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ENDOCRINE - HIGH WEIGHTED > ENDOCRINE - DIABETES MELLITUS > Flashcards

ENDOCRINE - DIABETES MELLITUS Flashcards

1
Q

What is type 1?

A
  • destroyed beta cells = insulin deficiency

- treat with insulin

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2
Q

What is type 2?

A
  • insulin reisistance

- treat with diet, oral antidiabetics or insulin

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3
Q

Symptoms of diabetes?

A
  • polyphagia
  • polydipsia
  • polyuria
  • weight loss
  • fatigue
  • blurred vision
  • poor wound healing
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4
Q

What are some long term macrovascular complications of diabetes?

A

CVD

  • T1D - always give statin as primary prevention
  • T2D - give statin if there is a 10-year q risk score > 10%
  • ACE may have a roll in preventing CVD
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5
Q

What are some long term microvascular complications?

A

Retinopathy

  • Eye test
  • Treat hypertension - prevents visual acuity

Neuropathy

  • diabetic foot - tingling, numbness, shooting pain, loss of sensitivity
  • strong opioids
  • duloxetine and tca’s (amitriptyline)
  • antiepileptics e.g. pregab and gaba

Nephropathy

  • Annual test for urinary protein
  • treat with ACE or ARB
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6
Q

Other than diabetic foot, what are some other complications of neuropathy?

A
  • autonomic neuropathy - erectile dys (sildenafil), diabetic diarrhoea (codeine or tetracycline), gastroparesis (erythromycin)
  • gustatory neuropathy - sweating face scalp head and neck - antimuscarinic (propenthaline bromide) or antiperspirant
  • neuropathic postural hypotension - fludrocortisone and increased salt intake
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7
Q

In what trimesters would a pregnant diabetic need to increase the amount of insulin?

A

2nd and 3rd

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8
Q

In pre existent diabetes, if a woman is planning a pregnancy what should she take to avoid deformities?

A

folic acid 5mg OD

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9
Q

Why should you reduce insulin immediately after birth?

A

increased risk of hypoglycaemia postnatal period

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10
Q

What should be the hba1c aim in pregnant women?

A

< 6.5%

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11
Q

In type 2 diabetes which drugs should be stopped in pregnancy?

A
  • all oral antidiabetic drugs except metformin - switch the others to insulin
  • in breast feeding also continue metformin
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12
Q

What is the treatment if FBG is <7mmol/L at diagnosis?

A
  • 1st line = diet and exercise

- 2nd line = metformin or insulin

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13
Q

what is the treatment if FBG is >7mmol/L at diagnosis?

A

1st line = insulin with or without metformin

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14
Q

What is the treatment for if FBG is 6-6.9mmol/L with hydraminiois (too much amniotic fluid)?

A

insulin without metformin

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15
Q

What would you give women that have a metformin intolerance and do not want insulin?

A

glibenclamide

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16
Q

What are risk factors for developing DKA?

A
  • Low beta cell function
  • alcohol abuse
  • surgery
  • sudden reduction in insulin
  • acute illness which can increase insulin requirement
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17
Q

What are the symptoms of DKA?

A
  • Severe high blood glucose and ketones
  • Pear drop breath
  • Polyuria
  • Excessive thirst
  • Abdominal pain
  • Anorexia
  • Difficulty breathing
  • Electrolyte imbalance
  • Confusion
  • Drowsiness
18
Q

What is the treatment for DKA?

A
  • IV infusion - soluble insulin, fluids (saline to rehydrate and increase circulating vol), potassium (correct hypokalaemia)
  • Continue established long acting insulin
  • Add glucose to infusion when <14 mol/L
  • Continue until pt able to eat and drink and blood ph >7.3
  • Give SC fast acting insulin
19
Q

When would you notify the DVLA?

A
  • If you’ve had 2 episodes of severe hypoglycaemia in the past 12 months
  • 1 episode if group 2
  • Impaired awareness
  • Disabling hypoglycaemia whilst driving
20
Q

How often does the DVLA say blood glucose needs to be monitored?

A

2 hours before and every 2 hours for long journeys

21
Q

Glucose levels should always be >5mmol when driving. What if it isn’t?

A

Take carbohydrate before driving

22
Q

What are the types of short acting insulin?

A

Soluble

  • given SC 15-20 mins before meals
  • diabetic emergencies and surgery
  • human soluble, beef/pork, bolus injection

Rapid-acting analogue

  • lower risk of hypos than soluble
  • take immediately before or after a meal
  • can be used as alternative to soluble in emergency
  • Lispro (humalog), Aspart (novorapid), Glulisline (Apridra), Bolus insulin
23
Q

Intermediate acting insulin:

A
  • Isophane
  • Never give IV - thrombosis
  • Basal insulin - take BD in conjunction with soluble insulin
24
Q

Long acting insulin:

A
  • Never give IV - thrombosis
  • Don’t mix with soluble insulin - binds in the syringe
  • Basal insulin - take OD at the same time each day to cover 24 hour period
  • Glargine (lantus), Determir (Levemir), Degludec (Tresiba), Protamine zinc
25
When would you need to increase your insulin requirements?
- infections of recurrent illness - 2nd and 3rd trimester of pregnancy - puberty - stress or accidental or surgical trauma
26
When would you need to decrease your insulin requirements?
- Coeliac disease | - Endocrine disorders e.g. addisons disease, hypopituitarism
27
What does a multiple injection regimen consist of?
- short/rapid acting insulin before meals + intermediate/long acting given OD or BD - good for acutely ill people or whos insulin regimen needs to keep changing
28
What does a biphasic mixtures regimen consist of?
- short/rapid acting insulin premixed with intermediate/long acting insulin given OD or BD before meals
29
What does a long/intermediate acting regimen consist of?
OD or BD with or without short acing before meals
30
Which regimen do type 1 diabetics requiring insulin start with?
multiple injection regimen
31
Which regimen do type 2 diabetics requiring insulin start with?
start with isophane (intermediate) OD or BD + short acting (soluble) as a biphasic or multiple injection regimen
32
Who is a continuous insulin pump recommended for?
- people who suffer recurrent unpredictable hypoglycaemia when using injection regimens - patients whos glycaemic control is >8.5% despite optimised multiple injection regimen - children <12 where MIR is impractical - must have tried it when they turn 12
33
What are the side effects of insulin?
- hypoglycaemia - do not miss meals, make sure time and dose of insulin are correct - lipodystrophy (pain at injection site) - rotate injection site - local injection site reactions - check technique
34
What interacts with insulin?
Enhanced hypoglycaemic effect of insulin by - ACE - BB (mask symptoms of it) - Alcohol Antagonised hypoglycaemic effect of insulin by - corticosteroids - oral contraceptives - loop/thiazide diuretics
35
What should diabetic patients do in times of illness (SICK)?
Sugar - check BG every 3-4 hours even at night - still monitor even if you feel better - no need to monitor in type 2 unless you're on insulin Insulin - never stop taking it Carbohydrates - maintain meal pattern - aim for 3L of fluid a day to prevent dehydration - seek urgent help if: drowsy, cant keep fluid down, persistent vomiting Ketones - check ketones every 3-4 hours even at night - if ketones are high immediately see GP
36
What should patients taking antidiabetic medication do in times of illness?
Stop metformin if dehydrated due to increased risk of lactic acidosis
37
What fridge temp should insulin be stored at?
2-8 degrees
38
Within how many days must the insulin be used once opened?
28 days
39
When should you discard insulin?
- if frozen | - if left outside the fridge for >48 hours between 15-30 degrees
40
What are the dose changes for insulin you need to be aware of?
- beef to human = reduce dose by 10% | - pork to human = no dose change
41
What would you do with insulin in a surgery scenario?
- before surgery = usual insulin - day of surgery = IV glucose with potassium - once pt starts eating and drinking = SC before breakfast and stop IV 30 mins later

ENDOCRINE - HIGH WEIGHTED (7 decks)

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