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Endocrine > T2DM > Flashcards

T2DM Flashcards

1
Q

Patients tend to present with T2DM in youth/middle/late-age and are usually lean/obese?

A

Middle/late aged patients who are usually obese

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2
Q

Ketonuria is strongly evident in T2DM. True/false?

A

False - it’s minimal or absent (strong = T1DM)

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3
Q

Microvascular complications are typically present upon diagnosis of T2DM. True/false?

A

True - around 20% of patients will have evidence of microvascular changes

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4
Q

List the risk factors for developing T2DM (8)

A

1) Obesity 2) Family history 3) Presence of gestational diabetes 4) Age 5) Ethnicity (Asian, African) 6) PMH of MI/stroke 7) Medications (e.g. antipsychotics) 8) Impaired glucose tolerance

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5
Q

Type 4 diabetes is associated with which condition?

A

Pregnancy (gestational diabetes)

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6
Q

True/false: Beta-cell failure occurs early in development of T2DM?

A

False - first insulin resistance, then beta cell hyperplasia, then failure.

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7
Q

Is there a direct correlation between BMI and T2DM development?

A

Yes - acceleration

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8
Q

T2DM is purely beta-cell related. True/false?

A

False - there are also genetic and environmental factors at play.

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9
Q

Microvascular complications are generally present at stage of T2DM diagnosis.

A

True (30% of cases)

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10
Q

What’s the HbA1c target for T2DM patients (<70)?

A

48-53mmol/L

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11
Q

What’s the HbA1c target for older diabetics (>70)?

A

53-75mmol/L

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12
Q

Close glycaemic control in T2DM can reduce macrovascular complications. True/false?

A

Unclear - limited evidence.

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13
Q

Diabetics should have what areas screened & how often?

A

Kidneys, eyes, feet. Annually.

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14
Q

What is the screening test for diabetic nephropathy?

A

Urinary albumin: creatinine ratio (dipstick)

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15
Q

Urinary screening of albumin: creatinine ratio should be taken on what type of urine sample?

A

Random (not a 1st pass)

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16
Q

Which other biochemistry should be checked when assessing urinary albumin: creatinine function?

A

U&E

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17
Q

What are the risk factors for progression of diabetic nephropathy (4)?

A

1) Hypertension 2) High cholesterol 3) Smoking 4) Poor glycaemic control

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18
Q

Which therapy should all patients with microalbuminuria be commenced on?

A

ACE inhibitor

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19
Q

Which eye conditions are diabetics more prone to developing? (3)

A

Diabetic retinopathy, cataracts, glaucoma (2x more common in diabetes)

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20
Q

Is blurry vision in diabetes always irreversible?

A

No, acute hyperglycaemia can cause blurred vision but is reversible.

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21
Q

What’s the most severe form of retinopathy?

A

Proliferative

22
Q

What treatments are available for diabetic retinopathy? (3)

A

Laser ablation, vitrectomy, anti-VEGF injection

23
Q

ED presents in which % of diabetic men?

A

50%

24
Q

This fundoscopy shows what abnormality?

A

Proliferative retinopathy (notice the new blood vessels forming)

25
Q

Is T2DM preventable?

A

Yes (in 90% of cases) - by diet and physical activity

26
Q

Good glycaemic control has been shown to reduce microvascular complications by which % at 10 years?

A

25% at 10 years

27
Q

True/false: T2DM is generally less milder than T1DM.

A

False - there is no mild form of DM. T2DM can be as severe as T1DM if uncontrolled.

28
Q

What’s the primary nutritional strategy for controlling T2DM?

A

Weight management

29
Q

Which % of T2DM are overweight?

A

80-90%

30
Q

In nutrition of T2DM, it’s more important to consider what sources of energy are in the diet over the total amount of energy in the diet. True/false?

A

False

31
Q

How many calories in a calorie-deficit diet can safely be prescribed?

A

600kcal

32
Q

What’s a reasonable expected weight-loss following consultation?

A

5-10%

33
Q

Sugars contribute more than other forms of carbohydrate in the development of DM. True/false?

A

False - no evidence for this.

34
Q
A
35
Q

How often should diabetics have eye screening?

A

Low risk: every 12 months

If retinopathy observable or maculopathy early: every 6 months

If any macula haemorrhage OR >4 retinal haemorrhage: urgent referal for opthalmology

36
Q

BP target in T2DM

A

<130/80mmHg

37
Q

Risk factors for progression of nephropathy in diabetes?

A

Smoking, poor glycaemic control, hypertension, high cholesterol.

38
Q

SGLT drugs act how

Example drug

A

Block glucose reabsorption in PCT.

Example: flozin drugs

39
Q

What are the insulin secretagogue drugs

A

SUR

GLP-1 agonists

DPP-IV inhibitors

40
Q

Example TZD

A

Pioglitazone

41
Q

Example DPP-IV

A

Gliptin

42
Q

Example GLP-1

A

Exenatide/ Liraglutide

43
Q

Side-effects of SUR drugs

A

Deranged LFTs, weight gain

44
Q

Side effects of SLGT2s inhibitors

A

Thrush, UTI

45
Q

Side effect of TZDs

A

Fracture risk, osteoporosis, heart failure, weight gain

46
Q

Side effect of metformin

A

Lactic acidosis, GI upset

47
Q

What are the weight-neutral or loss diabetes drugs

A

Metformin (loss), SGLT2 inhibitors (loss), GLP1, DPP-IV (loss)

48
Q

What are the weight-gaining diabetes drugs?

A

SURs (e.g. gliclazide), TZDs (e.g. pioglitazone)

49
Q

What is the average BMI the typical non-insulin dependent T2DM presents at?

A

28

50
Q

At BMI of 30, the risk of developing T2DM is increased how much

A

40-fold

51
Q

What is acarbose

A

Alpha-glucoside inhibitor (prevents absorption of glucose across lumen of GI tract)

Endocrine (17 decks)

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