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3D week 3 - hormones 2 > secondary care > Flashcards

secondary care Flashcards

1
Q

potential blood sample contaminants that could result in falsely high K+ values

A
  1. EDTA-K (anticoagulant used in blood bottles -> EDTA binds bivalent ions (Calcium and Magnesium) => Ca and Mg may be very low
  2. drip with K+
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2
Q

4 causes of falsely high K+ blood results

A
  1. delayed separation of cells
  2. haemolysis
  3. contamination
  4. thrombocytosis/leukocytosis
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3
Q

HbA1c diabetic targets (2)

A
  1. 48 mmol/L for most diabetics
  2. 53 mmol/L if on hypo causing meds
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4
Q

what diabetic medications should be stopped in the case of DKA or illness (and what shouldn’t be)

A

stop SGLT2is and sulphonyureas due to risk of dehydration; do not stop metformin

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5
Q

in what case should metformin be stopped

A

if eGFR<30

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6
Q

when is a GLP1 agonist good to give

A

if BMI >30 (helps weight loss by increasing satiety)

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7
Q

who might ultra long acting insulin be given to (2)

A
  1. elderly pts who are visited by district nurses
  2. frequent DKA pts (poorly controlled)
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8
Q

sites of insulin injection from fastest to slowest absorption time

A
  1. abdomen
  2. backs of arms
  3. legs
  4. buttocks
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9
Q

if on 2 different insulins, what should be recommended about the injection sites

A

the injection sites should be two completely different areas to avoid interaction

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10
Q

apart from appearance, why is lipohypertrophy bad

A

insulin can’t be absorbed as well here

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11
Q

can lipohypertrophy be reversed

A

if small areas then yes, but no if severe

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12
Q

why trying to combat hyperglycaemia, what should be done to the insulin dose

A

increase it by 10%

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13
Q

why trying to combat hypoglycaemia, what should be done to the insulin dose

A

reduce insulin by 10-20% and review in 1 week (needs time to take effect)

correcting hypos take priority over hypers

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14
Q

what blood glucose value is considered hypoglycaemic

A

<4

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15
Q

7 early hypoglycaemiasigns

A

adrenergic symptoms
1. palpitations
2. tremor
3. anxiety
4. sweating
5. hunger
6. headache
7. parasethesia

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16
Q

6 late hypoglycaemia signs

A

neuroglycaemic signs
1. confusion
2. unusual behavior (e.g. overly aggressive)
3. drowsiness
4. speech difficulties
5. seizure
6. coma

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17
Q

how to treat a hypo

A

ifcan eat - give simple sugars e.g. orange juice, 5 glucose tabs, dextrose tables, jelly babies, 2 glucogel

repeat up to 3 times until BG reaches 4mmol -> if not then IV dextrose may be required

follow up with a starchy snack (once BG is >4)

if can’t eat then IV dextrose

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18
Q

ketone values

A

<0.6 - normal
0.6-1.59 - slightly high, increase monitoring
1.6-2.9 - risk of DKA, contact diabetes team/GP
>= 3.0 - high risk of DKA, get medical help immediately

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19
Q

how should an IV insulin infusion be stopped

A

stop it so that there is an overlap with the normal insulin dose - IV insulin only has a half life of 5 mins and so the normal dose must be given within this time

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20
Q

what are the 2 categories of diabetes complications

A
  1. microvascular
  2. macrovascular
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21
Q

what 3 things should be checked in the diabetes annual review to account for macrovascular complications

A
  1. BP
  2. BMI
  3. cholesterol levels
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22
Q

what is checked in a diabetes annual review (11)

A
  1. blood pressure
  2. blood glucose (HbA1c)
  3. cholesterol
  4. eye screening (every 2 years)
  5. foot and leg check
  6. kidney test
  7. dietry advice
  8. emotional and physical support
  9. flu jab
  10. smoking cessation (advice)
  11. pregnancy (advice)
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23
Q

how often do diabetic get their eyes checked if no visual problems

A

every 2 years

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24
Q

what 3 areas are affected by microvascular complications and how should their function be checked

A
  1. kidney - eGFR, albumin:Creatanin ratio (give ACEi/ARB if high)
  2. nerves - foot examination, ask about autonomic symptoms
  3. retinopathy - retinal exam
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25
Q

what are the 2 types of neuropathy that can arise w diabetes and what are symptoms

A
  1. peripheral - loss of sensation in feet and hands (glove and stocking distribution), ulcers, paresthesia etc.
  2. autonomic - urinary incontinence, postural hypotension, gastroparesis
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26
Q

3 stages of diabetic retinopathy and what can be seen in each

A
  1. background retinopathy - microaneuyrism, hard exudate
  2. preproliferative - cotton wool spots, haemorrhages
  3. proliferative - neovascularisation ->can lead to vitreous haemorrhage
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27
Q

what does taking a SGLT2i for diabetes increase the risk of

A

normal glycaemic DKA -> decreased insulin levels as a result of the drug leads promotes gluconeogenesis and lipolysis -> increased ketone body production

28
Q

what can uclers to the bone pose a risk of

A

osetomyelitis

29
Q

what does the number in insulin names indicate e.g. Humalog mix 25

A

the percentage of short acting insulin -> 25% short acting and 75% intermediate acting in the example

30
Q

why does carb counting make it difficult to prescribe insulin for a pt

A

they take variable amounts of insulin depending on their carb intake so hard to prescribe a fixed rate => give a range of insulin doses

31
Q

when prescribing variable rate insulin, what should happen to the pts normal insulin prescription

A

short acting should be stopped but NEVER stop regular long acting dose

32
Q

indications for variable rate insulin (3)

A
  1. nil by mouth (e.g. pre-op)
  2. vomiting and can’t eat
  3. DKA (resolved buts still not eating)
33
Q

what are examples of typical diabetic foot chracteristics (4)

A
  1. high arch
  2. foot deformity (e.g. charcot’s, amputatio)
  3. muscle wasting
  4. toe clawing
34
Q

what is an early sign of charcot’s foot

A

the affected foot is warmer than the other

35
Q

why is KCL usually given in the second bag of fluids in the DKA protocol

A

insulin causes hypokalaemia - it promotes the entry of potassium into skeletal muscle and liver cells by increasing the activity of the Na- K-ATPase pump

36
Q

3 mainstays of DKA mgx

A
  1. insulin (0.1g/kg fixed rate)
  2. fluids - first bag normal saline 1L over 1hr
  3. KCl - 2nd/3rd bag NaCl 1L + KCl 40mmol over 2hrs
    (4. glucose - if BG <14 then give dextrose 10%)
37
Q

what fluid dose is given if haemodynamically unstable (BP <90/60)

A
  1. 500ml saline stat (over 15min), continue until BP normal
  2. if frail/at risk of fluid overload (e.g. HF) give 250ml stat
38
Q

what electrolyte disturbance is seen in addisonian crisis and why

A

hyponatremia and hyper kalemia -> lack of mineralcorticoids => no RAAS stimulation so Na+ not retained in kidneys -> fluid not retained (so BP drops) and instead K+ is retained (Na+/K+ pump is not initiated in the DCT due to RAAS system not working)

39
Q

why is low glucose seen in an addisonian crisis

A

due to low cortisol levels -> cortisol causes gluconeogenesis + gllucogenesis (i.e glucoe is high)

40
Q

what happens to BP in addisonian crisis and why

A

BP drops -> no mineralcorticoids => no aldosterone to control BP levels

41
Q

what other conditions are related to diabetes

A

other autoimmune conditions e.g. vitiligo, IBD, coeliac’s, pernicious anemia, hypothyroidism

42
Q

what 2 careers can diabetics not do

A

pilot and military

43
Q

what antibodies should be tested for if T1DM suspected

A
  1. anti - GAD65
  2. anti - IA2
  3. insulin antibodies (IAA)
  4. anti - zinc transporter 8
  5. C peptide (released when insulin made)
44
Q

how is osmolarity calculated

A

2(Na+ + K+) + urea + glucose

45
Q

when should pancreatic cancer be scanned for in diabetics

A

if >60 and new diabetes or if there is a big change in pre-existing diabetes

46
Q

what should be recommended to T1DM pt who binge drink

A

have carbs after a night out-> stops sugars coming crashing down

47
Q

if a diabetic pt has erectile dysfunction, what else are they likely to have

A

coronary heart disease (coronary bvs are smaller and so likely to be already blocked if larger penile arteries are blocked)

48
Q

if a 9am cortisol test shows levels <100 what should be done

A

immediately start steriods -> but also maje sure to check their meds and whether they have just come off night shifts r other things that can cause abnormal 9am cortisol

49
Q

is 9am cortisol test is 100-350 what should be done next

A

short synacthen test

50
Q

if a pt is taking oestrogen exogenously shoud they have a cortisol test

A

no - must omit oestrogen for 6 weeks prior

51
Q

when should cortisol levels reach their peak in the short synacthen test

A

after 30 mins

52
Q

what mgx is needed for congenital adrenal hyperplasia

A

lifelong steroid replacement

53
Q

a steroid card is required if you are taking steroids for longer than how many weeks

A

> 4 weeks

54
Q

what can be eaten to help reduce LDL levels

A

plant sterols

55
Q

how much does 10g of carb raise BG levels by

A

2.3 mmol

56
Q

what is a complication of thyroidectomy and what will this show on ECG

A

damage to parathyroid glands -> hypocalcaemia, will have long QT on ECG

57
Q

what is the cushing reflex

A

a physiological nervous system response to acute elevations of intracranial pressure (ICP), resulting in the Cushing triad of:
1. widened pulse pressure (increasing systolic, decreasing diastolic)
2. bradycardia;
3. irregular respirations

58
Q

what is there a risk of due to basal insulin pump malfunction

A

DKA -> give some back up insulin pens as there is no insulin to fall back onw

59
Q

what is glycaemic index and what affects this

A

the rate at which carbs are broken down into glucose -> fat and protein can affect this rate e.g. custard has a low GI as it contains fat and protein which slows down carb breakdown

60
Q

what is glycaemic load

A

number that estimates how much the food will raise a person’s blood glucose level after it is eaten

61
Q

glycaemic load calculation

A

glycaemic load = (Glycaemic Index x carbohydrate intake)/100

62
Q

what is the 15:15 rule for hypglycaemia treatment

A

15g high GI carb, wait 15 mins

63
Q

why is only IV hydrocortisone given as steroid replacement in addisonian cris

A

at high doses hydrocortisone acts as both a mineral and glucocorticoid => no role for fludrocortisone

64
Q

what severe complication can occur in pts taking carbimazole and what is the mgx

A

agranulocytosis - give GCSF

65
Q

2 causes for hypercalcaemia

A
  1. hyperparathyroidism
  2. malignancy (myeloma, PTH secreting, bone)
66
Q
A

3D week 3 - hormones 2 (6 decks)

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