Metabolic and Endocrine Flashcards
HbA1c target for T2DM managed by lifestyle and diet?
48 mmol/mol
HbA1c target for T2DM managed by combination of diet/lifestyle and single drug not associated with hypoglycaemia?
48 mmol/mol
HbA1c target for T2DM managed by a drug associated with hypoglycaemia or 2 or more antidiabetic drugs in combination?
53 mmol/mol
How often should HbA1c be monitored in people with T2DM?
3-6 monthly until stable HbA1c on unchanging treatment, then 6 monthly.
In those with T2DM managed with 1 drug at what HbA1c should diabetes management be intensified?
58 mmol/mol
When should a person with T2DM be offered self monitoring of glucose?
- on insulin therapy
- e/o hypoglycaemic episodes
- on drug which increases patients’ risk of hypoglycaemia whilst driving or operating machinery
- person pregnant or planning to become pregnant
Most common features of Klinefelters syndrome (47, XXY)?
infertility and small firm testes
Most common cause of end stage renal failure in the UK?
diabetes
Recommended monitoring for development or progression of CKD in patients after AKI even if serum creatinine returned to baseline?
for at least 2-3 years
What duration must abnormalities of kidney function and/or structure be present for to have diagnosis of CKD?
more than 3 months
e.g. if pt not previously tested has eGFR of <60, confirm that with rpt test in 2 weeks-if still at this level will need rpt in 3 months to make CKD diagnosis
Advice on initial detection of proteinuria in patients with suspected CKD?
early morning urine for ACR-if between 3 and 70 mg/mmol, confirm by subsequent morning sample (rpt within 3 months), if >70 no need to repeat
ACR of 3mg/mmol or more is clinically significant proteinuria
as part of initial investigations urine should be dipped for haeamaturia-if 1+ or more then arrange MSU to exclude UTI
Which patients with CKD should be offered a renal ultrasound?
- accelerated progression of CKD-sustained decrease in GFR of 25% or more and change in GFR category in 1 year OR sustained decreased in GFR of 15ml/min/year.
- visible or persistent invisible haematuria
- sx of urinary tract obstruction
- eGFR<30
- FH of PKD and age>20
- considered by nephrologist to need a renal biopsy
NICE guidance on statins in CKD?
offer atorvastatin 20mg OD as primary prevention for all patients with CKD
Why does chronically raised prolactin lead to the development of osteoporosis?
high prolactin inhibits the release of GnRH through negative feedback, suppressing oestrogen production that normally maintains bone health
1st line drug for treatment of prolactinoma?
cabergoline (dopamine agonist)
if resistant to rx, surgery and radiotherapy are the 2nd and 3rd line tx options
Most common cause of hyperprolactinaemia?
prolactinomas
Which drugs can reduce the absorption of levothyroxine?
iron tablets
calcium carbonate tablets
should be given at least 4 hours apart
Defining features of metabolic syndrome (syndrome X)?
HTN disturbance of blood lipid levels central/abdominal adiposity fatty liver insulin resistance and a tendency to develop thrombosis
How is T2DM diagnosed in an asymptomatic person?
Requires 2 abnormal HbA1c or fasting plasma glucose results-HbA1c 48 or higher, or fasting plasma glucose 7 or higher.
In which patients should HbA1c NOT be used to diagnose T2DM?
- children and young people aged under 18
- end stage renal disease
- HIV
- patients with high diabetes risk who are acutely unwell
- pregnant women or 2 months post partum
- sx of diabetes for <2 months
- on drugs that may cause hyperglycaemia e.g. steroids
- acute pancreatic damage e.g. surgery
interpret with caution if anemia, recent blood transfusion, altered red cell lifespan or abnormal Hb.
Definition of impaired glucose tolerance?
blood glucose of 7.8 or more but less than 11.1 after a 2hr OGTT
Management of a child suspected of having T2DM in primary care?
r/f immediately (same day) to multi-disciplinary paediatric diabetes care team who can confirm the diagnosis and provide immediate care
With which 2 other medications can dapagliflozin be combined with for triple therapy in managing T2DM?
metformin and a sulfonylurea
If 1st line tx ineffective, what are the options for 2nd line pharmacological tx of T2DM if metformin is CI or not tolerated?
gliptin plus pioglitazone OR
gliptin plus sulfonylurea OR
pioglitazone plus sulfonylurea
SGLT-2i instead of a gliptin if pioglitazone or sulfonylurea not appropriate
3rd line tx of T2DM in those where metformin CI or not tolerated?
consider starting insulin-based treatment
When to consider tx in T2DM with a GLP-1 agonist e.g. exenatide?
if triple therapy with metformin and 2 other anti-diabetic drugs has failed, consider combination tx with metformin, a sulfonylurea and GLP-1 mimetic if:
- BMI 35 or over and specific psychological/medical problems associated with obesity
- BMI <35 and insulin therapy would have significant occupational implications, or weight loss would benefit other significant obesity-related comorbidities.
Requirements for continuing therapy with GLP-1 mimetic?
HbA1c reduction of at least 11mmol/mol (1%) and weight loss of at least 3% of initial body weight in 6 months
Important foods to include in diet for people with T2DM?
high fibre
low glycaemic index e.g. fruit, vegetables, wholegrain and pulses
low fat dairy products
oily fish (salmon, sardines, mackerel, trout, pilchards, sprats, herring)
Initial body weight loss target in people with T2DM who are overweight (BMI 25 or greater)
5-10%
Recommended weekly exercise for adults in the UK?
moderate intensity exercise e.g. brisk walking/cycling over a week should be at least 150 mins (2.5hrs) in bouts of 10min or more
muscle strengthening exercise should also take place on at least 2 days a week
