endocrine system Flashcards
what causes type 1 diabetes
lack of insulin production due beta cell defect
- caused by autoimmune destruction of pancreatic beta cells.
how doe glucagon cause increase in blood glucose
pancreatic alpha cells of the islets of langerhans produce glucagon
glucagon increases blood glucose levels by inhibiting synthesis of glycogen
causing an increase in the formation of glucose from proteins and fats (gluconeogenesis)
Glucagon treatment in insulin induced hypoglycaemia
1mg every 20 minutes once/twice is there is still no response.
along with carb supplements to replenish glycogen stores when patient regains consciousness.
what is OGTT
oral glucose tolerance test
fast for 8 hours
then given 75 mg of anhydrous glucose/polycal/Rapilose
2 hours after a venuous blood sample is taken
what are the main drug classes to treat type 2 diabetes
1) sulphonylureas (SU)
2) sodium glucose co-transporter 2 inhibitors (SGLT-2i)
3) Biguanides (metformin
4) Thiazolidinediones (glitazones)
5) Dipeptidyl peptidase 4 inhibitors (DPP4i)
6) Glucagon like peptide 1 (GLP-1): incretin mimetics.
Things to monitor for diabetes
Blood Glucose Monitoring: For both Type 1 and Type 2 diabetes.
Pre-meal levels should generally be between 4-7 mmol/L,
post-meal levels should be around 5-9 mmol/L.
HbA1c: For both types, the general target is <48 mmol/mol (6.5%), though i
Blood Pressure: Target for both types is <140/80 mmHg, with more stringent goals (e.g., <130/80 mmHg) for those with kidney damage or cardiovascular risk factors.
Cardiovascular Risk: Annual reviews to assess cardiovascular health (lipids, smoking, etc.) and consider medications like statins are part of routine management. Statin therapy may be more aggressively considered in individuals aged 40-75 with Type 2 diabetes.
Kidney Care: Monitoring for kidney damage with regular albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) testing for both conditions, with a focus on early detection of kidney disease.
Eye and Foot Care: Regular eye exams and foot assessments are critical for detecting diabetic retinopathy and peripheral neuropathy, respectively. More frequent check-ups may be necessary for individuals with existing complications.
(condense this card down)
what is HHS
Hyperosmolar hyperglycaemic state
type 2 diabetes complication
higher than 30mmol for several days
is DKA more common in type 1 or type 2
type 1
DKA signs
type 1
blood glucose higher than 11mmol
polydypsia/poluria/weight loss/abdominal pain/ fruity breath
urinary ketones: higher than 2+
or capilarry blood ketones higher than 3mmol/L
what is DKA
complication of type 1 diabetes, can occur in type 2 too tho
- occurs when body breaks down fat for energy due to lack of insulin, leading to production of ketones.
- ketone levels increase, blood becomes more acidic, body functions disrupted.
testing: blood and urinary ketones
urinary ketones 2+/blood ketones 3mmol/L + are high.
symptoms of DKA
high blood sugar (11mmol/L +)
excessive thirst
weight loss
tachycardia
abdominal pain
urination
nausea
vomiting
pear drop breath
rapid breathing
what counselling to minimise risk of DKA during treatment with SGLT2 inhibitor
advise on signs and symptoms of dka
seek medical attention if: rapid weight loss, nausea, stomach pain, fruity breath occur
stop SGLT2 inhibitor if DKA is present
DKA treatment
fluid replacement
insulin therapy
correction of electrolyte imbalance: potassium levels
treating acidosis by using IV bicarbonate if necessary (if pH less than 6.9)
what is main aspect of diabetic nephropathy
raised urinary albumin excretion: lead to increased risk of CVD
(more than 300mg/24hrs)
- or proteinuria
diabetic nephropathy
- what is it
- testing
changes in glomerulus and interstitial tubules
testing: urine albumin to creatine ratio
serum creatine and eGFR
insulin monitoring
4-6 times a day b4 and after meals
- used to modify insulin dose or diet
Hyperthyroidism diseases
Graves disease
nodular disease
toxic adenoma
subacute tyroiditis: due to inflammation of thyroid gland
what is graves disease
autoimmune condition where abnormal IgG is produced
(TRABS, anti TPO and anti-TG)
- ophthalmopathy
graves disease: ophthalmopathy side effect explained
caused by deposition of glycosaminoglycans into retro orbit, causing t cell activation and stimulation of thyroid stimulating immunoglobulin (TSI)
signs and symptoms of hyperthyroidisim
- tachycardia
- tremor
- nervousness
- weight loss despite increased appetite
- warm skin
- hair thinning/hair loss
Normal TSH levels
0.5-5 microunits/ml
what anti-thyroid drug is preferred during pregnancy
propylthiouracil
inhibits T4 to T3 conversion
what is done before thyroid suregery
anithyroid drugs, lithium, beta blockers until pulse is less than 80 bpm
dose of iodine 800-1200mg/day
what are the 5 main types of hypothroidism
1) Primary autoimmune: most common, often due to Hashimoto’s thyroiditis
2) Primary postpartum
3) Primary subacute granulomatous
4) Primary Iatrogenic: from radioactive iodine treatment for graves disease etc. leads to permanent hypothyroidism
5) Secondary: damage to hypothalamic pituitary axis due to pituitary adenomas etc
symptoms of hypothyroidism
- raised cholesterol and LDL
- Macrocytic anaemia; abnormally large red blood cells
- fatigue
- weight gain despite increase in appetite
- cold intolerance
- dry skin hair loss
- muscle and joint pain
- constipation
- blurred vision
hypothyroidism treatment
Levothyroxine: take on empty stomach
side effects: -Palpitations
- Weight loss
- Increased appetite
- Sweating
- Nervousness
- Heat intolerance
- Tachycardia
- Insomnia
- Tremor
counselling: avoid antacids
monitoring: TSH levels
Hyperparathyroidism
where parathyroid glands produce too much parathyroid hormone (made up of 84 acids)
- causes phosphaturia (decrease in serum phosphate and increase in calcium)
what is the main function of PTH
control extracellular calcium concentrations
What does increase in calcium levels due to phosphaturia cause
- release of calcium and phosphate from bone matrix
- increases calcium reabsorption by the kidney
- increases renal production of calcitriol
- increases intestinal absorption of calcium
Primary hyperparathyroidism
excessive production of PTH
symptoms:
osteopenia
kidney stones
muscle weakness
fatigue
nausea
vomiting
Secondary hyperparathyroidism
occurs due to chronic renal failure/vitamin D deficiency
treatments: Vitamin D3 50,000 units weekly for 8 weeks.
- dietary phosphate restriction
- phosphate binders: sevelamer hydrochloride/lanthanum carbonate
- early intervention with vitamin D analogues: calcitriol
Hypoparathyroidism
causes hypocalcaemia
symptoms:
paraesthesia
fatigue
seizures (more common in epilepsy)
hoarseness of voice
wheezing
muscle cramps
hypomagnesaemia/hypokalaemia
what drugs treat hypoparathyroidism
- ergocalciferol
- calcitriol
- calcium carbonate
- calcium gluconate
Ergocalciferol
moa: converts to active vitamin D, increasing calcium absorption
side effects: hypercalcemia, hyperphosphatemia
vitamin d toxicity
BPH clinical presentation and complications
Benign prostatic hyperplasia
presentation:
- nocturia, urgency and urge incontinence
complications: - acute painful urinary retention that could lead to renal failure
- bladder instability and UTI’s
- haematuria
Diagnosis:
- physical exam
- prostate specific antigen (PSA) blood test
- urinalysis
- biopsy
Pharmacological treatment BPH
alpha blockers: - doxazosin: relaxes smooth muscle in the prostate and bladder neck, improving urine flow
- tamsulosin
5 alpha reductase inhibitors: - Finasteride: inhibits 5 alpha reductase, reducing conversion of testosterone into dihydrotestosterone, reducing prostate size.
- 5-ARI’s are usually used if PSA level is greater than 1.4ng/ml
what can be used topically to help baldness
minoxidil: a vasodilator that may stimulate limited hair growth. Effects reverse after stop taking it
- hair shredding, scalp irritation, contact dermatitis.
- finasteride can also be used but not topical.
nitrofurantoin dose UTI men
MR 100mg x2 a day
for 7 days
or trimethoprim 200mg x2 a day for 7 days
emergency contra`
1) IUD
2) levonorgestrel 1500mg single dose (72hrs)
3) ulipristal 3mg single dose (120hrs)
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question on UTI
