MET3 Revision: Diabetes I Flashcards
A patient is diagnosed with DMT1 after an admission for DKA.
What is the insulin regime you should start them on post-admission? [1]
Twice-daily basal insulin detemir (long acting), insulin aspart (short acting) bolus with meals
Name 4 complications associated with untreated diabetes
skin infections – staphylococcal skin abcesses, oral or genital candidiasis
foot problems – ulcers or neuropathic pain
retinopathy – perhaps found on routine eye test
acute myocardial infarct / stroke– diagnosed whilst in hospita
State 4 methods for diagnosing diabetes [4]
Fasting plasma glucose (FPG) (note NOT a capillary glucose [ie. a fingerprick test])
Random plasma glucose (RPG)
75 gram oral glucose tolerance test (OGTT / 2hr PG)
Haemoglobin A1c (HbA1c, glycated haemoglobin)
NOTE: One diagnostic test is enough to diagnose diabetes w/ symptom
Impaired glucose tolerance can only be diagnosed using which diagonostic test?
FPG
2 hr PG
RPG
HbA1c
Impaired glucose tolerance can only be diagnosed using which diagonostic test?
FPG
2 hr PG
RPG
HbA1c
Which HLA is associated with DMT1? [2]
HLA DR3 & DR4
Describe what pancreatic diabetes is [1]
Name 4 causes of pancreatic diabetes [4]
Pancreatic diabetes:
* Severe disease of pancreas causes damage to B cells
Causes:
Acute / Chronic Pancreatitis
Trauma / Pancreatectomy
Neoplasia
Cystic fibrosis
Haemochromatosis / Thalassaemia – due to iron overload
Name 6 endocrine diseases known to cause diabetes [6]
Acromegaly (excess growth hormone)
Cushing’s syndrome (excess cortisol)
Glucagonoma (excess glucagon)
Phaechromocytoma (excess adrenaline)
Hyperthyroidism (excess thyroid hormone)
Conn’s syndrome (excess aldosterone hormone
State 5 causes of drug induced diabetes [5]
Glucocorticoids
b-blockers
Thiazide diuretics
Tacrolimus (used in transplantation – may cause “New Onset Diabetes after Transplantation” [NODAT])
Atypical anti-psychotics – eg. olanzapine, risperidone, clozapine
Name two congenital viral infections that may cause diabetes [2]
Congenital rubella
Cytomegalovirus
DMT2 is caused by a combination of which two physiological factors? [2]
Insulin resistance AND B-cell failure
Insulin resistance AND B-cell failure are exacerbated by hyperglycaemia:
What is this concept called? [1]
Explain the pathophysiology [2]
Glucose toxicity:
High levels of glucose lead to poorer b-cell function leading to reduced insulin secretion
therefore lowering glucose may actually help b-cell function
Describe how alpha and beta cell mass changes in diabetic patients [2]
b-cell mass is relatively preserved (50% at autopsies) - but function declines
a-cell population increased
Which factors contribute to metabolic syndrome? [6]
BMI > 30 kg/m2 , or:
Abdominal Waist Circumference – ethnic specific
Low HDL Concentration
Blood pressure
Fasting glucose
Triglyceride
Label the treatment choices for the DM patients with multi-morbidities for patients already on metformin management and HbA1c remains above 53
CVD:
A: SGLT-inhibitor
B: GLP-1
Heart Failure:
C: SGLT-inhibitor
D: GLP-1
CKD
E: SGLT-inhibitor
F: GLP-1
High CV Risk:
G: SGLT-inhibitor
H: GLP-1
Frail / elderly:
I DPP-inhibitor (low hypoglycaemia risk)
Obesity
A: SGLT-inhibitor
B: GLP-1
Which drugs are contraindicated for patients with DMT2 who might also be suffering from:
Heart Failure [2]
CKD [1]
Frail / elderly [3]
Obesity [2]
Heart Failure:
- Pioglitazone: causes oedema as an AE
- Saxagliptin: increase risk of HF
CKD [2]
- Caution with SUs
Frail / elderly [3]
- SGLT2i (hypoglycaemia risk)
- GLPs (hypoglycaemia risk)
- Caution with SUs (hypoglycaemia risk)
Obesity
- SUs (weight gain)
- Pioglitzaone (weight gain)
When are the following useful / recommended as an additional step to DM patient medication? [3]
Sulfonylurea [1]
Pioglitazone [1]
Repaglinide [1]
Sulfonylurea: (gliclazide, glimepiride): if rapid glucose lowering needed and hypos are not a concern
Pioglitazone: can improve lipids, useful for insulin resistance if no C/Is
Repaglinide: can be useful in shift workers/ irregular meal patterns
Sick day rules:
During an acute dehydrating illness, patients with diabetes should be advised to stop the SADMAN drugs, and restart once they have been eating and drinking normally for 24-48 hours.
What do the SADMAN drugs refer to? [6]
State why need to stop each of the SADMAN drugs [6]
SGLT2 inhibitors: (risk of DKA)
ACE inhibitors: (risk of AKI)
Diuretics (risk of AKI)
Metformin (risk of lactic acidosis)
ARBs (risk of AKI)
NSAIDs (risk of AKI)
DPP4 inhibitors have a risk of causing which pathology? [1]
Pancreatitis