Endocrine - Diabetes and Complications Flashcards
what causes T1DM?
autoimmune destruction of the pancreatic islet cells
causes beta cell failure
absolute insulin deficiency results
what autoantibodies can those with T1DM have?
GAD
islet auto antigen 2 (IA-2)
symptoms of T1DM?
wt loss tired thirsty thrush blurred vision polyuria sweet smelling urine
Ix for T1DM? what level is needed for diagnosis?
HbA1c ≥48
fasting glucose ≥7
OGTT ≥11.1
random glucose ≥11.1
what treatment regime is used for T1DM? names of drugs?
basal bolus regime
long acting e.g lantus
rapid acting e.g humalog
what are the mealtime targets for T1DM? how many times should BM be checked?
pre meal 4-7
1-2hrs after <10
atleast 4 times a day
what should T1DM aim for with their HbA1c?
48
at a DM annual review, what is covered?
weight BP HbA1c U+Es, eGFR, A:C, lipids urinalysis insulin injections retinal + foot screening
features of a DKA?
thirst tired blurred vision polyuria vomiting kussmaul's respiration
Ix in DKA and results?
ketones >3 BM >11 bicarbonate <15/pH <7.3 (acid) high K, low Na high creatinine high lactate high amylase
Tx for a DKA?
500ml NaCl + KCl Insulin with 0.9% NaCl continue long acting subcut regime Glucose 10% once BM <14 LMWH
FIND CAUSE
what bloods should be monitored in DKA?
K
BM
blood ketones
features of a hypo?
sweating pale tremor palpitations nausea hungry confused
Tx for a hypo?
20-30g glucose IV/buccal/oral (depending on consciousness level)
what is charcot’s athropathy?
destructive inflammatory process of a foot with neuropathy
how is MODY inherited?
aut dom
what causes MODY?
gene defect causing impaired insulin secretion from pancreatic beta cells
risk factors for T2DM?
FHx CVD HT PCOS obesity inactivity GD
pathology behind T2DM?
progressive loss of beta cells
background of insulin resistance due to adiposity and lipotoxicity
blood test and results for diagnosis of T2DM?
HbA1c ≥48
fasting ≥7
OGTT ≥11.1
random ≥11.1
what is the HbA1c aim for T2DM?
<53
drug pathway for T2DM?
metformin
+ DPP-4 or TZD or SU
metformin + DPP-4 +SU
OR
metformin + TZD + SU
insulin
example of a DPP-4, SU, TZD?
DPP-4 = sitagliptin SU = gliclazine TZD = pioglitazone
what cholesterol lowering drugs are given in T2DM? when?
20mg atorvastatin
BP target for T2DM?
135/85mmHg (at home)
140/90 in GP
(10 above if over 80)
what complications can diabetes lead to?
macrovascular
- stroke
- CVD
- PVD
- ED
microvascular
- retinopathy
- nephropathy
- neuropathy (peripheral and autonomic)
who usually presents with hyperglycaemic hyperosmolar syndrome?
old patients
frail
high carb intake
how does hyperglycaemic hyperosmolar syndrome present?
hypovolaemia
hyperglycaemia
no ketonaemia
high osmolality
what is the pathology behind diabetic nephropathy?
afferent arteriole dilates
hyperfiltration and increased GFR
high glucose causes renal hypertrophy
nephrotic syndrome can result
what are the features of nephrotic syndrome?
proteinuria
hypoalbuminaemia
oedema
Ix for diabetic nephropathy?
urinalysis
albumin:creatinine ratio
eGFR
U+Es
BP aim for those with diabetic nephropathy?
130/80mmHg
Tx for diabetic nephropathy?
ACE/ARB
statins
BP and BM control
transplant
who gets hyperosmolar hyperglycaemic state?
old people
T2DM with some insulin deficiency
what can increase risk of hyperosmolar non ketotic coma?
diuretics
steroids
features of hyperosmolar non ketotic coma?
dehydrated
coma
polyuria
polydipsia
Ix for hyperosmolar non ketotic coma?
BM (>50) ABG FBC U+Es ketones plasma osmolarity
Tx for hyperosmolar non ketotic coma?
NaCl + KCl (if neede) Insulin Glucose (once BM lowers) heparin warfarin
what blood results are needed to a T1DM diagnosis?
hyperglycaemia symptoms + fasting/random once
OR
fasting/random twice
OR
OGTT
what levels are defined as an impaired fasting glucose?
fasting <7
OGTT >7.8 but <11.1
what levels are defined as an impaired glucose tolerance?
fasting >6.2 but <7
what is the management for those with an impaired fasting glucose/glucose tolerance?
lifestyle
annual review
what drug is favoured in treating MODY?
SU (e.g gliclazide)
at what HbA1c should a second drug be added in T2DM?
58
what drugs causes hypos?
SU
incretins (exanatide)
what drug increases risk of thrush?
SGLT-2 (dapagloflozin)
what drugs to avoid in CKD?
SU
what drugs cause wt gain?
SU
TZDs
