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Year 3 > LTC > Flashcards

LTC Flashcards

1
Q

Diagnostic criteria for diabetes

A

Random blood glucose >11.1mmol/L with osmostic Sx

Fasting blood glucose >7mmol/L

OGTT >11.1mmol/L

HbA1c >48mmol/mol (6.5%)

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2
Q

Process of OGTT

A

Fast for 8-12h before test - no food/ just water
Given sugary drink containing 75g glucose
Blood glucose taken either every 30 mins or just once at 2h

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3
Q

Gene associated with t1dm

A

HLA DR3/DR4

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4
Q

Risk factors for t2dm

A 
Increasing age
Smoking
Obesity
PCOS
Hypertension
Ethnicity - south asian / afrocarribean
Family history
Hx of GDM
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5
Q

Biguanide example, mechanism and side effects

A

Metformin

Decreases gluconeogensis, increases insulin sensitivity

S/E - Nausea, GI upset inc diarrhoea, abdo pain
Lactic acidosis if reduced renal function

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6
Q

Sulphonylurea example, mechanism and side effects

A

Gliclazide
Increases insulin secretion

S/E - main one is hypoglycaemia, also causes weight gain

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7
Q

DPP4 Inhibitor example, mechanism and side effects

A

Sitagliptin

Increases incretin, therefore decreases glucagon

S/E - headache, myalgia

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8
Q

Pioglitazone mechanism and side effecs

A

Increases PPAR-gamma expression, hence decreasing insulin resistance and decreasing gluconeogenesis

S/E - weight gain, increased infection risk, numbness, fluid retention

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9
Q

Suffix of DPP4 inhibitor drugs

A

Gliptin

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10
Q

Suffix of SGLT2 inhibitors

A

-Gliflozlin

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11
Q

SGLT2 inhibitor examples, mechanism, S/E

A

Empagliflozlin

Blocks glucose reabsorption in kidneys

S/E - increased infection risk

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12
Q

GLP analogue examples

A

Exenatide

Liraglutide

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13
Q

GLP analogue mechanism

A

Decreases gluconeongenesis, increases insulin production, decreases hunger, decreases GI motility (feel fuller)

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14
Q

Rapid acting insulins

A

Novorapid

Humalog

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15
Q

Short acting insulins

A

Actrapid

Humulin S

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16
Q

Intermediate insulins

A

Insulitard

Humulin I

17
Q

Long/Ultralong Insulins

A

Determir

Glargine

18
Q

Describe 3 insulin regimes

A

Once-daily basal insulin

Twice-daily mix insulin - breastfast and tea time, usually with Humulin M3

Basal-Bolus therapy - long acting basal with rapid/short boluses with meals

19
Q

4 injection sites for insulin

A

Abdomen
Upper arm
Thigh
Buttock

20
Q

Symptoms of HHS

A 
History >1 week
Dehydration
Altered GCS
Neurological signs - blurred vision, tremor
N+V
Malaise, weakness
21
Q

Diagnostic features of HHS

A 
Clinical dehydration
Glucose >30mmol/L
Low ketones
pH >7.3
Osmolality >320mOsmol/kg
22
Q

Management of HHS

A

Fluids
LMWH prophylaxis
K+ replacement
IV insulin if no improvement with fluids

23
Q

Symptoms of DKA

A 
Drowsiness
N+V
Abdominal pain
Sweet smelling breath
Kussmaul breathing - deep and laboured

May be history of trigger e.g. infection, MI, chemo, poor insulin compliance.

24
Q

Diagnosis of DKA

A

Acidaemia - pH <7.3
Hyperglycaemia - glucose >11.0mmol/L
Ketonaemia - >=3mmol/L or ketonuria >++

25
Q

Management of DKA

A

Fluids
IV insulin
Assess for K+ replacement

26
Q

Management of hypoglycaemia

A

10-15g fast acting CHO e.g. 200ml orange juice
Buccal glucose gel if inconscious / drowsy

Reassess BM in 10-15 mins, can repeat CHO after

IV therapy:

  1. IV dextrose
  2. IV glucagon - won’t work if pt malnourished

After BM has been corrected (>=4mmol/L), give long-acting CHO e.g. toast

27
Q

Diagnosis of diabetic nephropathy

A

Microalbuminuria - Albumin:Creatinine Ratio >=3

28
Q

Two tests used to screen for diabetic nephropathy

A

Albumin-Creatinine Ratio

Serum creatinine - to estimate eGFR

29
Q

Management of diabetic nephropathy

A

Control DM
Consider ACEi/ARB
Statin - to manage cardiovascular risk

30
Q

Stage 1, 2 and 3 diabetic retinopathy and management

A

Stage 1 = background retinopathy.
Dots - red microaneurysms, blots = haemorrhage

Stage 2 = pre-proliferative retinopathy
Cotton wool spots - white ischaemia

Stage 3 = proliferative retinopathy
Ischaemia –> growth factor release –> formation of new, fragile blood vessels

Stage 2+ should be referred to ophthalmology for pan-retinal photocoagulation

31
Q

9 things done in yrly diabetic review

A
  1. BP
  2. BMI
  3. Serum cholesterol
  4. Serum creatinine
  5. Albumin:Creatinine Ratio
  6. Smoking history
  7. Diabetic foot review
  8. Eye screening
  9. HbA1c

Year 3 (7 decks)

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