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ENDOCRINE - HIGH WEIGHTED > ENDOCRINE - DIABETES MELLITUS > Flashcards

ENDOCRINE - DIABETES MELLITUS Flashcards

1
Q

What is type 1?

A
  • destroyed beta cells = insulin deficiency

- treat with insulin

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2
Q

What is type 2?

A
  • insulin reisistance

- treat with diet, oral antidiabetics or insulin

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3
Q

Symptoms of diabetes?

A
  • polyphagia
  • polydipsia
  • polyuria
  • weight loss
  • fatigue
  • blurred vision
  • poor wound healing
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4
Q

What are some long term macrovascular complications of diabetes?

A

CVD

  • T1D - always give statin as primary prevention
  • T2D - give statin if there is a 10-year q risk score > 10%
  • ACE may have a roll in preventing CVD
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5
Q

What are some long term microvascular complications?

A

Retinopathy

  • Eye test
  • Treat hypertension - prevents visual acuity

Neuropathy

  • diabetic foot - tingling, numbness, shooting pain, loss of sensitivity
  • strong opioids
  • duloxetine and tca’s (amitriptyline)
  • antiepileptics e.g. pregab and gaba

Nephropathy

  • Annual test for urinary protein
  • treat with ACE or ARB
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6
Q

Other than diabetic foot, what are some other complications of neuropathy?

A
  • autonomic neuropathy - erectile dys (sildenafil), diabetic diarrhoea (codeine or tetracycline), gastroparesis (erythromycin)
  • gustatory neuropathy - sweating face scalp head and neck - antimuscarinic (propenthaline bromide) or antiperspirant
  • neuropathic postural hypotension - fludrocortisone and increased salt intake
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7
Q

In what trimesters would a pregnant diabetic need to increase the amount of insulin?

A

2nd and 3rd

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8
Q

In pre existent diabetes, if a woman is planning a pregnancy what should she take to avoid deformities?

A

folic acid 5mg OD

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9
Q

Why should you reduce insulin immediately after birth?

A

increased risk of hypoglycaemia postnatal period

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10
Q

What should be the hba1c aim in pregnant women?

A

< 6.5%

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11
Q

In type 2 diabetes which drugs should be stopped in pregnancy?

A
  • all oral antidiabetic drugs except metformin - switch the others to insulin
  • in breast feeding also continue metformin
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12
Q

What is the treatment if FBG is <7mmol/L at diagnosis?

A
  • 1st line = diet and exercise

- 2nd line = metformin or insulin

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13
Q

what is the treatment if FBG is >7mmol/L at diagnosis?

A

1st line = insulin with or without metformin

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14
Q

What is the treatment for if FBG is 6-6.9mmol/L with hydraminiois (too much amniotic fluid)?

A

insulin without metformin

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15
Q

What would you give women that have a metformin intolerance and do not want insulin?

A

glibenclamide

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16
Q

What are risk factors for developing DKA?

A
  • Low beta cell function
  • alcohol abuse
  • surgery
  • sudden reduction in insulin
  • acute illness which can increase insulin requirement
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17
Q

What are the symptoms of DKA?

A
  • Severe high blood glucose and ketones
  • Pear drop breath
  • Polyuria
  • Excessive thirst
  • Abdominal pain
  • Anorexia
  • Difficulty breathing
  • Electrolyte imbalance
  • Confusion
  • Drowsiness
18
Q

What is the treatment for DKA?

A
  • IV infusion - soluble insulin, fluids (saline to rehydrate and increase circulating vol), potassium (correct hypokalaemia)
  • Continue established long acting insulin
  • Add glucose to infusion when <14 mol/L
  • Continue until pt able to eat and drink and blood ph >7.3
  • Give SC fast acting insulin
19
Q

When would you notify the DVLA?

A
  • If you’ve had 2 episodes of severe hypoglycaemia in the past 12 months
  • 1 episode if group 2
  • Impaired awareness
  • Disabling hypoglycaemia whilst driving
20
Q

How often does the DVLA say blood glucose needs to be monitored?

A

2 hours before and every 2 hours for long journeys

21
Q

Glucose levels should always be >5mmol when driving. What if it isn’t?

A

Take carbohydrate before driving

22
Q

What are the types of short acting insulin?

A

Soluble

  • given SC 15-20 mins before meals
  • diabetic emergencies and surgery
  • human soluble, beef/pork, bolus injection

Rapid-acting analogue

  • lower risk of hypos than soluble
  • take immediately before or after a meal
  • can be used as alternative to soluble in emergency
  • Lispro (humalog), Aspart (novorapid), Glulisline (Apridra), Bolus insulin
23
Q

Intermediate acting insulin:

A
  • Isophane
  • Never give IV - thrombosis
  • Basal insulin - take BD in conjunction with soluble insulin
24
Q

Long acting insulin:

A
  • Never give IV - thrombosis
  • Don’t mix with soluble insulin - binds in the syringe
  • Basal insulin - take OD at the same time each day to cover 24 hour period
  • Glargine (lantus), Determir (Levemir), Degludec (Tresiba), Protamine zinc
25
Q

When would you need to increase your insulin requirements?

A
  • infections of recurrent illness
  • 2nd and 3rd trimester of pregnancy
  • puberty
  • stress or accidental or surgical trauma
26
Q

When would you need to decrease your insulin requirements?

A
  • Coeliac disease

- Endocrine disorders e.g. addisons disease, hypopituitarism

27
Q

What does a multiple injection regimen consist of?

A
  • short/rapid acting insulin before meals + intermediate/long acting given OD or BD
  • good for acutely ill people or whos insulin regimen needs to keep changing
28
Q

What does a biphasic mixtures regimen consist of?

A
  • short/rapid acting insulin premixed with intermediate/long acting insulin given OD or BD before meals
29
Q

What does a long/intermediate acting regimen consist of?

A

OD or BD with or without short acing before meals

30
Q

Which regimen do type 1 diabetics requiring insulin start with?

A

multiple injection regimen

31
Q

Which regimen do type 2 diabetics requiring insulin start with?

A

start with isophane (intermediate) OD or BD + short acting (soluble) as a biphasic or multiple injection regimen

32
Q

Who is a continuous insulin pump recommended for?

A
  • people who suffer recurrent unpredictable hypoglycaemia when using injection regimens
  • patients whos glycaemic control is >8.5% despite optimised multiple injection regimen
  • children <12 where MIR is impractical - must have tried it when they turn 12
33
Q

What are the side effects of insulin?

A
  • hypoglycaemia - do not miss meals, make sure time and dose of insulin are correct
  • lipodystrophy (pain at injection site) - rotate injection site
  • local injection site reactions - check technique
34
Q

What interacts with insulin?

A

Enhanced hypoglycaemic effect of insulin by

  • ACE
  • BB (mask symptoms of it)
  • Alcohol

Antagonised hypoglycaemic effect of insulin by

  • corticosteroids
  • oral contraceptives
  • loop/thiazide diuretics
35
Q

What should diabetic patients do in times of illness (SICK)?

A

Sugar

  • check BG every 3-4 hours even at night
  • still monitor even if you feel better
  • no need to monitor in type 2 unless you’re on insulin

Insulin

  • never stop taking it

Carbohydrates

  • maintain meal pattern
  • aim for 3L of fluid a day to prevent dehydration
  • seek urgent help if: drowsy, cant keep fluid down, persistent vomiting

Ketones

  • check ketones every 3-4 hours even at night
  • if ketones are high immediately see GP
36
Q

What should patients taking antidiabetic medication do in times of illness?

A

Stop metformin if dehydrated due to increased risk of lactic acidosis

37
Q

What fridge temp should insulin be stored at?

A

2-8 degrees

38
Q

Within how many days must the insulin be used once opened?

A

28 days

39
Q

When should you discard insulin?

A
  • if frozen

- if left outside the fridge for >48 hours between 15-30 degrees

40
Q

What are the dose changes for insulin you need to be aware of?

A
  • beef to human = reduce dose by 10%

- pork to human = no dose change

41
Q

What would you do with insulin in a surgery scenario?

A
  • before surgery = usual insulin
  • day of surgery = IV glucose with potassium
  • once pt starts eating and drinking = SC before breakfast and stop IV 30 mins later

ENDOCRINE - HIGH WEIGHTED (7 decks)

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