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Phase II > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is C-Peptide and what is it a good marker for?

A

C-Peptide is a peptide chain cleaved off from pro-insulin. Used for measuring endogenous insulin. Reduced and eventually disappears in T1DM

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2
Q

How does Ketoacidosis occur?

A

High rates of b-oxidation of fats occur in the liver due to low glucose utilisation. The low insulin/anti-insulin ratio + increased fatty acids leads to increased ketogenesis

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3
Q

What is the pathophysiology of T1DM

A

Destruction of b-cell of islets of Langerhans leading to absolute insulin deficiency

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4
Q

What is the pathophysiology of T2DM

A

Impaired insulin secretion and insulin resistance. Typically progresses from preliminary phase of impaired glucose tolerance or impaired fasting glucose

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5
Q

What are the risk factors for T1DM

A
  1. Other autoimmune diseases

2. hereditary - HLA DR3/DR4

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6
Q

What are the risk factors for T2DM

A
  1. Old age
  2. Family history
  3. Obesity/metabolic syndrome
  4. Alcohol excess
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7
Q

What are some secondary causes of DM

A

PEGGD:

  1. Pancreatic Disease
  2. Endocrine - cushing’s, acromegaly
  3. Genetic - wolfram’s, wilson’s, haemochromatosis
  4. Gestational diabetes
  5. Drugs - thiazides, corticosteroids, atypical antipsychotics
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8
Q

What is the presentation for both types of DM

A

Polyuria, polydipsia, lethargy, infections

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9
Q

What is the diff presentation seen in T1DM

A

Weight loss, dehydration, ketonuria, pear drop breath, hyperventilation

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10
Q

What are the eye complications of DM

A

Glaucoma, cataracts, retinopathy, CNIII or VI palsy.

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11
Q

How do you diagnose DM

A
  1. Symptoms AND one raised venous glucose test (fasting or random)
  2. Two raised venous glucose tests
  3. HbA1c >/= 6.5% but less than this does not exclude DM

Glucose tests:

  • Fasting glucose >/= 7mmol/L
  • Random glucose >/= 11.1mmol/L
  • OGTT >/= 11.1mmol/L
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12
Q

What are the conditions where HbA1c may not be used for diagnosis?

A

Anaemia, haemoglobinopathies, suspected gestational diabetes, children (HbF), CKD

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13
Q

What is the OGTT criteria for impaired glucose tolerance?

A

Random plasma glucose 7.8 - 11.0mmol/L

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14
Q

What is the fasting plasma glucose criteria for impaired fasting glucose?

A

Fasting plasma glucose 6.1-6.9mmol/L

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15
Q

Other investigations for DM?

A

Bedside - BP (may have HTN), Urine dip (for proteins)
Bloods - FBC, U&Es, LFTs, Lipids
Fundoscopy
Regular podiatry checkups

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16
Q

What are the common insulin regimens for T1DM and what are the benefits for each one

A

BD biphasic regimen - twice daily pre-mixed insulins. Useful for those with regular lifestyle.

Basal-Bolus regimen - intermediate/long acting at bedtime + short acting insulin to cover meal times. Useful for those with unpredictable mealtimes/lifestyle

Insulin pump therapy - adjustable basal infusion rate of insulin. Patient can then activate/programme boluses. Useful for patients with unpredictable lives, recurrent hypos, delayed meals.

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17
Q

Complications of insulin?

A

Hypoglycaemia, weight gain, insulin resistance, injection site complications: painful lesions, abscesses, lipohypertrophy.

18
Q

Causes of hypoglycaemia?

A

EXPLAIN:

  1. EXogenous drugs: insulin, oral hypoglycaemics, alcohol, aspirin poisoning, b-blockers.
  2. Pituitary insufficiency
  3. Liver Disease/failure
  4. Addison’s disease
  5. Islet cell tumours: insulinomas
  6. Non-pancreatic neoplasms (eg: fibrosarcomas)
19
Q

How can patients with hypoglycaemia present?

A
  1. Adrenergic symptoms: sweating, tremor, palpitations, pallor
  2. CNS: headache, confusion slurring of speech, change of behaviour
  3. Coma
20
Q

What is the management of severe hypoglycaemia

A
  1. If conscious -> 15-20g short acting carbohydrate/glucose. Glucogel can also be used if conscious but uncooperative
  2. If unconscious with IV access -> 200ml 10%glucose in 15mins (bolus)
  3. If unconscious but no IV access -> Glucagon 1mg IM.
21
Q

What lifestyle advice can you give patients with T2DM?

A

Control diet, regular exercise, smoking cessation, attend patient programmes: DESMOND, XPERT

22
Q

What are the HbA1c targets for adults with T2DM?

A
  1. If managed by lifestyle or on one drug not associated with hypo - 6.5%
  2. if managed by drugs associated with hypo - 7.0%
  3. If HbA1c >/= 7.5% need to reinforce about lifestyle or intensify drug treatment
23
Q

What are the side effects of Metformin?

A

GI disturbances - diarrhoea, abdo pain, nausea, vomiting.

Lactic acidosis

24
Q

What are the contraindications of Metformin?

A

hepatic and renal failure, elderly

25
Q

What are side effects of sulfonylureases?

A

Hypoglycaemia, weight gain, GI disturbances - diarrhoea, nausea, vomiting.

26
Q

What is the mechanism of sulfonylureases?

A

Antagonise B cell K+/ATPase activity resulting in depolarisation (due to reduced K+ exit), Depolarisation causes opening of voltage gated Ca2+ channels, resulting in exocytosis of insulin vesicles

27
Q

Contraindications of sulfonylureases?

A

hepatic and renal failure, elderly, breast feeding women.

28
Q

Which oral hypoglycaemic drugs are suitable for overweight diabetic patients?

A

DPP4 inhibitors (sitagliptins), GLP1 agonist - exenatide, SGLT2 inhibitors - canaglifozin.

29
Q

Indications for statin treatment for T1DM patients?

A

> 40 yrs old, have had T1DM for >10yrs, have established nephropathy, have other CVD risk factors.

30
Q

Indications for statin treatment for T2DM patients?

A

> /= 10% 10yr risk of developing CVD (based on QRISK2 tool).

31
Q

What are the blood pressure target for Diabetics?

A

<140/80mmHg. If end organ damage: <130/80mmHg

32
Q

What is the criteria for diagnosing DKA?

A
  1. Hyperglycaemia >11.1mmol/L
  2. pH <7.3 or bicarb <15mmol/L
  3. Ketonaemia >3mmol/L or ketonuria >+2 on ketostix
33
Q

Management of DKA?

A
  1. A to E
  2. Monitor obs and urine output
  3. Fluid Resuscitation + replace electrolytes
  4. IV insulin infusion at 0.1u/kg/hr
  5. Start dextrose when glucose <15mmol/L
  6. Treat underlying disease
34
Q

What are the characteristics of Hyperosmolar Hyperglycaemic State?

A

Hypovolaemia, marked hyperglycaemia (>30mmol/L) (without acidosis), hyperosmolarity (>/=320 serum osmolarity).

35
Q

Management of HHS?

A
  1. A to E
  2. Monitor obs and urine output
  3. IV fluid resuscitation
  4. Low dose IV insulin if blood glucose still high after fluids.
36
Q

What renal problems could diabetics develop?

A

renal artery atherosclerosis, papillary necrosis, glomerular lesions (deposition of glucose on BM), UTIs.

37
Q

Treatment of Diabetic nephropathy?

A

ACEI/ARBs

38
Q

What are the features of diabetic retinopathy seen on fundoscopy?

A
  1. Microaneurysms
  2. Hard exudates
  3. Haemorrhages - flame haemorrhages
  4. Cotton wool spots
  5. Neovascularisation - proliferative retinopathy
39
Q

What are the presentations of diabetic neuropathy?

A

Glove and stocking paraesthesia/pain, mononeuritis complex (Eg: CNIII lesion), autonomic neuropathy (eg: erectile dysfunction, postural hypotension, gastroparesis), amyotrophy

40
Q

What are the presentations of diabetic foot?

A

reduced sensation, reduced ankle jerk reflex, claw toes pes cavus, Ulcers! , charcot foot.

Phase II (4 decks)

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