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year two - endocrine system > Diabetes Mellitus (Type One) > Flashcards

Diabetes Mellitus (Type One) Flashcards

1
Q

What is type one diabetes?

A

A chronic condition in which the pancreas is unable to produce insulin

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2
Q

Describe the pathophysiology of type one diabetes

A

The body’s immune system attacks the beta Islet of Langerhans cells of the pancreas via anti-GAD autoantibodies

This results in lymphocyte infiltration and scarring of the Beta Islet of Langerhans cells – decreasing their ability to synthesis insulin

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3
Q

What is the positive feedback mechanism of type one diabetes - which ultimately leads to further hyperglycaemia?

A

When there is no insulin being produced, the cells of the body are unable to uptake glucose from the blood and use it for as a source of fuel

Therefore, the cells of the body respond as though the body is fasting and there is no glucose supply

Specifically, blood glucose levels are raised via increased lipolysis in adipose tissue, raised glucose production in liver tissue and reduced glucose uptake in muscle tissue

This is therefore a positive feedback process, which further increases glucose levels and result in hyperglycaemia

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4
Q

Describe the pathophysiology of ketogenesis in type one diabetes

A

Diabetes is similar to starvation, in the sense that individuals experience a lack of access to nutrients.

In periods of starvation, ketone bodies are produced by the liver from fatty acids as a source of energy for the brain.

However, it’s important to note that ketone body uptake is dependent upon insulin.

Therefore, in poorly controlled insulin-dependent diabetes, ketone body uptake is suppressed.

This causes an accumulation of ketone bodies in the plasma and life-threatening ketoacidosis

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5
Q

What plasma pH is defined as ketoacidosis?

A

Plasma pH <7.1

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6
Q

What is the normal blood ketone level?

A

< 0.6mmol/L

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7
Q

What is the blood ketone level in DKA patients?

A

> 1.6mmol/L

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8
Q

What ABG result indicates DKA?

A

Metabolic acidosis with an increased anion gap

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9
Q

How does type one diabetes cause polyuria and polydipsia?

A

The hyperglycaemia overwhelms the kidneys and glucose starts being filtered into the urine

The glucose in the urine draws water out with it in a process called osmotic diuresis

This causes polyuria and polydipsia

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10
Q

How does type one diabetes result in potassium imbalances?

A

Insulin usually drives potassium into cells

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11
Q

In untreated type one diabetes what is the expected serum potassium level? Explain this

A

Increased

This is due to the fact that insulin levels are low, therefore potassium is unable to move into cells

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12
Q

In untreated type one diabetes what is the expected total potassium level? Explain this

A

Decreased

This is due to the fact that there is no potassium stored in cells

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13
Q

What happens to potassium levels when insulin treatment is commenced in type one diabetics? What can this lead to?

A

Severe hypokalaemia

Fatal arrhythmia

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14
Q

What are the most dangerous aspects of DKAs?

A

Dehydration

Potassium imbalance

Ketogenesis

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15
Q

What is the initial treatment of DKAs? Why?

A

Fluid resuscitation

This allows correction of dehydration, electrolyte disturbances and acidosis

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16
Q

What are the four risk factors associated with type one diabetes?

A

Young Age < 20 Years Old

Family History

Autoimmune Conditions

Viral Exposure

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17
Q

What two genes are associated with type one diabetes?

A

HLA DR3

HLA DR4

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18
Q

What are the three autoimmune diseases associated with type one diabetes?

A

Thyroid disease

Coeliac disease

Pernicious anaemia

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19
Q

What are the two viruses associated with type one diabetes?

A

Coxsackie B virus

Enterovirus

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20
Q

What are the nine clinical features of type one diabetes?

A

Polyuria

Polydipsia

Dehydration

Weight Loss

Abdominal Pain

Nausea & Vomiting

Fruity Ketones Breath

Kussmaul Breathing

Reduced Consciousness

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21
Q

What is polyuria?

A

It is defined as increased urinary frequency, > 3L per day

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22
Q

What is polydypsia?

A

It is defined as increased thirst

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23
Q

What is Kussmal breathing?

A

It is characterised by a deep, rapid breathing pattern

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24
Q

When does Kussmal breathing tend to present? Explain

A

DKAs

It is a physiological response to acidosis, in which the body expels carbon dioxide to reduce acidic levels

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25
Q

What are the eight investigations used to diagnose type one diabetes?

A

Glycated Haemoglobin (HbA1C) Test

Random Blood Glucose Test

Fasting Blood Glucose Test

Oral Glucose Tolerance Test (OGTT)

C-Peptide Blood Test

Antibody Blood Tests

Blood Ketone Test

Urine Test

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26
Q

What is the HbA1c test?

A

It measures the quantity of glucose bound to haemoglobin

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27
Q

What does a HbA1c test indicate? How?

A

It indicates an average glucose levels for the past two to three months

This is due to the fact that glucose permanently binds to haemoglobin, which last up to a period of three months

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28
Q

What HbA1c test result indicates type one diabetes?

A

> 6.5% (48mmol/mol)

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29
Q

In what nine circumstances can a HbA1c test not be used to diagnose type one diabetes?

A

Haemoglobinopathies

Haemolytic Anaemia

Untreated Iron Deficiency Anaemia

Children

Pregnant Patients

HIV Patients

Chronic Kidney Disease Patients

Corticosteroid Administration

Patients with A Short Duration of Diabetes Symptoms

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30
Q

When after pregnancy is a HbA1c test no longer contraindicated?

A

> 2 months

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31
Q

What four conditions/treatments can result in a falsely low HbA1c reading?

A

Sickle Cell Anaemia

GP6D Deficiency

Hereditary Spherocytosis

Haemodialysis

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32
Q

What five conditions/treatments can result in a falsely high HbA1c reading?

A

Splenectomy

Iron Deficiency Anaemia

Folic Acid Anaemia

Vitamin B12 Deficiency

Alcoholism

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33
Q

Why are HbA1c tests not deemed as useful for diagnosing type one diabetes?

A

This is due to the fact that is may not accurately reflect a recent rapid rise in serum glucose

Therefore, a HbA1c < 6.5% does not exclude a diagnosis

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34
Q

What is a random blood glucose test?

A

It involves taking a blood sample and a random time

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35
Q

What random blood glucose test result indicates type one diabetes?

A

> 200mg/dL (11.1mmol/L)

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36
Q

What is the diagnostic criteria for a random blood glucose test for type one diabetes?

A

An increased result should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic

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37
Q

What is a fasting blood glucose test?

A

It involves taking a blood sample after an individual has fasted overnight

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38
Q

What fasting blood glucose test result indicates type one diabetes?

A

> 126mg/dL (7mmol/L)

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39
Q

What is the diagnostic criteria for a fasting blood glucose test for type one diabetes?

A

An increased result should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic

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40
Q

What is an oral glucose tolerance test (OGTT)?

A

It involves taking a patient’s baseline fasting plasma glucose, giving them a 75g glucose drink and then measuring their plasma glucose two hours later

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41
Q

What OGTT result indicates type one diabetes?

A

2 hour plasma level > 11.1 mmol/L

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42
Q

What is the diagnostic criteria for an OGTT for type one diabetes?

A

An increased result should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic

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43
Q

What is c-peptide?

A

It is a by-product of insulin production

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44
Q

What does a c-peptide blood test measure?

A

The endogenous insulin level within the body

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45
Q

How is a c-peptide blood test used to diagnose type one diabetes?

A

It is the first line investigation used to differentiate between type one diabetes and other diabetes

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46
Q

What c-peptide level indicates type one diabetes?

A

Reduced

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47
Q

When is a c-peptide blood test is recommended in type one diabetes?

A

This investigation is only recommended in individuals who present with atypical features ( > 50 years old, BMI > 25, slow evolution of hyperglycaemia)

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48
Q

How are anitbody blood tests used to diagnose type one diabetes?

A

It is used to differentiate between a diagnosis of type one and type two diabetes mellitus

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49
Q

What are the four antibodies associated with type one diabetes?

A

Anti-Glutamic Acid Decarboxylase (GAD)

Islet Cell Antibody (ICA)

Insulin Autoantibody (IAA)

Insulinoma-Associated-2-Autoantibodies (IA-2A)

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50
Q

When are antibody blood tests recommended in type one diabetes?

A

This investigation is only recommended in individuals who present with atypical features ( > 50 years old, BMI > 25, slow evolution of hyperglycaemia)

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51
Q

What blood ketone level indicates type one diabetes?

A

> 3mmol/l

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52
Q

How is a urine test used to diagnose type one diabetes?

A

It is used to measure the patient’s pH levels and look for the presence of glucose and ketones

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53
Q

What urine pH level is used to diagnose type one diabetes?

A

< 7.3mmol/

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54
Q

What is the diagnostic criteria required to obtain a diagnosis of type one diabetes?

A

One clinical feature

AND

Hyperglycaemia evidence

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55
Q

What are the five DIAGNOSTIC clinical features of type one diabetes?

A

Ketosis

Rapid Weight Loss

Age < 50 Years Old

BMI < 25

Autoimmune Disease History

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56
Q

What are the three DIAGNOSTIC blood results of type one diabetes?

A

Fasting Glucose > 7 mmol/l

OR

Random Glucose > 11.1 mmol/l

OR

OGTT > 11.1 mmol/l

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57
Q

Where do we remove blood from when conducting a glucose test - artery or vein?

A

Vein

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58
Q

Does an unrecordable blood glucose indicate a ketoacidosis or hypogylcaemia?

A

Ketoacidosis

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59
Q

What are the seven management options of DKA’s?

A

FIG-PICK

Fluids

Insulin

Glucose

Potassium

Infection

Chart

Ketones

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60
Q

Which IV fluid solution is used to treat DKA? At what dose?

A

1L 0.9% sodium chloride over one hour

Then 4 litres with added potassium over the next 12 hours

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61
Q

What is a complication of fluid resuscitation in DKAs?

A

Cerebral oedema

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62
Q

What is the insulin step of DKA management?

A

IV insulin infusion

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63
Q

Which insulin infusion is used to treat DKA? What rate is this given at?

A

Fixed rate actrapid

0.1 unit/Kg/hour

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64
Q

How do we modify the patient’s typical insulin regime when insulin infusion is commenced?

A

Continue injectable long acting insulin only

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65
Q

What is the glucose step of DKA management?

A

It involves closely monitoring the patient’s blood glucose levels

If it falls below 14mmol/l we prescribe them a 10% dextrose infusion at 125mls/hr in addition to the current saline regime

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66
Q

What is the potassium step of DKA management?

A

We closely monitor the patient’s serum potassium levels every four hours and correct as required

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67
Q

What is the maximum rate that potassium should be infused at?

A

10mmol per hour

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68
Q

What is the infection step of DKA management?

A

We treat any underlying triggers, such as infections

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69
Q

What is the chart step of DKA management?

A

We monitor the patient’s fluid balance by plotting it upon a chart

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70
Q

What is the ketone step of DKA management?

A

We closely monitor the patient’s blood ketones levels

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71
Q

What is the management option of hypophosphataemia in DKAs?

A

We continue current insulin therapy and initiate parenteral phosphate replacement therapy

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72
Q

In cases where DKA’s don’t resolve with 24 hours of treatment, what is the next appropriate management step?

A

Endocrinology review

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73
Q

How do we conservatively treat type one diabetes?

A

It involves educating patients on their own condition

We encourage them to undergo lifestyle changes

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74
Q

Why is it important that we educate type one diabetes patients ?

A

It allows patients to effectively carbohydrate count, independently adjust their insulin dose and monitor complication signs

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75
Q

How do we educate type one diabetes patients ?

A

It is usually conducted via various measures, including specialist clinics, the STEP programme and support groups

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76
Q

What five lifestyle changes do we encourage type one diabetics to take?

A

Dietary modification

Regular exercise

Smoking cessation

Reduce alcohol intake

Driving advice

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77
Q

What dietary advice is recommended in type one diabetes?

A

To eat regular meals – which are high in fibre and low in starchy carbohydrates

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78
Q

What is the glycemic index?

A

A rating system for foods containing carbohydrates

It shows how quickly each food affects blood glucose levels when that food is eaten on its own

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79
Q

What is a high glycemic index?

A

A high glycaemic index suggests carbohydrates are broken down quickly during digestion and therefore release their glucose into blood quickly

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80
Q

What is a low glycemic index?

A

A low glycaemic index suggests carbohydrates are broken down slowly during digestion and therefore release their glucose into the blood gradually

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81
Q

Why is it important that diabetic patients are aware of what foods have a high and low glycemic index?

A

It alters how they administer their insulin

Specifically, they need to inject their insulin earlier before consuming meals with a high glycaemic index

82
Q

What is diabulimia?

A

A condition in which insulin-dependent diabetic patients skip their insulin doses in order to lose weight

83
Q

What are the two clinical features of diabulimia?

A

Poor glycaemic control

Recurrent DKA

84
Q

What are the two reasons why we encourage diabetic patients to regularly exercise?

A

It enables weight loss

It increases insulin sensitivity

85
Q

What three things should diabetic patients do before exercising?

A

Eat sufficiently

Check glucose levels

Reduce their glucose intake

86
Q

What type of exercise should diabetic patients conduct? Why?

A

A mixture of both aerobic and anaerobic exercises

This is due to the fact that aerobic exercises, such as running, decreases blood glucose levels and anaerobic exercises, such as weightlifting, increases blood insulin levels

Therefore, a mixture prevents the risk of hypos developing

87
Q

How long should patients wait after an hypo to exercise?

A

24 hours

88
Q

Why do advise type one diabetics to stop smoking?

A

Smoking increases the risk of ischaemic heart disease, which is a common complication of diabetes

89
Q

What alcohol advice to we give to type one diabetics?

A

They can consume the same quantity of alcohol as the general population

However, they are advised to not drink more than two to three units at one time due to the associated hypo risk

90
Q

Why does alcohol increase the risk of hypos?

A

It reduces glycogenolysis

91
Q

Do individuals need to inform the DVLA if they are on insulin?

A

Yes

92
Q

What are the three criteria type one diabetes require to obtain a group one licence?

A

Hypoglycaemic awareness

They must not have an episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months

They have no relevant visual impairments

93
Q

What are the five criteria type one diabetes require to obtain a group two licence?

A

They should not have a severe hypoglycaemic event in the previous 12 months

They should have full hypoglycaemic awareness

They should show adequate control by regular glucose monitoring

They should demonstrate an understanding of the hypoglycaemia risks

They should have no debarring complications of diabetes

94
Q

How long prior to driving should individuals check glucose levels?

A

2 hours

95
Q

How long should patients wait after a hypo to start driving?

A

45 minutes

96
Q

What is the first line pharmacological option of type one diabetes?

A

Insulin

97
Q

What are the two administration routes of insulin?

A

Subcutaneous injection

Insulin pumps

98
Q

Why can insulin not be prescribed as an oral tablet?

A

It is a polypeptide inactivated by the GI tract

99
Q

What are the three side effects of insulin?

A

Hypoglycaemia

Weight gain

Lipodystrophy

100
Q

When does short acting insulin start to work? How long for?

A

30mins

8hrs

101
Q

What are the three short acting insulins?

A

Humulin S

Actrapid

Insuman Rapid

102
Q

When does rapid acting insulin start to work? How long for?

A

10mins

4hrs

103
Q

What are the three rapid acting insulins?

A

Humalog

Novorapid

Apidra

104
Q

When does intermediate acting insulin start to work? How long for?

A

1hr

16hrs

105
Q

What are the three intermediate acting insulins?

A

Insulatard

Humulin I

Insuman Basal

106
Q

When does long acting insulin start to work? How long for?

A

1hr

24hrs

107
Q

What are the two long acting insulins?

A

Lantus

Levemir

108
Q

What are the three insulin regimens?

A

Twice daily

Three times daily

Four times daily

109
Q

What is a twice daily insulin regimen?

A

Rapid acting insulin mixed with intermediate acting insulin before breakfast (BB)

Rapid acting insulin mixed with intermediate acting insulin before evening meal (BT)

110
Q

What is a three times daily insulin regimen?

A

Rapid acting insulin mixed with intermediate acting insulin BB

Rapid acting insulin before BT

Intermediate acting insulin at bedtime (BBed)

111
Q

What is the gold standard insulin regimen?

A

Four times daily

112
Q

What is a four times daily insulin regimen?

A

A short acting insulin before each meal (BB, BL, BT)

An intermediate acting insulin BBed

113
Q

What insulin regimen is recommended in newly diagnosed type one diabetics?

A

Basal-bolus insulin regimen with twice daily insulin detemir

114
Q

What unit of insulin is required per 10g of carbohydrates?

A

1 unit

115
Q

How many mmol/l does one unit of insulin reduce glucose levels by?

A

3 mmol/l

116
Q

In which three regions do patients tend to inject insulin?

A

Abdomen

Thigh

Buttocks

117
Q

Why is it important that patients rotate injection sites?

A

This prevents the development of lipodystrophy

118
Q

What is lipodystrophy?

A

It occurs when the subcutaneous fat hardens, and patients don’t absorb insulin properly from further injections into this spot

119
Q

What is a sign of lipodystrophy?

A

A patient is not responding to insulin as expected

120
Q

What is factitious hypoglycaemia? What does it indicate?

A

It is defined as high insulin levels in the absence of elevated c-peptide levels

It indicates that individuals are injecting too much insulin

121
Q

What is insulinoma? What does it indicate?

A

It is defined as high insulin and c-peptide levels

It indicates an insulin secreting tumour

122
Q

What is the triad of insulinoma?

A

Whipple’s triad

  • Hypoglycaemia Features
  • Plasma Glucose < 2.5
  • Glucose Administration Reverses Features
123
Q

What investigation result indicates c-peptide?

A

The c-peptide levels do not fall on the administration of insulin

124
Q

What are the four sick day rules of insulin?

A

They should increase the frequency of blood glucose and ketone monitoring

In cases where individuals have elevated blood glucose and ketone levels, they should administer a corrective dose of insulin

They should encourage fluid intake aiming for at least 3L in 24 hours

In cases where they are struggling to eat, they should intake sugary drinks to maintain carbohydrate levels

They should never stop their insulin, even if they are struggling to eat

125
Q

How often should individuals monitor blood glucose and ketone levels when unwell?

A

Up to four hourly

126
Q

How can individuals work out the corrective dose of insulin - when unwell and high glucose/ketone levels?

A

The total daily insulin dose divided by 6 – with a maximum of 15 units

127
Q

Why should individuals never stop their insulin - even when ill?

A

To prevent a DKA

128
Q

What should all individuals treated with insulin recieve?

A

Glucagon Kit

129
Q

How should once-daily insulin doses be changed to on the day before and the day of surgery?

A

It should be reduced by 20%

130
Q

When is metformin recommended to treat type one diabetes?

A

BMI > 25

131
Q

What are the six monitoring investigations for type one diabetes?

A

HbA1c Test

Capillary Blood Glucose

Freestyle Libra

Digital Retinal Screening

Foot Screening

Urine Test

132
Q

How often do we conduct a HbA1c test in type one diabetics?

A

Every 3 to 6 months

133
Q

What is the target HbA1c level in type one diabetes?

A

< 6.5% (48 mmol/moll)

134
Q

How often should individuals conduct a capillary blood glucose?

A

At least four times a day, including before each meal and before bed

135
Q

In which six circumstances is it recommended that individuals increase capillary blood glucose monitoring?

A

Hypoglycaemic episodes

Illness

Before and after physical activity

When planning pregnancy

During pregnancy

Breastfeeding

136
Q

What is the target capillary blood glucose level in the morning?

A

5 - 7 mmol/l

137
Q

What is the target capillary blood glucose level before meals and other times of the day?

A

4 - 7 mmol/l

138
Q

What is a freestyle libra?

A

It is a sensor on the skin that measures the glucose level of interstitial fluid

In order to obtain blood glucose readings, the user needs to swipe over the sensor

139
Q

What is the advantage of a freestyle libra?

A

It records the glucose at short intervals, enabling patients to understand how their glucose levels fluctuate over time

140
Q

How often do freestyle Libra sensors need replacing?

A

Every two weeks

141
Q

How often should digital retinal screening be conducted in type one diabetics? What is an exception to this?

A

Annually

In pregnancy, this should be more frequent

142
Q

Why do we conduct digital retinal screening in type one diabetics?

A

To monitor the development of diabetic retinopathy

143
Q

How often should foot screening be conducted in type one diabetics?

A

15 months

144
Q

Why do we conduct foot screening in type one diabetics?

A

To monitor the development of diabetic foot complications

145
Q

How do we manage diabetic patients who develop foot problems, other than simple calluses?

A

A referral to the local diabetic foot clinic

146
Q

How often should a urine test be conducted in type one diabetics?

A

Annually

147
Q

Why do we conduct a urine test in type one diabetics?

A

To check for micrmicroalbuminuria and neuropathy development

148
Q

What urine test is used to monitor type one diabetes?

A

Albumin: creatinine ratio (ACR)

149
Q

What ACR urine test result indicates microalbuminuria development?

A

Increased ACR > 2.5

150
Q

What are the three short term complications of type one diabetes?

A

Hypoglycaemia

Hyperglycaemia

Potassium Imbalance

151
Q

What is hypoglycaemia?

A

It is defined as a low blood glucose level, specifically below 4mmol/L

152
Q

What are the five reasons for hypoglycaemia in type one diabetics?

A

Skipping a meal

Injecting too much insulin

Lipodystrophy

Physical activity

Alcohol intake

153
Q

What are the five clinical signs of hypoglycaemia?

A

Tremor

Sweating

Hunger

Dizziness

Blurred Vision

154
Q

What is the first line management option of hypoglycaemia in a community setting?

A

Oral glucose 10 - 20g should be given in liquid, gel or tablet form

OR

A quick acting carbohydrate may be given - glycogen or dextrogel

155
Q

What is the first line management option of hypoglycaemia in a hospital setting - when the patient is alert?

A

A quick acting carbohydrate may be given - glycogen or dextrogel

156
Q

What is the first line management option of hypoglycaemia in a hospital setting - when the patient is unconscious or unable to swallow?

A

SC or IM glucagon

157
Q

What is the second line management option of hypoglycaemia in a hospital setting - when the patient is unconscious or unable to swallow?

A

IV 20% glucose

158
Q

What are the four reasons for hyperglycaemia in type one diabetics?

A

Eating too much

Eating the wrong types of foods

Not injecting enough insulin

Illness

159
Q

How do we treat mild hyperglycaemia?

A

Patients can treat themselves by administrating an additional dose of insulin that should bring their glucose levels back to normal

Diabetic patients should be aware that it can take several hours to take effect and repeated doses could lead to hypoglycaemia

160
Q

What glucose level indicates DKA?

A

> 40mmol/l

161
Q

What are the five clinical features of DKA?

A

Nausea

Vomiting

Abdominal pain

Kaussmal breathing

Ketone breath

162
Q

What six blood test results indicate DKAs?

A

Decreased Na levels

Increased K levels

Increased urea levels

Increased creatinine levels

Increased glucose levels

Decreased bicarbonate levels

163
Q

What are the four macrovascular complications of type one diabetes?

A

Coronary Artery Disease

Peripheral Ischaemia

Stroke

Hypertension

164
Q

What is the first line antihypertensive used to manage hypertension in type one diabetes?

A

ACEI/ARBs - regardless of age

ARBS = black patients

CCBs = renovascular disease

165
Q

What is the blood pressure target in type one diabetics with hypertension?

A

< 135/85mmHg

166
Q

What is the blood pressure target in type one diabetics with hypertension - however they have developed albuminuria or 2 features of metabolic syndrome?

A

< 130/80mmHg

167
Q

How does type one diabetes result in macrovascular complications?

A

Diabetes accelerates the process of atherosclerosis

This is due to the fact that when glucose binds to LDL, it inhibits its ability to binds to liver cell receptors

This means that LDL continues to circulate within the bloodstream, resulting in hyperlipidaemia and thus atherosclerosis

168
Q

What are the three management options after developing macrovascualr complication development in type one diabetics?

A

We review the patient’s diabetic treatment

We can consider prescribing statins

We encourage patients to adopt healthier lifestyle choices, such as smoking cessation, diet modifications, etc

169
Q

What is the most common cause of death in diabetic patients?

A

MI

170
Q

What are the four microvascular complications of type one diabetes?

A

Diabetic Retinopathy

Diabetic Neuropathy

Gastrointestinal Autonomic Neuropathy

Diabetic Nephropathy

171
Q

What is diabetic retinopathy?

A

It is defined as damage to the blood vessels supplying the retina of the eye

172
Q

What are the four clinical features of diabetic retinopathy?

A

Retinal infarction

Exudate formation

Haemorrhage

Cataract formation

173
Q

What is diabetic neuropathy?

A

It is defined as nerve damage, which results in sensory loss to the bodies’ extremities – hands, feet and arms

174
Q

What are the three clinical features of diabetic neuropathy?

A

Paraesthesia

Burning Neuropathic Pain

Neuropathic Ulcers

175
Q

What is the characteristic feature of diabetic neuropathy?

A

‘Glove and stocking’ distribution’

176
Q

What is a glove and stocking’ distribution’?

A

It describes a distribution in which the lower legs are affected first

177
Q

What are the two main contributing factors of diabetic foot disease?

A

Peripheral Arterial Disease

Loss of Sensation

178
Q

What are the four pharmacological management options of diabetes neuropathy?

A

Amitriptyline

Duloxetine

Gabapentin

Pregabalin

179
Q

What is the second line management option of diabetic neuropathy?

A

We trial one of the other three pharmacological management options

180
Q

What is the management option of resistant diabetic neuropathy?

A

We can refer individuals to pain management clinics

181
Q

What is gastrointestinal autonomic neuropathy?

A

It is defined as nerve damage involving those that control autonomic body functions of the gastrointestinal system

182
Q

What are the three clinical features of gastrointestinal autonomic neuropathy?

A

Gastroparesis

Chronic diarrhoea

Gastro-oesophageal reflux disease

183
Q

What is gastroparesis?

A

It is defined as bloating and vomiting associated with erratic blood glucose control.

184
Q

What are the three pharmacological management options of gastrointestinal autonomic neuropathy?

A

Metoclopramide

Domperidone

Erythromycin

185
Q

What is diabetic nephropathy?

A

It is is defined as damage to the renal blood vessels

186
Q

What are the three complications of diabetic nephropathy, if untreated?

A

Microalbuminuria

End-stage renal disease

Renal failure

187
Q

What is a feature of diabetic retinopathy on US scan?

A

Enlarged Kidneys

188
Q

What are the four management options of diabetic nephropathy?

A

Dietary Protein Restriction

Glycaemic Control

ACE Inhibitor/Angiotensin-II Receptor Antagonist

Atorvastatin Administration

189
Q

How do microvascular complications develop in diabetic patients?

A

In arterioles and capillaries, there is a subendothelial space located between the endothelial cells and the basal lamina layers. This subendothelial space allows the movement of molecules into and out of the vessel lumen.

In diabetes, molecules are unable to move out of this subendothelial space. This results in a build-up of trapped molecules, which thickens the basal lamina layer and narrows the vessel lumen. Overtime, this lumen narrowing can result in ischemia – which tends to affect the nerve and arteries of the kidney, foot and eyes.

There are two reasons as to which molecules are unable to move out of the subendothelial space in diabetic patients…

Albumin is a protein which freely moves in and out of the subendothelial space. However, in diabetic patients, albumin binds to glycosylated collagen fibres in the outermost layer of the vessel – thus trapping it in the subendothelial space.

In normal circumstances, basal lamina proteins don’t cross link and can therefore be removed from the subendothelial space. However, in diabetes, the glycosylated proteins bind to their neighbouring proteins (cross link) and therefore cannot be easily removed.

190
Q

How is diabetes associated with the development of infections?

A

It causes suppression of the immune system

191
Q

What are the four infections associated with type one diabetics?

A

Urinary Tract Infections

Pneumonia

Fungal Infections

Skin & Soft Tissue Infections

192
Q

What fungal infection is associated with type one diabetes?

A

Candidiasis

193
Q

What skin and soft tissue infection is associated with type one diabetes?

A

Feet

194
Q

What organism is most commonly associated with diabetic foot infections?

A

Pseudomonas Aeruginosa

195
Q

What drugs induce type one diabetes?

A

Thiaziade diuretics

196
Q

What drug reduces hypoglycaemic awareness?

A

Beta-blockers

197
Q

What are the differences between type one and type two diabetes?

A

Type one = onset < 20, more acute onset, recent weight loss, DKA features, ketonuria common

Type two = onset > 40, onset slower, obesity strong risk factor, milder symptoms, ketonuria rare

198
Q

What are the two main contributing factors of diabetic foot disease?

A

Peripheral Arterial Disease

Loss of Sensation

199
Q

How should once-daily insulin doses be changed to on the day before and the day of surgery?

A

It should be reduced by 20%

200
Q

How should once-daily insulin doses be changed to on the day before and the day of surgery?

A

It should be reduced by 20%

year two - endocrine system (17 decks)

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