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T2DM Flashcards

1
Q

How do you work out the osmolality?

A

Cations + anions + glucose + urea

However there’s too much anions so you just double the cations (sodium and potassium) then add glucose and urea

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2
Q

Normal osmolality

A

Na + K x 2 = 288
+ 4 + 4 for glucose and urea

296mil osmoles per kg

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3
Q

Why don’t they get acidosis?

A

They have enough insulin to suppress ketoacidosis

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4
Q

Why do over half the patients in the UK not know they have diabetes?

A

They think the polydipsia/polyuria is due to UTI/prostate trouble

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5
Q

What are the three microvascular complications?

A

Retinopathy
Nephropathy
Neuropathy

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6
Q

Features of macrovascular complications

A

Ischemic heart disease
Cerebrovascular disease
Peripheral gangrene

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7
Q

What are the features of background retinopathy?

A

Hard exudates
Microaneurysms
Blot haemorrhages

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8
Q

Why does the patient see fine despite background retinopathy?

A

Because the macula is preserved

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9
Q

Treatment for background retinopathy?

A

Improve BLOOD GLUCOSE CONTROL

not blood pressure (this is for nephropathy)

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10
Q

What are hard exudates?

A

cholesterol deposits

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11
Q

What is the difference between cotton wool spots and hard exudates?

A

Cotton wool spots actually look soft around the edge

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12
Q

What is the next stage of eye disease after background?

A

Pre-proliferative

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13
Q

What are the features of pre-proliferative

A

Cotton wool spots (the hard edges become round and soft)

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14
Q

Features of proliferative eye disease

A

Neovascularisation

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15
Q

What are cotton wool spots?

A

The products of ischaemia

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16
Q

Treatment of pre-proliferative

A

Pan retinal photocoagulation (around the periphery)

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17
Q

How long does it take to see the effect of proper diabetes control? What study published this data and when?

A

15 years

UKPDS, 1998

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18
Q

What happened 10 years after this study, in 2008? What is the name of the key effect?

A

The legacy effect - the benefits of having tight control for 20 years extends for nearly 10 years even after the cessation of randomised control!

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19
Q

DCCT

A

Type 1 diabetes

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20
Q

What did the Accord research show?

A

This study was done on older people with more than 6% HbA1c with vascular disease

They had

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21
Q

What happens if you suddenly tighten up control in older people with poor control?

A

It increases their chances of hypos and therefore daeath

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22
Q

What happens if you suddenly tighten up control in older people with poor control?

A

It increases their chances of hypos and therefore death

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23
Q

Name a sulphonylurea

A

Gliclazide

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24
Q

Name insulin sensitisers

A

Pioglitazones

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25
Which drug was banned after the Accord study?
Rosiglitazone
26
What do you add after insulin sensitisers?
Add insulin
27
What do you add after insulin?
Incretins e.g. GLP-1
28
What prevents breakdown of GLP-1?
DPP4 inhibitors
29
What is the problem with using natural soluble insulin sc?
It forms a hexamer under the skin (A and B chain form parallel links) and releases c-peptide Took a while to work so had to be injected 30 mins before meals
30
What did pharmaceutical companies do to reduce the time taken for the insulin to work?
Lispro - rapidly acting as they switched the lysine and proline Aspart - lysine removed? (proline and aspartate)
31
Give an example of long acting insulin
Glargine Arginine added to B chain
32
What is the point of giving background long acting insulin?
less risk of hypoglycemia
33
What is detemir?
Long chain insulin 14 carbon fatty acid chain attached to b29 delayed onset 7hr can be used as part of bolus
34
What is the advantage of insulin over other diabetic drugs?
Metformin Sulphonylurea - skin reactions? Thiazolidinediones - hepatic, osteoporosis (rare)
35
What are the disadvantages of insulin?
Can't work if you drive a HGV as hypoglycemia is common Weight gain (as it makes you more hungry)
36
What is GLP1?
Secreted from gut, stimulates pancreas to make insulin
37
What is another advantage of GLP1?
Reduces gastric emptying (feel more full)
38
What ending do DPP4 inhibitors have?
Gliptins (DPP4 inhibitors)
39
Give examples of GLP1 analogues
Exanatide | Liraglutide (Saxenda)
40
How do SGLT2 inhibitors work?
Block reabsorption of glucose so increases glucosuria
41
Main SE of SGLT2 inhibitors?
UTI | Thrush
42
Example of an SGLT2 inbhibitor?
Empagliflozin
43
Which study showed how beneficial SGLT2 inhibitors were?
EMPA-REG Outcome study
44
What is the effect of SGLT2 inhibitors on the kidneys
GFR is acutely changed, but then remains stable, and it maintains renal function Thus renoprotective
45
The risk of death increases if someone has
CKD plus diabetes
46
What histological features are seen on kidney biopsy?
Mesangial expansion BM thickening Glomerulosclerosis
47
What are the features of kidney disease
Increased proteinuria Increased BP Deranged kidney fucntion
48
Normal range for proteins in urine?
<30mg/24hrs
49
Microalbuminuria range
30-300mg/34hr
50
What is nephrotic syndrome?
More than 3g/24hrs
51
What are the four interventions for kidney contrl
Tight diabetic control BP control Inhibit RAS with ACEi/ARB Start smoking
52
When do you start treatment on
Once someone has micro albuminuria
53
Give an example of an ARB
Irbesartan
54
What is the effect of ACEi on creatinine within days of starting it?
The creatinine gets worse, but it gets better so keep going with it
55
ACEi should not be used in?
SHOULD NOT BE USED IN RENAL ARTERY STENOSIS
56
ACEi causes hyper or hypokalemia?
hyperkalemia
57
???
Less albuminuria | Less GFR
58
SE of metformin
Diarrhoea | Tummy ache
59
When do you try a second oral agent after metformin?
If the non-insulin monotherapy does not achieve the target HbA1C after 3 months
60
What is the second line for diabetes after metformin?
GLP-1 receptor agonist (e.g. liraglutide) or basal insulin
61
A network meta analysis shows that which drugs should you give if someone has atherosclerosis/vascular disease, AND diabetes?
Empagliflozin | Liraglutide
62
What are the glutides?
GLP-1 agonists (incretins, increase
63
SE of SGLT-2 inhibitors
Increased risk of genital skin reactions
64
If you need to minimise hypoglycaemia, what do you do?
DDP4?
65
Gliclazide should be given when
If the pt is overweight?

DPD (38 decks)

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