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- Y6 Endocrinology > T2DM (Y6) > Flashcards

T2DM (Y6) Flashcards

1
Q

What is the cause of blurred vision in diabetes mellitus?

A

Osmotic effects of glucose on the lens of the eye –> alter refraction and blur vision

Patient should NOT see optician until blood glucose normalised

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2
Q

What is the initial management of T2DM at diagnosis ?`

A

Advice on diet

Advice on physcial activity

Screening for diabetic complications

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3
Q

Why is metformin 1st line? What needs to be monitored on it?

A

Good glucose lowering efficacy and is weight neutral

Increase dose gradually to avoid adverse effects

If intolerable switch to modified release metformin

RENAL function must be monitored BEFORE and DURING use

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4
Q

Which T2DM treatments increase weight?

A

Pioglitazone (thiazolidinediones - increases sensitivity)

Gliclazide (sulfonylurea - stimulates beta cells)

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5
Q

When are patients at increased risk of lactic acidosis with metformin?

A

If they are in renal failure

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6
Q

Which T2DM drug has a side effect of fluid retention?

A

thiazolidinediones (glitazones) - can sometimes precipitate cardiac failure

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7
Q

What are the main SE of metformin?

A

nausea and diarrhoea

lactic acidosis (rare)

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8
Q

Which T2DM drug causes hypoglycaemia?

A

Sulfonylureas

Insulin

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9
Q

In addition to the previously mentioned therapies what else needs to be considered in T2DM?

A

Cardiovascular risk factors = consider HTN and lipid therapies

1st line HTN = ACEi e.g. ramipril

Irrespective of the lipid profile however, this patient requires lipid-lowering therapy as most authorities recommend starting statin therapy in all diabetic patients aged 84 years and younger with a QRISK2 score of 10% or more.

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10
Q

What do statins reduce?

A

LDL

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11
Q

Summarise the medications used for T2DM, their side effects and effects on weight and hypoglycaemia.

A
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12
Q

Summarise the algorithm for first line treatments in T2DM.

A
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13
Q

Summarise the treatment options in T2DM if further interventions are needed after first line therapy.

A
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14
Q

List the 4 complications of microvascular disease in diabetes.

A

Renal damage

Retinopathy

Neuropathy - autonomic and peripheral

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15
Q

How often do you get screening for complications in type 2 diabetes?

A

Eye screening - at diagnosis and every 2 years if low risk (no previous retinopathy) or annually if high risk (previous retinopathy)

Foot check - at diagnosis then annually

Diabetic kidney disease - annually

Cardiovascular risk - BP, full lipid profile, height weight BMI = annually

Peripheral and autonomic neuropathy - varies

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16
Q

What is shown?

A
  • Rubeosis iridis (formation of abnormal blood vessels on the anterior iris).
  • an ophthalmological emergency in diabetic retinopathy
17
Q

How often should patients check their own feet in diabetic foot problems?

A

Every day - including the skin and between the toes

Avoid tight shoes and socks

Change socks daily

18
Q

How is a diabetic foot check conducted?

A

Examine for:

  • Peripheral neuropathy — a 10 g monofilament should be used as part of a foot sensory examination, to assess for loss of protective sensation (LOPS).
  • PAD - palpate DP and PT; ABPI if indicated
  • Ulcers or pre-ulcerative signs -
  • Infection, inflammation
  • Deformity
  • Gangrene
  • Charcot arthropathy
  • Foot hygiene

Assess footwear and consider referral to podiatry

19
Q

How do you assess for diabetic kidney disease?

A

Early morning first void urine analysis = look for microalbuminuria (by estimating ACR)

Serum creatinine at the same time = for eGFR measurement

20
Q

Should you routinely give antiplatelet for prevention of CVD in diabetes type 2?

A

No

21
Q

How do you assess for CVD risk in diabetes?

A
  • Assess risk factors - smoking, blood glucose
  • BP
  • Albuminuria (CKD)
  • Lipid profile - aim for 40% reduction in LDL
  • Height, weight, BMI measurement
21
Q

How do you assess for peripheral and autonomic neuropathy in diabetes?

A
  • Sensory - ask for symptoms e.g. numbness, burning, shooting pains, paraesthesias in glove and stocking distribution
  • Motor - wasting, cramps, twitching

Autonomic:

  • Postural hypotension (30*mmHg drop on standing 1min and 3mins after lying down 5mins)
  • Diabetic gastroparesis - bloating, delayed emptying, nausea, vomiting
  • Lower GI - nocturnal diarrhoea, faecal incontinence
  • Urinary - hesitancy, reduced frequency, inadequate emptying, retention
  • Sexual dysfunction - ED or retrograde ejaculation
  • Sweating - reduced in glove and stocking distribution
  • Impaired awareness of hypoglycaemia

*other guidelines say 20mmHg but NICE says 30mmhg

- Y6 Endocrinology (33 decks)

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