Brainscape's Knowledge GenomeTM

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


See full index

Year 3 - GP > SLA 14 - Diabetes > Flashcards

SLA 14 - Diabetes Flashcards

1
Q

What is diabetes mellitus?

A

A metabolic disorder characterised by persistent hyperglycaemia with disturbances of carbohydrate, protein, and fat metabolism resulting from insulin deficiency or insulin resistance.

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

Pathogenesis of T1DM.

A

The autoimmune destruction of beta-cells in the pancreas leads to absolute insulin deficiency.

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

Which specific genetic mutations are associated with the onset of T1DM?

A

HLA DR3 and HLA DR4

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

Presentation of T1DM.

A
  • polyuria
  • polydispsia
  • weight loss
  • excessive tiredness
  • ketosis (urine dip)

T1DM usually has a juvenile onset, but can occur at any age.

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

Which tests can be used to aid a diagnosis of T1DM?

A
  • random plasma glucose >11.1mmol/L
  • fasting plasma glucose >7mmol/L
  • oral glucose tolerance test >11.1mmol/L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the diagnostic criteria for T1DM?

A
  1. Symptomatic + 1x positive test
  2. Asymptomatic + 2x positive test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is T1DM managed on initial presentation?

A

Immediate same day referral to the hospital to confirm diagnosis and start insulin.

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

How is T1DM managed for adults in primary care?

A
  • ensure individual care plan is in place (review annually)
  • manage lifestyle factors (e.g. diet, exercise, alcohol intake)
  • provide information on diabetes support groups (e.g. Diabetes UK)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is included in the individual care plan for T1DM?

A

Medical assessment to confirm diagnosis and detect adverse vascular risk factors (e.g. hypertension).

Environmental assessment to understand circumstances of person (e.g. social, home, work) and preferences in nutrition and physical activity.

Cultural and educational assessment to identify prior knowledge, enabling optimal advice on treatment modalities and diabetes education programmes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How should T1DM be monitored?

A
  1. HbA1c every 3-6 months (<6.5%)
  2. Self-monitoring of blood glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When should self-monitoring of blood glucose be performed?

A
  • before breakfast
  • 2 hours after meals
  • during periods of illness
  • before driving
  • if feel hypoglycaemic

Advise routine self-monitoring at least 4 times per day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give the optimal targets for glucose self-monitoring in adults with T1DM in the following circumstances:

a) on waking

b) before meals

c) 90 minutes after meals

A

a) 5-7mmol/L

b) 5-7mmol/L

c) 5-9mmol/L

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

Give some possible complications of T1DM.

A

Microvascular complications including retinopathy, nephropathy and neuropathy.

Macrovascular complications including stroke, peripheral arterial disease and MI.

Metabolic complications including diabetic ketoacidosis (DKA) and hypoglycaemia.

Psychological complications including anxiety, depression, and eating disorders.

Autoimmune complications including thyroid disease, coeliac and Addison’s.

Reduced quality of life and life expectancy.

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

Outline the pathogenesis of DKA.

A

Insulin deficiency results in increase is glucagon and cortisol, which enhance hepatic glycogenolysis and gluconeogenesis resulting in severe hyperglycaemia.

Enhanced lipolysis liberates fatty acids that are metabolised by ketogenesis, resulting in large quantities of ketone bodies and subsequent metabolic acidosis.

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

Why is DKA a medical emergency?

A

DKA leads to dehydration and electrolyte imbalances, due to osmotic diuresis due to hyperglycaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When should you suspect DKA?

A

Finger prick BM > 11mmol/L AND:

  • polydipsia
  • polyuria
  • fruity smell of acetone on breath
  • acidotic breathing (Kussmaul respirations)
  • dehydration
  • shock

Note hyperglycaemia may not always be present, especially in children and young people on insulin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give some precipitating factors for DKA.

A
  • infection
  • non-adherence to insulin treatment regime
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What investigations can be performed if a diagnosis of DKA is suspected?

A

Test for ketones

Urine 2+

Blood >3mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is DKA managed in primary care?

A

Emergency admission to hospital.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When should you suspect hypoglycaemia?

A

Finger prick BM < 3.5mmol/L AND:

  • sweating
  • palpitations
  • weakness or lethargy
  • impaired vision
  • convulsions
  • coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the DAFNE programme?

A

Dose Adjustment For Normal Eating

A structured education programme for T1DM, allowing patients to lead as normal a life as possible.

It teaches patients how to maintain blood glucose levels within healthy targets, by counting the carbohydrates in each meal and injecting the right dose of insulin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are sick day rules for adults with T1DM?

A
  • never stop insulin
  • check BM more frequently (1-2 hours and through the night)
  • check blood or urine ketones more frequently
  • maintain normal eating pattern
  • drink at least 3L/day to prevent dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How should cardiovascular risk factors be managed in T1DM?

A
  • lifestyle changes (e.g. diet, exercise, alcohol intake)
  • blood pressure (target <135/85, first line antihypertensive is ACEi)
  • 20mg atorvastatin for primary prevention of CVD (do not use QRISK)
24
Q

How should complications of T1DM be monitored?

A

At every appt, measure HbA1c, BMI, waist circumference, screen for depression and eating disorders (e.g. diabulimia), check smoking status.

Annual reviews should check injection sites, assess cardiovascular risk factors and screen for thyroid disease, diabetic foot disease, diabetic retinopathy and diabetic nephropathy.

25
Q

How are the following complications assessed in T1DM?

a) retinopathy

b) neuropathy

c) nephropathy

A

a) annual review by local eye clinic, and opthalmoscopy by GP (if abnormal blood vessels on retina, refer to opthalmologist).

b) ask about erectile dysfunction (offer PDE-5 inhibitor if so), ask about autonomic neuropathy, do diabetic foot checks.

c) screen annually by bringing in first-morning urine and looking at creatinine:albumin ratio and eGFR. Advise low protein diet and offer ACEi if nephropathy.

26
Q

What are some signs of autonomic nephropathy in T1DM?

A
  • bladder emptying problems
  • unexplained diarrhoea
  • postural hypotension
  • excessive sweating
  • impotence

Occurs due to damage to the nerves controlling the autonomic nervous system.

27
Q

What are the different insulin regimes for T1DM?

A

Offer multiple daily injection basal-bolus insulin regimes as 1st line.

Offer twice daily insulin detemir as long acting basal insulin, then a rapid-acting insulin analogue injected just before meals.

28
Q

What advice should be given to patients on insulin injection sites?

A
  1. Pinch the skin (avoid injecting the muscle)
  2. Check injection sites regularly for lumps (lipohypertrohy)
  3. Rotate injection sites (prevents lipohypertrophy and lipodystrophy)
  4. Switch from left to right side of body weekly
29
Q

How can hypoglycaemia be managed?

A

Promptly consume 10-20g of fast-acting form of carbohydrate (e.g. glucose tablets, lucozade energy, sugar in water).

Recheck blood glucose in 10-15 minutes - if no improvement, repeat oral intake.

At next meal increase the amount of carbohydrates.

If patient unconscious give 1g glucagon IM or call 999.

30
Q

What are some adverse effects of insulin?

A
  • painful injection site
  • bruising and bleeding
  • lipohypertrophy
  • insulin leakage
31
Q

Give some drugs that can enhance the hypoglycaemic effect of insulin.

A
  • alcohol
  • anabolic steroids
  • ACEi
  • beta-blockers (mask signs of hypoglycaemia)
  • fibrates
32
Q

Give some drugs that antagonise the hypoglycaemic effect of insulin.

A
  • corticosteroids
  • diuretics
  • glucagon
  • levothyroxine
  • oral contraceptives
33
Q

Presentation of T2DM.

A

Persistent hyperglycaemia:
- fasting plasma glucose >11mmol/L
- HbA1c > 6.5%

Risk factors (e.g. obesity, FHx, PCOS) present.

Note characteristics (e.g. thirst, recurrent infections) less pronounced than in T1DM.

34
Q

What is the diagnostic criteria of T2DM?

A

Asymptomatic + 2x positive test results

Symptomatic + 1x positive test result

35
Q

When should HbA1c results be interpreted with caution?

A

Any pathology that either lengthens or reduces the lifespan of an erythrocyte, as prolonged or shortened exposure to glucose.

E.g. sickle cell trait.

36
Q

Outline the pathogenesis of T2DM.

A

Persistent hyperglycaemia eventually results in insulin deficiency and insulin resistance.

37
Q

What initial management should be offered to a newly diagnosed adult with T2DM?

A

Individual care plan (e.g. polypharamacy)

Structured education programme (e.g. DESMOND)

Provide information on government disability benefits

Manage lifestyle issues (e.g. exercise, alcohol intake, diet)

Screen for diabetic complications

38
Q

What are the treatment targets for adults with T2DM?

A

Should measure HbA1c every 3/12 until stable, then measure every 6/12.

Aim for HbA1c <6.5% if T2DM managed by lifestyle changes and/or one drug not associated with hypoglycaemia (e.g. metformin).

Aim for HbA1c <7.0% if T2DM managed by one drug associated with hypoglycaemia (e.g. sulfonylurea) or if taking multiple medications.

Individual targets may lax for the elderly or frail, who are unlikely to see long term benefits of lower blood sugars.

39
Q

When should T2DMs do self-monitoring of their blood glucose?

A

Not routinely advised as does not help improve sugars, unless:

  • insulin therapy
  • evidence of hypoglycaemic episodes
  • pregnant
  • corticosteroids
40
Q

What is the first line treatment for T2DM?

A

Metformin

41
Q

Metformin

a) drug class

b) MOA

c) benefits

d) side effects

e) contraindications

f) drug interactions

A

a) biguanide

b) Inhibits gluconeogenesis and increases peripheral utilisation of glucose, working only if residual functioning pancreatic islet cells.

c) cardioprotective as lowers cholesterol and triglycerides; limits weight gain as lowers appetite; can be used in pregnancy; no hypoglycaemia.

d) GI upset; heart burn; metallic taste; lactic acidosis; vitamin B12 deficiency.

e) alcohol intoxication; DKA; eGFR<30ml/min

f) alcohol increases risk of lactic acidosis; beta-blockers may mask hypoglycaemia; corticosteroids / COCP / thiazide diuretics may antagonise

42
Q

If metformin is not tolerated, for example due to gastrointestinal side effects, what is the next step in managing the patient?

A

Switch to modified-release metformin.

43
Q

When is an SGLT-2 inhibitor indicated in the treatment of T2DM?

A

SGLT-2 inhibitor + Metformin if:

  • high risk of CVD
  • established CVD
  • chronic heart failure
44
Q

If a patient’s HbA1c is not controlled by first line treatment in T2DM, what is the next step in management?

A

Second line; add one of:
- DPP-4 inhibitor
- pioglitazone
- sulfonylurea

If the above is not effective, you can then consider beginning an insulin-based treatment.

45
Q

What immediate treatment is recommended for adults with T2DM who have symptomatic hyperglycaemia?

A

Insulin or sulfonylurea

46
Q

What advice on:

a) diet

b) exercise

c) weight

can be given to a T2DM patient?

A

a) high-fibre, low-glycaemic-index sources of carbohydrates (e.g. fruit, vegetables, wholegrain); low fait dairy products; oily fish

b) 150 minutes of moderate exercise each week

c) 5-10% body weight loss and consider referral to dietician

47
Q

What statin should be given to diabetics?

A

20mg OD atorvastatin if:
- QRISK >10%
- T1DM
- CKD

80mg OD atorvastatin if established IHD / CVD / PAD

48
Q

Give an example of medication that should be prescribed with caution in a patient with autonomic nephropathy.

A
  • TCA antidepressants
  • antihypertensives

Increase risk of postural hypotension

49
Q

Sitagliptin:

a) drug class

b) MOA

c) benefits

d) side effects

e) contraindications

f) drug interactions

A

a) gliptins.

b) DDP4 inhibitor so increases GLP1 and GIP in the blood, causing increased insulin secretion and decreased glucagon secretion.

c) no hypoglycaemia as only released on eating; weight loss as decreased appetite.

d) GI symptoms (e.g. constipation); acute pancreatitis; back pain; arthralgia; skin reactions; headaches.

e) hepatic impairment; renal impairment; pregnancy; DKA; heart failure

f) beta-blockers mask hypoglycaemia; ACEi increases risk of angio-oedema

50
Q

What are some adverse reactions specific to the following drugs:

  • sitagliptin
  • saxagliptin
  • linagliptin
A

Black triangle drugs so intensely monitored and patients encouraged to report adverse reactions.

Sitagliptin: interstitial lung disease; impaired renal function; thrombocytopenia; acute renal failure

Saxagliptin: erectile dysfunction; peripheral oedema; dyslipidaemia; hypertriglyceridaemia.

Linagliptin: nasopharyngitis; cough.

51
Q

Pioglitazone:

a) drug class

b) MOA

c) benefits

d) side effects

e) contraindications

f) drug interactions

A

a) glitazones

b) reduces peripheral insulin resistance in muscles and adipose tissue by activating PPAR-y receptors.

c) lowers lipids

d) weight gain; fracture risk; risk of bladder cancer; decreased visual acuity.

e) heart failure; bladder cancer; haematuria; pregnancy

f) beta blockers mask hypoglycaemia.

52
Q

Gliclazide:

a) drug class

b) MOA

c) benefits

d) side effects

e) contraindications

f) drug interactions

A

a) sulfonylurea

b) activating ATP-K+ channels on the pancreas, stimulating the release of insulin.

c) reduce risk of microvascular complications; potent.

d) hypoglycaemia; weight gain; abdominal disturbances; skin reactions

e) pregnancy; DKA; severe renal/hepatic impairment; G6PDH deficiency

f) NSAIDs / warfarin displace protein from bound site.

53
Q

Exenatide:

a) drug class

b) MOA

c) benefits

d) side-effects

e) contraindications

f) drug interactions

A

a) GLP-analogue / insulin mimetic

b) activates GLP-1 receptor stimulating insulin secretion and suppressing glucagon secretion.

c) CVS benefits; weight loss by appetite decrease; low risk of hypoglycaemia

d) GI disturbances (N+V); GORD; painful to inject; headaches; renal impairment

e) DKA; renal impairment, gastroparesis; IBS

f) affects absorption of other drugs so inject at least 1 hour before.

54
Q

Dapagliflozin:

a) drug class

b) MOA

c) benefits

d) side-effects

e) contraindications

f) drug interactions

A

a) SGLT-2 inhibitor

b) reversibly inhibits SGLT-2 in the PCT to reduce glucose reabsorption and increase urinary glucose excretion.

c) beneficial to CVS; low risk of hypos.

d) polyuria; UTIs; thrush; Fournier’s gangrene; constipation; thirst; toe amputation.

e) DKA; renal impairment; foot ulceration (risk of amputation).

f) thiazides / loop diuretics can volume deplete.

55
Q

What drugs may you consider giving to diabetics to manage their vascular risk factors?

A
  • statins
  • ACEi (T2DM) / CCB (T1DM)
  • stop smoking
56
Q

What is reactive hypoglycaemia?

A

Low blood sugar that occurs after eating a meal, usually within 4 hours of eating, caused by the pancreas secreting too much insulin.

57
Q

Give the macrovascular complications of diabetes.

A
  • cerebrovascular disease
  • peripheral vascular disease
  • coronary heart disease

Year 3 - GP (17 decks)

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