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Year 3 > Case 5 - Diabetes > Flashcards

Case 5 - Diabetes Flashcards

1
Q

What are the typical symptoms of hyperglycaemia?

A

Polyuria
Thirst
Weight loss
Tiredness

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2
Q

What is the minimum random blood glucose level that is sufficient to make a diagnosis of diabetes mellitus?

A

> 13mmol/l

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3
Q

What are the normal levels for HbA1c and what is it to diagnose diabetes?

A

Normal < 42mmol/mol
Pre diabetes 42-47mmol/mol
Diabetes >48mmol/mol

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4
Q

What is the minimum glucose level after a fasting glucose test to diagnose diabetes mellitus?

A

> 7.0mmol/L

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5
Q

What are the 9 main tests at an annual diabetes check?

A 
Weight 
Blood pressure
Smoking status 
HbA1c - aim for less than 6.5%
Urinary albumin 
Serum creatinine 
Cholesterol
Eye exam
Foot exam
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6
Q

What level of glucose indicates hypoglycaemia?

A

<3mmol/L (or 4mmol/L ‘four is the floor)

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7
Q

What are the common symptoms of hypoglycaemia?

A 
Sweating
Anxiety 
Hunger
Tremor
Palpitations 
Dizziness
Confusion 
Drowsiness
Visual disturbance 
Seizures
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8
Q

What is the drug therapy guidelines for type II diabetes?

A 
1st line - metformin
2nd line (HbA1c >58mmol/mol) - metformin + 2nd drug 
3rd line (HbA1c >58mmol/mol) - metformin + 2nd drug + 3rd drug
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9
Q

What is the main side effects of metformin?

A

Gastrointestinal upset

Lactic acidosis

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10
Q

How does treatment of diabetes differ in pregnant women?

A

Women can be treated with metformin alone, or in combination with insulin

Both gliclazide and liraglutide are contraindicated in pregnancy

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11
Q

How can C-peptide be used to differentiate between type I and type II diabetes?

A

C-peptide will be low in type I diabetes (as the pancreas is not making enough insulin precursor which breaks down to form insulin and C-peptide)

C-peptide is normal or high in type II diabetes

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12
Q

How often should a person with type I diabetes monitor their blood glucose each day?

A

At least 4 times a day, including before each meal and before bed

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13
Q

What are the type I diabetes daily blood glucose targets?

A

5-7mmol/l on waking

4-7 mmol/l before meals at other times of the day

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14
Q

Name the most common sulfonylurea drug

What is the most common side effect?

A

Glicazide

Hypoglycaemia

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15
Q

Name the most common TZD (thiazolidinediones) drug used in diabetes?

A

Pioglitazone

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16
Q

Name the most common DDP-4 inhibitor used in diabetes?

A

Sitagliptin

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17
Q

What are the major side effects of glitazones?

A

Worsening of heart failure due to fluid retention
Increased risk of fractures
Liver dysfunction
Weight gain

18
Q

What is the difference between nephrogenic diabetes insipidus and cranial diabetes insipidus?

How do the treatments differ?

A

Cranial diabetes insipidus is where the pituitary gland is unable to produce sufficient amounts of vasopression (ADH) - Treat with desmopressin

Nephrogenic diabetes is caused by the kidneys inability to respond to vasopressin - treat with thiazide diuretic (chlorothiazide)

19
Q

What drugs can cause nephrogenic diabetes insipidus?

A

Demeclocycline (tetracycline antibiotic)

Lithium

20
Q

What should the target blood pressure be for patients with diabetes with and without end organ damage

A

With end organ damage: 130/80

No end organ damage: 140/80

21
Q

What are the major side effects of sulfonylureas?

A

Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)

22
Q

At what threshold of HbA1C should you consider adding a 2nd drug to metformin for type II diabetes?

A

58mmol/mol

23
Q

What is the first line treatment for hypertension in patients with diabetes?

A

Ramipril (regardless of age)

24
Q

What is the immediate treatment for a patient with diabetic ketoacdosis

A

Intravenous insulin

Intravenous fluids enriched with potassium

25
Q

Why do you use VBGs instead of ABGs to monitor acutely unwell patients

A

Less painful
If you don’t need to know about O2 and CO2 levels
Information about pH and bicarbonate are very similar
VBGs provide information about potassium and glucose

26
Q

What are the ‘sick-day rules’ for a patient with diabetes mellitus?

A

Increase frequency of BM monitoring to 4 hourly
Aim to drink 3L of fluid in 24 hours
If not eating, drink sugary drinks to maintain carbohydrate intake

27
Q

Which hormones oppose the action of insulin?

A

Glucagon
Cortisol
Noradrenaline

28
Q

How would you differentiate if a patient had type I or type II diabetes?

A

Age
Family History
Urine Test - ketones could be raised in type I diabetes
Anti GAD antibodies - present in type I diabetes

29
Q

What is the differential diagnosis for polyuria?

A

UTI
Diabetes mellitus
Diabetes insipidus
Hypercalcemia

30
Q

What is balantis?

A

A fungal infection of the penis

Hyperglycaemia is a risk factor

31
Q

What are the complications of uncontrolled diabetes?

A

Diabetic retinopathy
Diabetic neuropathy
Vascular disease - peripheral vascular disease
Diabetic nephropathy

32
Q

What is diabetic ketoacidosis (DKA)?

A

Where a patient has hyperglycaemia + ketosis + metabolic acidosis

Characterised by severe insulin deficiency, and also stresses that act to secrete glucagon, catecholamines and cortisol which act to increase blood glucose

33
Q

What are the different insulin regimes for type I diabetics?

A

BD biphasic regimen - twice daily premixed insulins by pen, useful for patients with regular lifestyles

QDS regimen - before meals ultra fast insulin + bedtime long acting analogue. Useful for patients for flexible lifestyle (e.g adjust dose for meal sizes or exercise)

34
Q

What is the DAFNE principles for diabetes?

A

Dose adjustment for normal eating

This is to help diabetics live the most normal life possible. They can adjust their insulin dosages before meals.

35
Q

What is non diabetic hyperglycaemia?

A

Where there is a higher level of glucose but not at diabetic levels
There is some impaired glucose tolerance
Higher risk of progression to T2DM (5-10% progress each year)
This increases the risk of macrovascular disease
It can occur in pregnancy - gestational diabetes

36
Q

What are the main risk factors for diabetes?

A 
Weight - visceral obesity having a bigger effect 
Physical activity
Diet 
Smoking 
Poor blood pressure 
Black and South Asian more at risk
37
Q

What is hyperosmolar hyperglycaemic state (HHS)?

A

A complication of type II diabetes where high glucose levels results in high osmolarity without significant ketoacidosis

Symptoms include: dehydration, weakness, leg cramps, uriantion, thirst, nausea, dry skin

38
Q

What are the different insulin types?

A 
Quick acting (Subcutaneous injection, IV infusion)
Slow acting (subcutaneous injection only)
Biphasic - mix of both in a ratio 25/75 or 30/70
39
Q

How is severe hypoglycaemia treated?

A

If patient can cooperate - encourage lucozade or equivalent
Unable to cooperate but conscious - glucose gel (glucogel)
If patient is in coma stage/fitting - IV/IM glucagon

40
Q

What are the adverse effects of SGLT2 inhibitors?

A

Genital infections

Diabetic ketoacidosis

41
Q

Which diabetic drug class are associated with an increase risk of bladder cancer?

A

Thiazolidinediones

In particular pioglitazone

42
Q

What are the adverse effects of GLP-1 mimetics?

A

Nausea
Vomiting
Pancreatitis

Year 3 (24 decks)

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