Week 23 - endocrine Flashcards
What is C peptide ?
a by-product of insulin synthesis
used to measure endogenous insulin production
What is C peptide used to measure ?
endogenous insulin production
because it is a by-product of insulin synthesis in pancreas
Where is ADH produced ?
posterior pituitary
Where is LH produced ?
anterior pituitary
Where is growth hormone (GH) produced ?
anterior pituitary
Where is prolactin produced ?
anterior pituitary
Where is adrenocorticotropic hormone (ACTH) produced ?
anterior pituitary
Which of these is not a function of glucagon …
a) gluconeogenesis ?
b) glycolysis ?
c) glycogenolysis ?
glucagon inhibits glycolysis
which conditions are associated with graves’ disease ?
- T1DM
- alopecia areata
- vitiligo
What can cause candidal balanitis
- diabetes
- oral antibiotics
- poor hygiene in uncircumcised males
- immunosuppression (inc. HIV infection)
What does candidal balanitis present like?
- swollen and tender glans penis
- thick white exudate/discharge under foreskin
- erythema under foreskin
what result of a random glucose test in a patient with polyuria would be diagnostic of diabetes ?
random blood glucose of 14 in a patient with polyuria
what result of a fasting glucose test in a patient with polyuria would be diagnostic of diabetes ?
a fasting glucose test of 7.2 in a patient with polyuria
what result of a random glucose test in a patient with no symptoms would be diagnostic of diabetes ?
a fasting glucose test of 12 in a patient with no symptoms, repeated found to be 11.5
what is the diagnostic criteria for diabetes regarding blood glucose testing ?
a blood glucose result of
- fasting 7+
- random 11.1+
in symptomatic patients
if asymptomatic then above criteria must be met on 2 separate occasions
what is the diagnostic criteria for diabetes regarding HbA1c testing ?
HbA1c of 48 or more in symptomatic patients
if asymptomatic then a second HbA1c is required and 2 consecutive tests of 48+ is diagnostic
what age range can you not use HbA1c as diagnostic criteria for diabetes ?
younger than 18
What are the hall mark symptoms of T2DM?
- tiredness
- polyuria/polydipsia
- recurrent infection e.g thrush
- unintentional weight loss
- blurred vision (retinopathy)
- foot ulcers/sores (neuropathy)
- acanthosis nigricans (dark skin in armpits/neck due to insulin resistance)
What are the symptoms of hyperglycaemia ?
- increased thirst (polydipsia)
- increased urine frequency/urgency
- weight loss
- tiredness
What is the main hyperglycaemic emergency seen in T1DM ?
DKA
What is the main hyperglycaemic emergency seen in T2DM ?
hyperosmolar hyperglycaemic state
What are there risk factors for developing T2DM ?
- Fx
- obesity (truncal distribution)
- poor diet (high in sugar and fat)
- inactivity
- age >45
- high lipid levels
- ethnicity (not caucasian)
- history of gestational diabetes
- PCOS (can cause insulin resistance)
what is checked at an annual diabetic review ?
- blood sugars
- HbA1c
- cholesterol
- blood pressure
- urine
- eye tests
- foot examination
- height and weight
When is medication considered in T2DM ?
if lifestyle measures aren’t helping HbA1c get lower than 48
(HbA1c checked every 3-6 months)
what is the scoring system called that scores a persons risk of cardiovascular disease ?
QRISK2
what is the most common side effect of metformin ?
gastro disturbance
what can be done to reduce a patients GI upset on metformin ?
- take with a meal
- swap to modified release tablets
what is the initial starting regime for metformin ?
500mg OD
titrated up to 1g BD if needed
When is insulin therapy considered in T2DM ?
when a combo of 3 meds aren’t reducing HbA1c below target range
What other types of medication should be considered in diabetic patients ?
- ACE inhibitors (antihypertensives)
- statins (if QRISK over 10%)
what is the BP target in diabetic patients ?
below 140/80
below 130/80 in patients with ‘end organ damage’
what is the diagnostic criteria for DKA ?
- BM >11 (or known diabetes)
- capillary ketones >3mmol/L (or urinary >2+)
- venous pH <7.3 or bicarb <15 (acidosis)
must have all 3 for diagnosis
What is the typical presentation of DKA ?
confusion, vomiting and abdo pin
what are signs of DKA ?
- abdo pain
- vomiting / diarrhoea
- confusion
- lethargy
- weight loss
- fruity smelling breath
- increased thirst/urinary frequency
- kussmal breathing (deep sighing respiration)
- dehydration
- features of shock
- visual disturbances
- inability to tolerate fluids
What is immediate treatment of DKA ?
- fixed rate insulin (0.1 units/kg/hr)
- fluid replacement
- correct electrolyte imbalances (K+)
is sliding scale insulin used in DKA ?
no ! fixed rate is treatment and sliding scales is for patients being kept nil by mouth, with poor control in hospital or going into surgery
which electrolyte is most important to monitor and control in DKA therapy ?
potassium
what happens to potassium when insulin is given ?
potassium drops as well as blood sugar
that’s why insulin/dextrose is a treatment for hyperkalaemia !
as a junior doctor, when would you involve a senior during DKA ?
from the start, always - every patient is different and DKA deteriorates quickly !
