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HYMS Y4 > KEY DIABETES MELLITUS > Flashcards

KEY DIABETES MELLITUS Flashcards

1
Q

5 main pathological features in DKA.

A 
Hyperglycaemia.
Dehydration.
Ketosis.
Metabolic acidosis (low bicarbonate)
Potassium imbalance.
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2
Q

S+S of DKA.

A 
Polyuria.
Polydipsia.
N+V.
Acetone smell to breath.
Dehydration + hypotension. 
Altered consciousness.
Symptoms of underlying trigger (e.g. infection)
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3
Q

Cause of T1DM?

A

Pancreases does not produce insulin (genetic predisposition + environmental trigger).

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4
Q

What environmental triggers have been linked with development of T1DM?

A

Viruses such as cocksackie virus B and enterovirus.

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5
Q

Priorities in management of DKA?

A

Fluid resuscitation + FRII.

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6
Q

3 diagnostic criteria for DKA?

A

1) Hyperglycaemia (glucose >11)
2) Ketosis (blood ketones >3)
3) Acidosis (blood pH <7.3)

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7
Q

Management for DKA?

A

1) Fluids
2) FRII (e.g. Actrapid 0.1 unit/kg/hour)
3) Glucose (keep >14)
4) Potassium
5) Infection (treat underlying triggers)
6) Chart fluid balance
7) Ketones (monitor)

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8
Q

What should you do in a patient treated for DKA before stopping insulin and fluid infusions?

A

Establish them on their normal subcutaneous insulin regimen.

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9
Q

What is the maximum rate that potassium can be infused at?

A

10mmol/ hour.

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10
Q

Management for T1DM?

A

Basal-bolus regimen of insulin.

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11
Q

Briefly describe the basal-bolus regimen of insulin administration.

A

Background long-acting insulin given once daily

Short acting insulin injected 30 minutes before intake of carbohydrates

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12
Q

1 unit of ActRapid reduces blood glucose levels by roughly how much?

A

4mmol/ litre.

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13
Q

Complication of injecting insulin into the same place repetitively?

A

Lipodystrophy - subsequent injections into lipodystrophied areas causes a poorer uptake of insulin.

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14
Q

2 short term complications of diabetes.

A

Hypoglycaemia.

Hyperglycaemia/ DKA.

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15
Q

Acceptable blood sugar range in diabetics before meals (i.e. fasted blood glucose)?

A

4 - 7

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16
Q

Acceptable blood sugar range in a person with T1DM 90 minutes after their last meal?

A

<9.

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17
Q

Acceptable blood sugar range in a person with T2DM 90 minutes after their last meal?

A

<8.5.

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18
Q

Normal blood sugar range in a person without diabetes upon fasting?

A

4 - 5.9.

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19
Q

Normal blood sugar range in a person without diabetes 90 minutes after their last meal?

A

<7.8.

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20
Q

Management of hypoglycaemia?

A

1st line > 15-20g quick acting carbohydrate (+ long acting carbohydrate)
2nd line > glucose gel
3rd line > IM glucagon/ dextrose IVI

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21
Q

Main effect of chronic hyperglycaemia?

A

Damage to endothelial cells of blood vessels = leaky + malfunctioning vessels.

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22
Q

2 other effects of chronic hyperglycaemia?

A

Suppression of immune system.

Optimal environment for infectious organisms to thrive.

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23
Q

Name 3 microvascular complications of diabetes.

A

Peripheral neuropathy
Retinopathy
Diabetic nephropathy

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24
Q

Name 3 microvascular complications of diabetes.

A

CAD
Peripheral ischaemia (poor healing, ulcers, diabetic foot)
Stroke
HTN

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25
Q

Name 3 infection related complications of diabetes.

A

UTIs
Pneumonia
Skin + soft tissue infections
Fungal infections

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26
Q

Frequency of diabetic eye screening?

A

Every 2 years if low risk of sight loss

Annually for anyone else

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27
Q

Frequency of diabetic foot checks?

A

Annually.

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28
Q

Frequency of diabetic kidney disease screening?

A

Annually.

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29
Q

Frequency of CV risk factor assessment?

A

Annually.

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30
Q

How often is HbA1c measured in those with T1DM?

A

Every 3-6 months.

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31
Q

Basic pathophysiology of type 2 diabetes?

A

Repeated exposure to insulin + glucose > cells become resistant to effects > more insulin required to produce a response > pancreas become fatigued + damaged > pancreas produces less insulin > chronic hyperglycaemia > complications of diabetes.

32
Q

Non-modifiable risk factors for T2DM?

A

Older age
Ethnicity (BAME origin)
FHx

33
Q

Modifiable risk factors for T2DM?

A

Obesity
Sedentary lifestyle
High carbohydrate diet (particularly refined carbs)

34
Q

How is diabetes screened for?

A

Usually HbA1c

35
Q

S+S of T2DM that should prompt screening?

A 
Fatigue
Polydipsia
Polyuria
Unintentional weight loss
Opportunistic infections
Slow healing
Glycosuria
36
Q

3 ways in which pre-diabetes can be diagnosed?

A

1) HbA1c 42-47
2) Impaired fasting glucose 5.5-6.9
3) Impaired glucose tolerance 7.8 - 11.1 at 2 hours on OGTT

37
Q

General rule of diagnosing diabetes?

A

Symptomatic + 1 positive result = diabetes.

Asymptomatic + 2 positive results = diabetes.

38
Q

HbA1c level for diagnosing diabetes?

A

48 and above

39
Q

Random glucose level for diagnosing diabetes?

A

> 11.1

40
Q

Fasting glucose level for diagnosing diabetes?

A

> 7

41
Q

OGTT level for diagnosing diabetes?

A

> 11.1

42
Q

Normal HbA1c?

A

<42

43
Q

Conservative management for T2DM?

A 
Dietary modification > vegetables + oily fish + low glycaemic index foods.
Exercise and weight loss
Smoking cessation
Optimise treatment for other illnesses
Monitor for complications
44
Q

HbA1c target for newly diagnosed T2 diabetics?

A

=48

45
Q

HbA1c target for T2 diabetics managed with higher steps than metformin?

A

=53

46
Q

Time of onset and total time of action of rapid-acting insulins?

A

Work within 10 minutes, last for 4 hours.

47
Q

Time of onset and total time of action of short-acting insulins?

A

Work within 30 minutes, last for 8 hours.

48
Q

Time of onset and total time of action of intermediate-acting insulins?

A

Work within an hour, last for 16 hours.

49
Q

Time of onset and total time of action of long-acting insulins?

A

Work within an hour, last for 24 hours.

50
Q

Examples of rapid acting insulins?

A

Novorapid
Humalog
Apidra

51
Q

Examples of short acting insulins?

A

Actrapid
Humulin S
Insuman rapid

52
Q

Examples of intermediate acting insulins?

A

Insulatard
Humulin I
Insuman basal

53
Q

Examples of long acting insulins?

A

Lantus
Levemir
Degludec (lasts over 40 hours)

54
Q

What is contained in combination insulins?

A

Rapid acting + intermediate acting insulins.

55
Q

Examples of combination insulins?

A

Humalog 25
Humalog 50
Novomix 30

**Number is proportion of intermediate acting insulin in combination.

56
Q

1st line medical management in T2DM?

A

Metformin titrated as tolerated starting at 500mg OD

57
Q

2nd line medical management in T2DM?

A

Dual therapy: Metformin + one of:

  • Sulfonylurea
  • Pioglitazone
  • DPP-4 inhibitor
  • SGLT-2 inhibitor
58
Q

3rd line medical management in T2DM?

A

Triple therapy: Metformin + 2 second line drugs

OR

Metformin + insulin

59
Q

Preferred anti-glycemic drugs to be used in CVD?

A

SGLT-2 inhibitors or GLP-1 mimetics.

60
Q

Name a biguanide.

A

Metformin.

61
Q

MoA of Metformin?

A

Increases insulin sensitivity.

62
Q

Side effects of Metformin?

A

‘Weight neutral’
Diarrhoea + abdo pain
Lactic acidosis

63
Q

Name a thiazolidinedione.

A

Pioglitazone.

64
Q

MoA of Pioglitazone?

A

Increases insulin insensitivity.

65
Q

Side effects of Pioglitazone?

A 
Weight gain
Fluid retention
Anaemia
Heart failure
Bladder cancer in extended use
66
Q

Name a sulfonylurea.

A

Gliclazide.

67
Q

MoA of sulfonylureas?

A

Stimulate insulin release from the pancreas.

68
Q

Side effects of sulfonylureas?

A

Weight gain
Hypoglycaemia
Increased risk of CVD + MI when used as mono therapy.

69
Q

Name a DPP-4 inhibitor.

A

Sitagliptin.

70
Q

MoA of DPP-4 inhibitors?

A

Inhibit DPP-4 enzyme + increased GLP-1 activity (which reduces blood glucose levels).

71
Q

Side effects of DPP-4 inhibitors?

A

GIT upset
Symptoms of URTI
Pancreatitis

72
Q

Name a GLP-1 mimetic.

A

Exenatide

Liraglutide

73
Q

MoA of GLP-1 mimetics?

A

Mimic the action of GLP-1 which reduces blood sugar levels.

74
Q

Side effects of GLP-1 mimetics?

A

GIT upset
Weight loss
Dizziness
LOW risk of hypoglycaemia

75
Q

Name an SGLT-2 inhibitor.

A

Empagliflozin
Canagliflozin
Dapagliflozin

76
Q

MoA of SGLT-2 inhibitors.

A

Block SGLT-2 protein from reabsorbing glucose in the proximal tubules = more glucose excreted in urine.

77
Q

Side effects of SGLT-2 inhibitors.

A

Glycosuria
Increased rate UTIs/ candidiasis
Weight loss
DKA

HYMS Y4 (8 decks)

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