U56 Flashcards
What is metabolic syndrome?
cluster of conditions that occur together increasing your risk of CVD related mortality and DM
what values of reduced HDL are a factor predisposing individuals to the metabolic syndrome?
males - (<40mg/dl) (1.03)
females - (<50) (1.23)
OR
treatment for this lipid abnormality
what values of increased TGs are a factor predisposing individuals to the metabolic syndrome?
> 150 (1.7) OR treatment for this lipid abnormality
which adipose tissue contains lots of mitochondria expressing UCP-1?
BAT
which adipose specialises in efficient long term storage of lipid?
WAT
which adipose tissue is responsible for non-shivering thermogenesis?
BAT
what level does adiponectin circulate in the plasma at?
2-10mcg/ml
which adipose-derived signalling molecule increases insulin sensitivity through inhibiting hepatic glucose production?
adiponectin
what can happen with chronic FFA levels?
FFA increases insulin secretion however chronic levels impair this response leading to T2 DM diminishing pancreatic insulin production
what has IL-6 been shown to increase?
lipolysis and leptin production leading to insulin resistance
does visceral or subcutaneous fat produce more IL-6?
visceral
what is resistin associated with?
insulin resistance - visceral fat produces 15 times more resistin than subcutaneous
what can TNF-a do at local level?
increase lipolysis, lipogenesis and secretion of leptin whilst impairing insulin signalling and secretion of adiponectin
how can visceral fat deliver signalling molecules to liver so quickly?
contains more macrophages which can quickly deliver WAT-derived signalling molecules to liver
what is the max theoretical weightloss in energy balance per week?
230g/MJ
what do low carb diets limit consumption to?
20g/day rising to 100g once target weight is reached
what does high protein suppress?
neuropeptide Y - keeping you stated longer
what is the diagnosis criteria for DM in respect to FPG?
> 7.0
what is the diagnosis criteria for DM in respect to random venous plasma glucose?
equal to or >11.1
why would you need to refer T1 DM to a dietician?
they need to link thier carb intake to thier insulin
when would you add metformin to a T1 diabetics regime?
add to insulin if the adults BMI > 25 or south asain >23 wants to improve blood glucose control while minimising effective insulin dose
how often should Hba1c be measured in children?
4 times a year
how often should Hba1c be measured in adults?
every 3-6 months
what is the target blood glucose after meals in adults and children?
5-9mmol/l
when is CSII recommended for adults and children over 12 with T1 DM?
when attempts to achieve target HbA1c with multiple daily injections result in the person experiencing severe hypoglycaemia
OR
HbA1c levels have remained high (69 or above) on MDI therapy despire high level of care
what is 1st line for managing T2 DM unless pt presents severe symptoms?
diet and lifestyle modifications for 3 months
when should you STOP metformin and give what instead?
if EGFR below 30 and give DPP-4, pioglitazone or sulfonylureas
when should you consider combination therapy with metformin + sulfonylureas + GLP-1 mimetic?
- BMI >35 and specific problem associated with obesity
- BMI <35 and who insulin therapy would have significant implications OR weight loss would benefit other obesity related co-morbidities
when would you consider self-monitoring in T2 DM?
DONT unless
- person is pregnant or planning to become preg
- person is on insulin (2nd intensification)
- evidence of hypoglycaemic episodes
- the person is on oral medication which may increase thier risk of hypo episodes while driving etc
intensive control of what condition reduces risk both micro and macrovascular complications?
HTN
what is first line treatment for BP control in someone planning to become pregnant?
CCB
consider statin treatment in all T1 diabetics but espcially in…
- over 40
- have DM for more than 10 years
- have establish diabetic nephropthy (main cause of CKD)
- have other CVD risk factors
when does retinopathy start in T1 DM?
starts after 10 or more years but in T2 DM it may present at diagnosis
what is target BP for pt with complications such as microalbuminuria?
130/80
initial treatment choice for peripheral neuropathy?
amitryptiline, duloxetine, gabapentin or pregabalin
what would you offer if initial treatment of peripheral neuropathy is not effective?
consider switching drugs or consider tramadol ONLY if acute rescue therapy is needed
when would you offer capsaicin cream for peripheral neuropathy?
when oral treatments arent tolerated or who wish to avoid oral treatments
what would you offer for gustatory sweating?
antimuscuranics - propantheline bromide
above what hba1c level should you avoid getting pregnant?
above 86mmol/l
what is the first choice for long acting insulin in pregnancy?
isophane insulin
how often should you check your blood glucose when driving?
every 2 hrs and if its less than 5 - eat some carbs before driving
what is one of the commonest causes of thyrotoxicosis?
graves disease - autoimmune condition
what test identify grave’s disease?
TRABs
what drugs can interfere with tests for hyperthyroidism?
LILAC
lithium, interferons, levodopa, amiodarone, corticosteroids
immediate treatment for thyrotoxicosis
offer non selective Bblockers to all non asthmatics, carbimazole (40mg OD) OR propylthiouracil (150mg BD)
what is the most common adverse effect of anti-thyroid treatment?
rash and arthropathy
what is the block and replacement method?
continue high dose carbimazole to suppress endogenous thyroid hormone production + give standard replacement dose of levothyroxine to maintain euthyroidism - results in steadier state and fewer hospital admissions
how would you treat thyroid crisis?
propylthiouracil orally and high dose of lugol’s iodine
propanolol - effective b blockade by IV infusion
glucocorticoids by IV
which anti-psychotics are most likely to cause drug induced diabetes?
clozapine and olanzapine - hyperglycaemia
which drugs induce hypoglycaemia?
insulin, meglinitides, sulfonylureas
what drug induced conditions can vinblastine cause?
gynaecomastia and syndrome of inappropriate ADH
what drug induced condition can carbenoxolone cause?
hyperaldosteronism
how is adiponectin and anti-atherosclerotic agent?
inhibits transformation of macrophages to foam cells (contain cholesterol - these can form a plaque that can lead to atherosclerosis)
risk factors for nephropathy in DM?
- smoking
- raised plasma lipids
- hypertension
- hyperglycaemia
mechanism of propylthiouracil?
inhibits peripheral deiodination of T4 to T3
what would a sore throat or mouth ulcers suggest in a patient on anti-thyroid drugs?
agranulocytosis - seek urgent FBC, and stop medication
treatment for thyrotoxicosis?
propylthiouracil and lugols iodine, IV glucocorticoids, IV propanolol
which anti-thyroid drug is preferred in pregnancy?
propylthiouracil
How does NICE recommend that health risks relating to overweight/obesity should be assessed?
BMI + waist circumference when your BMI is less than 35
