What is the HbA1C targets for T2DM?
Lifestyle = 48
Lifestyle + metformin = 48
Lifestyle + any drug cause hypoglycaemia (sulfonylurea) = 53
Diabetes Mellitus sick day rules
- Increase frequency of blood glucose monitoring to four hourly or more frequently
- Encourage fluid intake aiming for at least 3 litres in 24hrs
- If unable to take struggling to eat may need sugary drinks to maintain carbohydrate intake
- It is useful to educate patients so that they have a box of ‘sick day supplies’ that they can access if they become unwell
- Access to a mobile phone has been shown to reduce progression of ketosis to diabetic ketoacidosis
- Continue taking medication
What is Hashimoto’s thyroiditis
autoimmune disorder of the thyroid gland
typically associated with hypothyroidism although there may be a transient thyrotoxicosis in the acute phase
Clinical features of Hashimoto’s thyroiditis
- hypo sx
- goitre
- anti-TPO and anti-thyroglobulin antibodies
What may trigger thyroid storm
- surgery
- trauma
- infection
- iodine load e.g CT Contrast
Management of thyroid storm
symptomatic tx (paracetemol), treat underlying, beta blockers
- anti-thyroid drugs: e.g. propylthiouracil
- Lugol’s iodine
- dexamethasone (blocks conversion of T3 to T4)
What is Subacute (De Quervain’s) thyroiditis
thought to occur following viral infection and typically presents with hyperthyroidism
Investigations for Subacute (De Quervain’s) thyroiditis
thyroid scintigraphy: globally reduced uptake of iodine-131
Management of Subacute (De Quervain’s) thyroiditis
analgesia, self-limiting
Diagnostic critieria for DKA
- glucose > 11 mmol/l or known diabetes mellitus
- pH < 7.3
- bicarbonate < 15 mmol/l
- ketones > 3 mmol/l or
- urine ketones ++ on dipstick
Management of DKA
- Fluid replacement
- Insulin
- Correction of electrolyte disturbance
- Long-acting insulin
What is hypoglycaemia
blood glucose concentrations <3.3 mmol/L
Symptoms of hypoglycaemia
- Sweating
- Shaking
- Hunger
- Anxiety
- Nausea
- weakness
- vision change
- confusion
- dizziness
Symptoms of severe hypoglycaemia
- convulsion
- coma
Management of hypoglycaemia
- in the community:
- oral glucose 10-20g should be given in liquid, gel or tablet form
- Alternatively, a propriety quick-acting carbohydrate may be given: GlucoGel or Dextrogel.
- A ‘HypoKit’ may be prescribed which contains a syringe and vial of glucagon for IM or SC injection at home - in a hospital setting:
- If the patient is alert, a quick-acting carbohydrate may be given (as above)
- If the patient is unconscious or unable to swallow, subcut or IM glucagon
- Alternatively, IV 20% glucose solution through a large vein
Define hypercholesterolaemia
Total cholesterol > 7.5 mmol