Endocrinology Flashcards
What are the components of the classic triad of diabetes? What also may be observed?
Hyperglycemic triad - polyuria, polydipsia, weight loss (dehydration)
- Secondary enuresis (bedwetting) and recurrent infections
What diagnostic tests should be carried out for diabetes mellitus?
- Baseline bloods
- HbA1c
- TFT - TPO to check for autoimmune thyroid disease
- Anti-TTG - associated with coeliac disease
- Consider insulin antibodies
Describe the basal-bolus regime:
Basal = long-acting insulin the evening
Bolus = short acting insulin prior to meals
What are some pros of the insulin pump (tethered or patched) as a management for DM?
Pros:
- Better sugar control
- Flexible eating
- Less injections
What are some cons of the insulin pump as a management for DM?
Cons:
- Challenges in using pump
- Attached at all times
- Blockage + infection
Complications of untreated/uncontrolled DM?
- Hypoglycemia
- Nocturnal hypoglycemia
- Hyperglycemia
- Macrovascular, microvascular complications
- Infection
What are symptoms of hypoglycemia?
Too much insulin: hunger, tremor, sweat, irritable (mood change), dizzy, pallor
(LOC, coma, death if untreated)
What is the treatment for hypoglycemia?
Rapid acting glucose, slow acting carbs or IV dextrose, IM glucagon
How should nocturnal hypoglycemia be treated?
Sweaty overnight so raised glucose - bolus insulin regime and bedtime snack
Name the microvascular and macrovascular complications of DM?
Macrovascular: stroke, CAD, HTN, diabetic foot (peripheral ischemia)
Microvascular: peripheral neuropathy, retinopathy
What are potential infections of DM patients?
UTI, pneumonia, fungal
What is the target range of HbA1c?
Risk of developing T2DM, HbA1c: <42mmol/mol
If you are controlling T1DM, HbA1c: <48mmol/mol
What is the treatment for diabetic ketoacidosis (DKA)?
IV mannitol, IV hypertonic saline
Describe the pathophysiological process where diabetic ketoacidosis is caused?
- Not enough glucose nor glycogen stores
- Liver takes fatty acids and converts to ketones
- Ketone soluble so cross B-B barrier
- Used by brain
- Normally buffered in healthy individual, but unhealthy unable to buffer
- Hyperglycemia ketosis
- Metabolic ketoacidosis (:. diabetic ketoacidosis)
What are the risks of DKA?
- Ketoacidosis
- Dehydration
- Potassium imbalance
- Cerebral oedema
What is the treatment for DKA?
IV mannitol, IV hypertonic saline
How will a patient in DKA present?
Polyuria, polydipsia, N/V, WL, acetone smell on breath, dehydration, hypotension, altered consciousness
Addison’s disease?
Adrenal glands damaged - reduced cortisol and aldosterone
What causes Addison’s disease?
Autoimmune and primary adrenal insufficiency
What is secondary adrenal insufficiency?
Inadequate ACTH stimulating the adrenal glands so less cortisol released
What causes secondary adrenal insufficiency?
Pituitary gland damaged due to congenital underdevelopment, surgery, infection
What is tertiary adrenal insufficiency?
Not enough CRH released by hypothalamus
What causes tertiary adrenal insufficiency?
Long-term steroid use suppressing the hypothalamus
What is adrenal insufficiency?
Insufficient cortisol and adrenaline produced by the adrenal glands
