Long term CCs part I Flashcards

Question

Grading severity of asthma?

Answer 1

- Moderate: PEFR >50-75%, normal speech and no features of acute severe or life-threatening asthma - Acute severe: PEFR 33-50% or RR 25/min in people aged >12 - Life threatening: PEFR <33% or oxygen sats <92% or altered consciousness or exhaustion or cardiac arrhythmia

Answer 2

Metabolic disorder characterised by hyperglycaemia due to absolute insulin deficiency/ reduced effectiveness of insulin AI T1DM: Characterised by absolute insulin deficiency and presence of antibodies to pancreatic beta cells Idiopathic: Uncommon form characterised by absence of antibodies- more common in African/ asian ancestry

Answer 3

T1DM= 5-10% of all diabetes patients Usually adolescent onset but can occur at any age. M:F; 1.5: 1

Answer 4

Insulin deficiency from autoimmune destruction of insulin-secreting pancreatic beta cells: this causes persistent hyperglycaemia Pts can't use glucose > this stimulates secretion of glucagon, adrenaline, cortisol and GH > this promotes gluconeogenesis, glucogenolysis and ketogenesis in the liver > patients present with hyperglycaemia and anion gap metabolic acidosis

Answer 5

``` Genetics: HLA D3 and HLAD4 linked Poor diet (low vit D, early exposure to cow’s milk) Family or personal Hx of autoimmunity ```

Answer 6

``` Polydipsia (↑ thirst) Polyuria (↑ urination) Lethargy Boils/slow-healing sores Visual blurring Genital thrush/pruritis vulvae Frequent, recurrent or prolonged infections – esp. gum, skin, vaginal, UTIs Unexplained weight loss despite extreme hunger Ketosis ```

Answer 7

``` Diabetic ketoacidosis: ketonaemia 3 mmol /l and over or significant ketonuria (more than 2 + on standard urine sticks) blood glucose over 11 mmol /l or known diabetes mellitus. venous bicarbonate (HCO3 ) ) below 15 mmol /l and /or venous pH less than 7.3 ``` - Lethargy/ confusion - Visual disturbance - Increased thirst and urinary frequency - Inability to tolerate fluids - Fruity smell of acetone on breath - Persistent vomiting and or diarrhoea - Abdominal pain - Weight loss

Answer 8

Persistent hyperglycaemia Ketonuria Tachypnoea Lethargy Kussmaul breathing Dehydration: dry skin, mucus membranes, reduced skin turgor. Sunken eyes and prolonged cap refill in severe cases Shock: resulting from severe dehydration- tachycardia, poor peripheral perfusion, lethargy drowsiness and decreased consciousness

Answer 9

``` Vascular disease Nephropathy Diabetic retinopathy Diabetic feet Neuropathy: Direct damage to the nerves by hyperglycaemia and decreased blood flow to nerves ``` DM is a risk factor for the development of atherosclerosis which increases the risk of HF, stroke and PAD

Answer 10

Low C-peptide + presence of autoantibodies – islet cell antibodies (ICA) and anti-glutamic acid decarboxylase (GAD) antibodies HbA1c >48mmol/mol

Answer 11

* Symptoms of hyperglycaemia (3 main of polyuria, polydipsia, unexplained weight loss, visual blurring, genital thrush, lethargy) AND raised venous glucose detected once: * Fasting >7mmol/L * Random >11.1mmol/L OR * Raised venous glucose on two separate occasions with no Sx OR raised oral glucose tolerance test (OGTT) – gold standard: * 2h value >11.1mmol/L – OGTT: pt. fasts overnight, then in the morning the fasting blood glucose is taken. Then you give them a sugary drink and periodically test blood sugar for the next 2 hours > results are based on value after 2 hours.

Answer 12

Provide an individual care plan Offer a structured education programme e.g. DAFNE Provide info on communicating with diabetes specialist care team Manage lifestyle issues: meal planning, carb counting, avoid drinking alcohol on empty stomach, spread weekly units over min 3 days, advise on smoking misuse Provide up to date info on diabetes support groups e.g. diabetes UK

Answer 13

HBA1C <48mmol/mol Fasting plasma glucose 5-7mmol/L Plasma glucose before meal 4-7mmol/L Plasma glucose after meal 5-9mmolL- 90 mins after eating Pt needs to be careful and have a fast acting carbohydrate in the car, avoid driving if meal is delayed, check glucose before starting the journey and 2 hours into the journey. Young people driving- target is 5mmol/L Pt can be fined up to £1000 if they fail to tell the DVLA about a condition For cars and motorcycle: must have an awareness of hypoglycaemia and no more than 1 episode of hypo while awake in the preceding 12 months

Answer 14

1L of 0.9 normal saline over 1 hour- when K+ result available start replacement 50 units of actrapid in 49.5ml of 0.9% NaCl Insulin: rate: 0.1 units/kg of bodyweight/ hour IV Advise patient to consume 10-20g of fast acting carbohydrate preferably in liquid form. Recheck blood glucose after 10-15 mins. If person is unconscious- IM glucagon should be administered immediately. Call 999 for children <8/ IM glucagon not available or alcohol is the cause

Answer 15

Rapid acting insulin: onset 15 mins, duration 2-5 hours. E.g. Humalog and Novorapid Short acting insulin: onset 30-60 mins, duration 8 hours. E.g. Actrapid and Humalin S Intermediate acting (isophane) insulins: onset 1-2 hours, duration 11-24 hours. E.g. Humulin I and Insulatard Long acting insulins: duration of up to 24 hours. Steady state level achieved after 2-4 days to produce a constant level of insulin 1. Human Insulins- produced by recombinant DNA and have the same amino acid sequence as human insulin 2. Human insulin analogues: Same make up as human insulin but modified to have extended duration of action or faster absorption 3. Animal insulins: Extracted and purified from animal sources- bovine or porcine- not commonly used

Answer 16

1Multiple daily injection basal bolus insulin regime: Offer twice daily insulin detemtir as the long-acting basal insulin therapy. Offer RA insulin analogue injected before meals for mealtime insulin replacement If 1 is not possible consider a twice-daily human mixed insulin regimen 3. Insulin pump therapy recommended if multiple daily injections results in severe hypoglycaemia or HBA1C levels have remained high Subcut injection as it’ll be destroyed by gastric acid otherwise and not absorbed across the gut mucosa. General advice: leave for 30 mins at room temp prior, check expiry date before administration, read manufacturer’s advice, use a new needle for each injection, choose appropriate injection site. Needle should be injected at 90 degrees to skin- pinch skin a. Large dose b. Accidental IM injection due to poor injection technique c. Exercise: faster absorption due to increased blood flow at injection site d. Injection site- rate depends on which site is used e. Age: faster in younger children as they have less subcut fat f. Fat mass: absorption is slower if there is a large amount of subcut fat

Answer 17

Insulin resistance and relative insulin deficiency result in persistent hyperglycaemia Higher prevalence in South Asia Decrease in insulin secretion with or without insulin resistance. Pancreas is unable to secrete enough insulin to compensate

Answer 18

Obesity Lack of exercise Calorie and alcohol excess: low fibre, high glycaemic index diet may increase the risk of being overweight FamHx: People with a fam Hx are 2-6 times more likely to have diabetes Ethnicity: People of Asian, African and Black communities are 2-4times more likely to develop History of gestational diabetes: 7 fold increased risk of developing T2DM Drug treatment: Statins, corticosteroids and a combined treatment with a thiazide diuretic + beta blocker can increase risk of T2DM Polycystic ovarian syndrome: This increases the risk of impaired glucose regulation Metabolic syndrome Low birth weight for gestational age