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AKT > Endocrinology 2 > Flashcards

Endocrinology 2 Flashcards

1
Q

C-peptide levels are typically low or high in T1DM?

A

typically low

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2
Q

Name four antibodies associated with T1DM

Which one correlates strongly with age?

A
  1. anti-GAD (glutamic acid decaroxylase)
  2. ICA (islet cell antibodies)
  3. IAA (insulin autoantibodies)
  4. Insulinoma associated 2 autoantibodies

3 - found in 90% of young children, but only 60% in older patients

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3
Q

What is the diagnostic criteria for T1DM and symptomatic T2DM?
Fasting glucose
Random glucose

A

fasting glucose >=7.0 mmol/l
random glucose >=11.1 mmol/l (or after 75g oral glucose tolerance test)

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4
Q

Ix for T1DM (2)

A

measurement of C-peptide or autoantibodies

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5
Q

Diagnostic criteria for an asymptomatic (T2DM) but has raised glucose as per diagnostic criteria

A

fasting glucose 7 or more
random 11 or more
on two separate occasions

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6
Q

HbA1c diagnostic criteria

A

=>48 (6.5%) (at least two readings)

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7
Q

When can you not use a HbA1c?
(5)

A

haemoglobinopathies
haemolytic anaemia
untreated iron deficiency anaemia
(the above essentially means anything haematology related)

suspected GDM
HIV
CKD
If taking medication that may cause hyperglycaemia (for example corticosteroids)

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8
Q

Impaired fasting glucose measurements:

If within that range then offer which test?

A

6.1-7.0 fasting

OGTT

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9
Q

Impaired glucose tolerance measurements for OGTT

A

Fasting glucose <7 and OGTT 2 hour 7.8>= - <11.1

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10
Q

T1DM
How often should HbA1c be monitored?
What is the target?

A

every 3-6 months
48 (6.5%) or lower

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11
Q

How often should T1DM self monitor their glucose?

Targets on waking and before meals?

A

QDS, before each meal and before bed

5-7 on waking
4-7 before meals

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12
Q

T1DM mx

A

basal-bolus regimens
BD insulin detemir regime of choice
OR
OD glargine or detemir

rapid acting insulin analogues with meals

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13
Q

When would you add in metformin for a T1DM?

A

BMI >=25

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14
Q

T2DM targets
Lifestyle, metformin, drugs that can cause hypoglycaemia
How often to be checked?

A

Every 3-6 months until stable, then 6 monthly
Target 48 if on lifestyle or metformin
If on a drug that can cause hypoglycaemia target 53

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15
Q

T2DM targets
Lifestyle
Metformin
Drugs that can cause hypoglycaemia

A

48/6.5
48/6.5%

53/7%

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16
Q

When do you add a second drug for rx of T2DM?

What is the target for a pt like this?

A

Once HbA1c is 58

53/ 7%

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17
Q

T2DM Mx Step 1

A

QRISK 10%>/ CVD/ chronic heart failure = metformin, once established then SGLT2 inhib

If not then just metformin

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18
Q

What to do if metformin is not tolerated?

A

Switch to MR metformin

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19
Q

If metformin is CI then what do you give?

A

QRISK>10%/ CVD/ heart failure = monotherapy SGLT2

If not then DPP4, pioglitazone or sulfonylurea

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20
Q

Step 2 T2DM mx

A

If HbA1c has risen to 58 add any of the following:

DPP4/ pioglit/sulfonylurea
SGLT2 if NICE criteria met

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21
Q

3rd line T2DM

A

If HbA1c has risen to 58 add any of the following:

DPP4/ pioglit/sulfonylurea
SGLT2 if NICE criteria met

OR can start insulin

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22
Q

What would you do next if triple therapy for diabetes is ineffective

A

Swap a drug for a GLP1 mimetic if BMI >35 of if insulin would have occupational implications

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23
Q

When would you continue a GLP1 mimetic?

A

If there is a reduction of at least 11 or 1% of HbA1c and a weight loss of at least 3% of initial body weight in 6 months.

24
Q

Which insulin is recommended to be started on with T2DM?

A

Isophane intermediate acting ON or BD

25
Q

Examples of GLP1 mimetic
Administration (for both)
It should not be given when?

A

Exanatide + liraglutide
Exanatide SC within 60 minutes before the morning and evening meals
After meals

Liraglutide OD

26
Q

Exanatide and liraglutide can be given with which two drugs?

A

Metformin + sulfonylurea

27
Q

Standard release exanatide can be given with

A

basal insulin
or just metformin

28
Q

Examples of DPP4 inhibitors

A

sitagliptin, vildagliptin

29
Q

Thiazolidindiones example

A

pioglitazone

30
Q

Pioglitazone SE (4)

CI

A

weight gain
liver impairment
fluid retention
bladder cancer

CI heart failure

31
Q

SGLT 2 examples

A

canagliflozin, dapagliflozin

32
Q

Examples
SGLT2
DPP4
Thiazolidinidiones
Sulfonylurea
GLP1 mimetics

A

SGLT2 - canagliflozin
DPP4 - sitagliptin
Thiazolidinidiones - pioglitazone
Sulfonylurea - gliclazide
GLP1 mimetics - exanatide

33
Q

SE
SGLT2
DPP4
Thiazolidinidiones
Sulfonylurea
GLP1 mimetics

A

SGLT2 - weight loss, risk of amputation, UTI, gangrene
DPP4
Thiazolidinidiones - weight gain, fluid retention, bladder ca, liver impairment
Sulfonylurea -hypoglycaemia
GLP1 mimetics

34
Q

SGLT2 SE (4)
Canagliflozin

A

weight loss
increased risk of amputation
urinary and genital infection
fournier’s gangrene

35
Q

Sulfonylureas SE (6)

A

hypoglycaemia
weight gain

SIADH
liver impairment
Peripheral neuropathy
Bone marrow suppression

36
Q

What can cause a lower than expected HbA1c (3)

A

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis

37
Q

What can cause a higher than expected HbA1c (3)

A

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

38
Q

Sick rules
If patient is sick and insulin dependent and sugars and ketones are raised what is rule of thumb for corrective doses that should be given?

A

Daily insulin dose divided by 6 with a max dose of 15 units

39
Q

When might a pt need admitting with ketones and raised sugars? (4)

A

underlying illness
unable to keep fluids down
persistent diarrhoea
BM >20 persistently despite additional insulin

40
Q

Rules for T2DM during Ramadan
Food in the morning recommendation:

Metformin dosing

A

eat a meal containing long-acting carbohydrates prior to sunrise

the dose should be split one-third before sunrise (Suhoor) and two-thirds after sunset (Iftar)

41
Q

Rules for T2DM during Ramadan

Sulfonylureas

Pioglitazone

A

OD should be switched to the evening
If BD, take a larger proportion after sunset

No changes

42
Q

Diabetic neuropathy mx

1st line (3)
Rescue

A

amitryptilline/ duloxetine/ gabapentin

Rescue tramadol

43
Q

What can be used for localised neuropathic pain such as post herpetic neuralgia?

A

Topical capsaicin

44
Q

Mx of gastroparesis (GI autonomic neuropathy in DM) (3)

A

Metoclopramide/ domperidone or erythromycin

45
Q

How often should diabetic patients have an annual foot screen?
How is it done?

A

Annually
- palpate both pulses in the foot
- 10g monofilament to be used

46
Q

Diabetic foot disease
Low risk
Moderate
High

If high risk?

A

Low - only callus RF
Moderate - deformity or neuropathy or non critical limb ischaemia
High - previous ulcer/ amputation/ RRT/ neuropathy + critical limb ischaemia together

FU with local diabetic foot centre regularly

47
Q

Most common causes of DKA (3)

A

Infection
Missed insulin
MI

48
Q

Diagnostic criteria DKA (4)
Glucose
pH
bicarb
ketones

A

glucose > 11
pH <7.3
bicarb <15
ketones >3/ +++

49
Q

Mx of DKA

Insulin management

A

Fluid replacement
NaCl over 1 hour
NaKCL over 2, 2, 4,4, 6 hrs

Insulin 0.1unit/kg/hour

50
Q

DKA resolution is defined as? (3)

A

DKA resolution is defined as:
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L

51
Q

When do you give dextrose in DKA?
What do you give?

A

gluc<15
5% dex

52
Q

Rapid acting human insulin analogues examples (2)

A

Novorapid (insulin aspart)
Humalog S (insulin lispro)

53
Q

Soluble insulin short acting examples (2)

A

Short acting
Actrapid
Humulin S

54
Q

Intermediate acting insulin example

A

Isophane

55
Q

Long-acting insulin example

A

Insulin determir (levemir) OD or BD
Insulin glargine (lantus) OD

56
Q

What drug can cause a reduction in hypoglycaemic awareness

A

BB

AKT (52 decks)

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