Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrinology and Diabetes > Management of Diabetes > Flashcards

Management of Diabetes Flashcards

1
Q

What are the aims of management with regards to type 1 diabetes?

A

Prompt diagnosis
Encouragement of self management
Correction of acute metabolic upsets
Facilitate long term health and wellbeing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is a prompt diagnosis important in type 1 diabetes?

A

DKA can develop and cause death if diabetes is left undiagnosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What steps can be taken to make an early diagnosis of type 1 diabetes?

A

Remember symptoms- thirsty, thinner, tired and more frequent toilet visits (4 Ts)
Test immediately- use a finger prick glucose test
Contact local team for a same day review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some symptoms specific to children that may indicate type 1 diabetes?

A 
A return to bed-wetting in a previously dry child
Heavier than usual nappies
Candidiasis
Constipation
Skin infections
Irritability/ behaviour change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the symptoms of diabetic ketoacidosis?

A 
Nausea & vomiting
Abdominal pain
Sweet smelling breath
Drowsiness
Rapid, deep respiration
Coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What steps should be taken in cases of diabetic ketoacidosis?

A

Test blood glucose with a finger prick test to confirm cause but DO NOT arrange for any laboratory tests
In children call a specialist for a same day review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the current strategies to support people with type 1 diabetes?

A

Education- can be team based, structured or personal
Help with nutrition/lifestyle management
Skills training
Methods of receiving insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When do type 1 diabetics need to be able to check their blood glucose levels?

A

To adjust insulin levels
Before driving
To tighten control of their diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What levels of ketones are considered normal, at risk of DKA and in DKA?

A

<0.6mmol/L-normal

  1. 6-2.9 mmol/L- at risk of DKA
  2. 0 or above- DKA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the different kinds of insulin?

A 
Rapid acting
Short acting
Intermediate acting
Long acting
Continuous acting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What adjustments in lifestyle are necessary after a diabetes diagnosis?

A 
Exercise
Diet
Driving
Smoking
Alcohol
Conception/contraception
Drugs
Holiday
Employment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Under what blood glucose measurement is somebody considered hypoglycaemic?

A

> 4mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What drugs put patients at risk of experiencing hypoglycaemic episodes?

A

Insulin and sulphonyureas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes a hypoglycaemic episode?

A

An imbalance between nutrition, exercise and insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the symptoms of a hypoglycaemic episode?

A 
Sweating
Palpitations
Hunger
Shaking
Headache
Nausea
Confusion
Drowsiness 
Odd behaviours
Speech difficulty
Incoordination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What volume of carbohydrate should be used to treat a hypo?

A

15-20g

17
Q

How can hypos be treated if the patient cannot take CHO orally?

A

Out of hospital- 1mg glucagon or Glucogel/Dextrogel

In hospital- 75-80ml 20% glucose or 25-50ml of 50% glucose

18
Q

How can hypos be avoided in insulin dependent diabetics?

A 
Blood glucose monitoring
Site rotation and checking
Review diet
Consider change in insulin regimen
Deliver insulin before and after exercise
19
Q

What are the signs of DKA?

A 
Dry mucus membranes
Sunken eyes
Tachycardia
Hypotension
Ketotic breath
Kussmaul resp.
Altered mental state
Hypothermia
20
Q

What are the possible complications of DKA?

A 
Hyper/hypokalaemia
Hypoglycaemia
Cerebral oedema
Aspiration pneumonia
Arterial and venous thromboembolism
ARDS
21
Q

What measures may need to be taken in treating DKA?

A 
Measure glucose, Us + Es, ketones, bicarbonate and arterial blood gases
Give IV saline
Give IV insulin
Give IV potassium in saline
May need antibiotics
Consider heparin and NG tube
22
Q

What factors help facilitate long term health and well being in cases of type 1 diabetes?

A

Optimal blood glucose (HbA1c to reduce microvascular disease)
Optimal blood pressure control (to reduce risk of nephropathy)
Manage cardiovascular risk factors
Screen for early detection of complications (feet, kidneys, eyes)

23
Q

What should patients with type 2 diabetes expect from their care?

A 
Blood glucose levels
Blood pressure checked
Blood lipids
Eyes and feet screened
Kidney function tested
Weight management
Smoking cessation
An individual care plan
Structured education
Psychological/emotional support
24
Q

What are the aims of treatment of diabetes?

A

Relief of primary symptoms
Prevention of complications
Preservation of quality of life

25
Q

Describe the 5-step framework that should be considered when choosing a glucose lowering drug

A
  1. Set a target HbA1c
  2. Are there other risk factors that are more important?
  3. Are the current treatments optimised?
  4. What are the glucose lowering options?
  5. Agree a review date and HbA1c target with the patient
26
Q

In what cases should you consider relaxing a HbA1c target?

A 
People who are older or frail
Adults with type 2 diabetes that have:
-reduced life expectancy
-high risk of hypoglycaemia
-where intensive management not appropriate (eg multiple comorbities)
27
Q

What are the first line treatments of antihyperglycaemic therapy in type 2 diabetes and when is each recommended?

A

Metformin first line

Sulfonyureas if weight loss or osmotic symptoms are present

28
Q

What are the second line treatments of antihyperglycaemic therapy in type 2 diabetes and when is each recommended?

A

Sulfonyureas- if not already prescribed
Thiazolidinedione- if hypos are a concern and no congestive heart failure
DPP-IV inhibitor or SGLT-2 inhibitor- if hypos and weight gain are concerns

29
Q

What are the third line treatments of antihyperglycaemic therapy in type 2 diabetes and when is each recommended?

A

Add an additional one of the second line treatments
Also can use injectable medications:
GLP-1 agonist- if BMI >30 with a desire to lose weight
Insulin- if osmotic symptoms/rising HbA1c

30
Q 
Give examples of the following classes of medications:
Sulfonyureas
Thiazolidinedione
DPP-IV inhibitor
SGLT-2 inhibitor
GLP-1 agonist
A 
Sulfonyureas- glimepiride/gliclazide
Thiazolidinedione- pioglitazone
DPP-IV inhibitor- sitagliptin
SGLT-2 inhibitor- empagliflozin
GLP-1 agonist- lixisenatide
31
Q

Why is metformin the first choice in treating hyperglycaemia?

A

Improves outcomes
Well tolerated
Cheap

32
Q

What is the mechanism of metformin treating hyperglycaemia?

A

Affects glucose production and decreases fatty acid synthesis
Improves receptor function
Inhibits gluconeogenic pathways

33
Q

What are the disadvantages of metformin?

A

Risk of lactic acidosis
GI side effects common
Risk of vitamin B12 malabsorption

34
Q

Describe the mechanism of action of sulfonyureas

A

Bind to sulfonyurea receptors on functioning pancreatic beta-cells, closing the linked ATP-sensitive potassium channels. This causes a decreased potassium influx depolarisation of the cell membrane so voltage-gated calcium channels open and cause an influx of calcium. This causes translation and exocytosis of secretory granules of insulin into the cell

35
Q

What are the advantages of sulfonyureas?

A 
Can be used with metformin
Rapid improvement of control and systematic improvement 
Rapid titration
Well tolerated
Cheap
36
Q

What are the disadvantages of sulfonyureas?

A

Risk of hypoglycaemia
Weight gain
Caution needed in renal and hepatic disease
Contraindicated in pregnancy and breast feeding
Side effects include hypersensitivity and blood disorders

37
Q

Describe the mechanism of action of thiazolidinedione

A

Selectively stimulates the PPAR-gamma and modulates the transcription of insulin-sensitive genes involved in the control of glucose and lipid metabolism in muscle, adipose tissue and the liver. It reduces insulin resistance in the liver and peripheries, increases the expense of insulin-dependent glucose, decreases withdrawal of glucose from the liver and reduces quantity of glucose, insulin and glycated haemoglobin in the bloodstream

38
Q

What are the advantages of pioglitazione?

A

Helpful in cases where insulin resistance is significant
Reduces HbA1c marginally
Cheap
Cardiovascular safety established

39
Q

What are the disadvantages of pioglitazione?

A

Increased risk of bladder cancer
Fluid retention
Weight gain
Increases risk of fractures in females

Endocrinology and Diabetes (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions