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MRCS A > Endocrinology - Diabetes > Flashcards

Endocrinology - Diabetes Flashcards

1
Q

Normal fasting glucose levels

A

Up to 6mmol/L

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2
Q

Impaired fasting glucose levels

A

6-7mmol/L

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3
Q

Diabetic fasting glucose levels

A

> 7mmol/L

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4
Q

Pathophysiology T1DM

A

Autoimmune disease w/ antibodies targeted against B cells –> cell death Inadequate Insulin secretion

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5
Q

PS T1DM (1st ep)

A

2-6w Hx of
Polyuria
Polydipsia
W loss

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6
Q

Pathophysiology T2DM

A

Blood levels insulin initially normal
Insulin resistance
Beta cells then decompensate and stop XS insulin production –> hyperglycaemia

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7
Q

PS T2DM

A

Over m/y
Lack of E
Visual blurring
Pruritis vulvae/balanitis b/c candida infection

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8
Q

PS older pt of T2DM

A

Retinopathy
Polyneuropathy
ED
Aa disease
Staph skin infections

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9
Q

Hereditary links T1DM

A

HLA-DR3/DR4

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10
Q

Concordance in twins - T1DM

A

30-50%

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11
Q

Concordance in twins - T2DM

A

50%

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12
Q

2’ causes of DM

A

CF
Chronic pancreatitis
Pancreatectomy
Hereditary haemochromatosis
Carcinoma pancreas
Cushing’s
Acromegaly
Thyrotoxicosis
Phaeochromocytoma
Glucagonoma
Drug induced
Freidreich’s ataxia
Dystrophia myotonica

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13
Q

HbA1c levels diabetic

A

> 48mmol/L

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14
Q

Pre-diabetic levels HbA1c

A

42-7mmol/L

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15
Q

Who would using HbA1c be inappropriate in?

A

<18 y/o
T1DM
Pregnancy
Acutely unwell
Those on meds that raise blood sugars
Any haemolytic disorder
ESRD
HIV
certain drugs

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16
Q

Patients taking which 3 drugs would it be inappropriate to do a HbA1c on

A

Dapsone
Erythropoetin
Ribavirin

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17
Q

75g glucose load test - normal values

A

fasting < 7
2 h < 7.8

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18
Q

75g glucose load test - impaired fasting glucose

A

Fasting 6.1-7
2h <7.8

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19
Q

75g glucose load test - imapired glucose tolerance

A

Fasting <7
2h 7.8-11

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20
Q

75g glucose load test - DM

A

fasting <7
2h >11

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21
Q

+ves of HbA1c over glucose tests (3)

A

Non-fasting
Quicker for patient than GGT
Avoids glucose load

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22
Q

Genetic linkage MODY

A

Autosomal dominant

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23
Q

When should you suspect T1DM in a patient > 40?

A

If comorbid autoimmune disease
And BMI <25

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24
Q

Non-medication Mx T2DM (9)

A

Individualised care plan
Group education programme
Screen - complications
Monitor CV risk
Diet advice
Weight loss (5-10%)
Increase PAL
Stop smoking
Alcohol advice

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25
Q

Alcohol advice for pt w/ DM

A

Limit intake
Carb containing snack before and after consumption

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26
Q

How to monitor CV risk for pt w/ T2DM

A

BP control
Qrisk score

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27
Q

Relevance of Qrisk score + T2DM

A

If 10y risk >10% - offer 20mg atorvastatin

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28
Q

Screening for complications yearly T2DM (3)

A

Fundoscopy
Nephropathy screen
Foot check

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29
Q

Target HbA1c diabetics

A

6.5% (48)

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30
Q

1st line Dx regime T2DM

A

Metformin - 500mg od –> every meal

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31
Q

1st line Dx regime T2DM if metformin isn’t tolerated/CI

A

Gliptin
Or
Thiazolidinedone
Or
Sulphonylurea

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32
Q

2nd line Dx regime T2DM

A

Metformin + 2nd Dx

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33
Q

3rd line Dx regime T2DM

A

Triple therapy
= Metformin
+
Sulphonylurea
+
Gliptin/pioglitazone

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34
Q

Alternative to triple therapy T2DM if metfomin C/I

A

Insulin regimen

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35
Q

Mode of action Metformin

A

Decr hepatic glucose prod
Increase peripheral insulin sensitivity

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36
Q

C/I metformin (4)

A

eGFR 30 or <
Alcoholic
If pt risk lactic acidosis (DKA)
If Pt at risk tissue hypoxia

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37
Q

What must be monitored when on metformin annually

A

Renal fct

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38
Q

SE metformin (3)

A

GI Sx
Lactic acidosis
Vit B12 defic

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39
Q

E.g. S acting Sulphonylureas

A

Tolbutamide

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40
Q

E.g. Med acting Sulphonylureas

A

Glicazide

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41
Q

E.g. long acting Sulphonylureas

A

Glibenclamide

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42
Q

Mode of action Sulphonylureas

A

Increase insulin secretion

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43
Q

Who should Sulphonylureas be prescribed with caution? (2)

A

Elderly - risk hypoglycaemic events
Obese

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44
Q

SE Sulphonylureas (2)

A

Norm well tolerated
GI
LIver

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45
Q

E.g. of Thiazolidinediones

A

Pioglitazone

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46
Q

mode of action Thiazolidinediones

A

PPARy activators - increase peripheral insulin senstivity

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47
Q

SE Thiazolidinediones (4)

A

Fl retention
W gain
Liver dysfunction
Bladder cancer

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48
Q

What must be monitored with Thiazolidinediones

A

LFTs

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49
Q

Who are Thiazolidinediones C/I in ?

A

CCF
Because of fl retention

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50
Q

E.g. of gliptin

A

Sitagliptin

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51
Q

Mode of action gliptin

A

DPP-4 inhibitors
Increase post prandial release

52
Q

Who to avoid gliptins in?

A

Cardiac
Hepatic
Renal dysfunction

53
Q

SE gliptins (2)

A

GI disturbance
Rarely acute pancreatitis

54
Q

E.g. of GLP-1 mimetics

A

Enaxatide

55
Q

Who qualifies for trial of GLP-1 mimetics ?

A

If BMI >35
Or <35 + Other co-morbidities/insulin therapy would have negative occu impacts

56
Q

SE GLP-1 mimetics (2)

A

GI
Rarely acute pancreatitis

57
Q

DAFNE

A

Dose adjusted for normal eating

58
Q

Aim of short acting insulins

A

Mimic bodys insulin secretion in response to food

59
Q

E.g. of rapid acting short acting insulins (2)

A

humalog
Novoramid

60
Q

When are rapid acting short acting insulins administered/

A

with or just after food

61
Q

Onset of action time rapid acting short acting insulins

A

15 mins

62
Q

Duration action rapid acting short acting insulins

A

2-5hrs

63
Q

E.g.s of soluble short acting insulins (2)

A

Actarapid
Humulin S

64
Q

When are soluble short acting insulins administered?

A

30 mins before food

65
Q

Duration of action soluble short acting insulin?

A

Up to 8 hours

66
Q

Aim of intermediate acting insulins

A

Mimic basal insulin secretion

67
Q

e.g.s of intermediate acting insulins (2)

A

Humulin I
Insulatard

68
Q

Onset time intermediate acting insulins

A

1-2hours

69
Q

Duration intermediate acting insulins

A

16-35hrs

70
Q

Aim of long acting insulins

A

Mimic basal insulin secretion

71
Q

E.gs of long acting insulins (4)

A

Lantus
Levemir
Tresiba
Detemir

72
Q

Which insulin regime is recommended T1DM? /

A

Basal bolus
b.d long acting
Rapid acting wih each meal

73
Q

Insulin regime T2DM

A

continue metformin Tx
Intermediate acting insulin o.d./b.d.
biphasic preps in HbA1c partic high

74
Q

Complications of insulin therapy

A

Weight gain
Insulin resistance
Pain, redness, swelling at injection site
Lipohypertrophy at injection site
injection site abscess

75
Q

Define ketosis

A

Elevated plasma ketone levels in absence of acidosis

76
Q

Which type of diabetic gets DKA

A

T1DM

77
Q

3 circumstances under which DKA occurs (3)

A

Prev undiagnosed DM
Interruption of insulin therapy
Stress of intercurrent

78
Q

biochemical features DKA (5)

A

Hyperglycaemia >10
Kertones +ve
HCO3- - low
Plasma Na - usually low
Plasma K+ - high or norm/high

79
Q

PS DKA (8)

A

Prostration
Kussmaul resp
N+V
Abdo pain
Confusion/stupor
Coma
Skin dry
Marked polyuria

80
Q

Ix DKA (7)

A

U+E
Creatinine
Blood glucose
VBG
ECG
CXR
Pregnancy

81
Q

How is the severity of DKA determined

A

pH

82
Q

mild DKA

A

pH >7.3

83
Q

mod DKA

A

pH 7.1-7.3

84
Q

severe DKA

A

pH <7.1

85
Q

Immediate Tx DKA

A

A-E
1L 0.9%NaCl over 1hr
IV insulin

86
Q

How to do the bags of NaCl IV for DKA Tx

A

bag 1 - 1L over 1hr
bag 2 - 1L over 2hr
bag 3 - 1L over 2hr
bag 4- 1L over 4hr

87
Q

How to change management for DKA patient after recovery?

A

–> SC insulin when pt can eat/drink + pH>7.3
Stop IV infusion 1hr after SC starts
Rx to DM team

88
Q

Which type of diabetes gets HHS?

A

T2DM
(elderly, usually previously undiagnosed)

89
Q

Precipitating factors HHS (3)

A

Consuming glucose rich foods
Meds - thiazide diuretics, steroids, b blockers
Illness - infection/MI

90
Q

CF HHS (2)

A

Dehydration
Stupor/coma

91
Q

Diagnosing HHS (6)

A

Osm >320
Severe hyperglycaemia (often >40)
Ketones - -ve
HCO3 - -ve
Plasma Na+ - v high
Plasma K+ - norm/high

92
Q

How to calculate osmolality

A

2(Na+) + urea + glucose

93
Q

Mx HHS

A

Aggressive fl
Low dose fixed IV insulin
Considder K+ replacement
Prophylactic LMWH

94
Q

How long in HHS can it take for electrolytes to return to normal?

A

72hrs

95
Q

Def hypogylcaemia

A

plasma glucose <3mmol/L

96
Q

Autonomic Sx - hypoglycaemia (5)

A

Sweating
Anxiety
Hunger
Tremor
Palpitations

97
Q

Neuroglycopenic Sx - hypoglycaemia (3)

A

Confusion
Drowsiness/coma
Seizure

98
Q

Effect of glucagon (3)

A

Increase glycogenolysis
Increase gluconeogenesis
Inhibit glycogen synthesis

99
Q

Adult causes hypoglycaemia with raised insulin (4)

A

Insulin admin
hypoglycaemia Dx (sulphonylureas)
Insulinomas
Septicaemia

100
Q

Adult causes of hypoglycaemia without raised insulin (3)

A

Sever liver/kidney disease
Hormonal + GF tumours
Hypopituitary, hypoadrenalism, low GH

101
Q

Mx hypoglycaemia - if can swallow

A

10-20g fasting acting carb
Recheck glucose 10-15 mins
When Sx improve - eat long acting carb

102
Q

Mx hypoglycaemia - if pt unconscious

A

1mg IM glucagon immediately
If doesn’t respond in 10 mins - call 999
In hospital - IV 100ml 20% glucose up to 3 times

103
Q

When is glucagon therapy for hypoglycaemia not effective?

A

If alcohol has been consumed

104
Q

Which microvascular structures are particularlya affected in diabetes?

A

Small vessels of retina, glomeruli and nn sheaths

105
Q

3 ways in which diabetes can affect the eyes

A

Diabetic retinopathy
Cataract
External ocular palsies

106
Q

Symmetrical polyneuropathy - pattern of sensory loss

A

Glove and stocking

107
Q

Which aspects of sensory loss are lost first in symmetrical polyneuropathy

A

Vibration
Deep pain
Temperature

108
Q

Other PS symmetrical polyneuropathy (4)

A

Pt losing balace when eyes closed
Walking on cotton wall
Interosseus wasting of small mm feet
Unrecognised trauma w/ poor healing –> ulcers

109
Q

What neuropathic arthropathy may develop from Symmetrical polyneuropathy

A

Charcot’s foot

110
Q

What is acute painful neuropathy?

A

Painful burning pains in feet, shins and ant thighs

111
Q

What is acute painful neuropathy associated with?

A

Poor glycaemic control

112
Q

At what time of day is acute painful neuropathy worst for patients?

A

Night

113
Q

When does acute painful polyneuropathy remit?

A

After 3-12 m of glycaemic control

114
Q

What are CN neuropathies occur in pt w/ DM?

A

III
IV
VI

115
Q

Which isolated peripheral nn lesions are more common in DM?

A

Nn compression syndromes e.g. carpal tunnel
Foot drop b/c lesions on sciatic nn

116
Q

What is mononeuritis multiplex?

A

When > 1 nn is affected by mononeuropathy

117
Q

What is diabetic amyotrophy?

A

Progressive wasting of mm tissues in DM

118
Q

PS diabetic amyotrophy

A

Painful wasting, typically of quadriceps mm
Norm middle aged men
Rare

119
Q

Sympathetic dysfunction - autonomic neuropathy (4)

A

–>
postural HoTN
Ejaculatory failure
Reduced sweating
Horners syndrome

120
Q

Parasympathetic dysfunction - autonomic neuropathy (4)

A

Erectile dysfunction
Constipation
Urinary retention
Holmes Adie pupil

121
Q

When do renal complications manifest - T1DM

A

15-25y after diagnosis

122
Q

What is the leading cause of premature death in young diabetics?

A

CKD

123
Q

What % diabetics get nephropathy

A

30%

124
Q

Nephropathy testing

A

ev 6 months - microabuliminuria

125
Q

What should every pt w/ microalbuminuria be started on

A

ACEi

126
Q

Non-diabetic causes of microalbumin

A

Exercise
UTI/inflamm
Contamination of genital tract
Acute illness - esp fever
Cardiac failure
HTN

127
Q

Macrovascular complications DM

A

Incr risk:
Stroke
MI
gangrene

MRCS A (36 decks)

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