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DONE CLINICAL > DIABESITY > Flashcards

DIABESITY Flashcards

1
Q

What is the equation for calculating BMI?

A

BMI = kg/m2

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2
Q

BMI is accurate for elderly populations, pregnant women and those with a high muscle mass. TRUE or FALSE

A

FALSE because muscle is heavier than fat so can give a misleading reading

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3
Q

A BMI of 25 is classed as what?

A

Overweight (25-29.9)

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4
Q

A BMI of 35 is classed as Obesity I, II or III?

A

Obesity II (35-39.9)

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5
Q

A BMI of what or over is classed as obese?

A

30+

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6
Q

To reduce risk of co-morbidities such as insulin resistance, a target waist circumference in men and women is what?

A

Below 88 women

Below 102 men

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7
Q

Orlistat can be given to those with a BMI of…

A

28kg/m2 + with risk

30kg/m2 + no risk

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8
Q

Orlistat therapy can only be continued beyond 3 months if lost at least ____% of initial body weight since stat of treatment

A

5%

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9
Q

What is the dose of Orlistat than can be purchased OTC if over 18 and criteria is met?

A

60mg capsule

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10
Q

Bariatric surgery can be considered in those with BMI of…

A

35 or more with co-morbidities (T2DM or High blood pressure)

40 or more

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11
Q

What are the 4 T’s of diabetes identification?

A

Tiredness, Thinner, Toilet, Thirst

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12
Q

Diagnosis = random venous plasma glucose conc of what?

A

> 11.1 mmol/l

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13
Q

Diagnosis = fasting venous plasma glucose conc of what?

A

> 7.0 mmol/l

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14
Q

Blood pressure targets in those with T2DM are…

A

below 130/80

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15
Q

What is first line treatment in Type 2 diabetes?

A

Oral Metformin (biguanide)

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16
Q

If Metformin contraindicated/not tolerated consider…

A
  • DPP-4 inhibitor
  • pioglitazone (thiazolidinedione)
  • sulphonylurea
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17
Q

If blood pressure not adequately controlled then introduce…

A

ACEI if tolerated/recommended

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18
Q

What should be calculated in those with Type 2 diabetes to check cardiovascular risk?

A

Q risk score - assess need for statin etc…

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19
Q

Trembling, sweating, tachycardia, faintness, loss of concentration, drowsiness and confusion are symptoms of…

A

Hypoglycaemia - risk associated with sulphonylureas

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20
Q

Sulfonylureas can cause weight gain TRUE or FALSE

A

TRUE - they can cause weight gain

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21
Q

Sulfonylureas should be used with caution in the elderly due to risk of what?

A

Hypos - they are frail and may have a low food intake

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22
Q

Sulfonylureas pose a risk of hypernatraemia due to effects on increasing renal sensitivity to ADH. TRUE OR FALSE

A

FALSE - Sulfonylureas pose a risk of hyPOnatraemia due to effects on increasing renal sensitivity to ADH.

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23
Q

Give an example of two Meglitinides and when their use is licensed…

A

Repaglinide and Nateglinide (comb therapy when metformin alone inadequate)

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24
Q

What is the main use for non adherence to alpha glycosides inhibitors and give an example of one.

A

Acarbose - flatulence

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25
Q

List two side effects of Thiazolidinediones (Pioglitazone)

When should you not use them?

A

Weight gain and oedema

  • DONT use in congestive heart failure
  • DONT use if hepatic function impairment
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26
Q

DPP-4 inhibitors are also knows as the…

A

Gliptins (Sitagliptin, Bildagliptin, Saxagliptin)

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27
Q

Name two Incretin Mimetics (GLP-1 agonists)

A

Liraglutide and exenatide

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28
Q

Incretin mimetics (GLP-1 agonists) can aid weight loss TRUE or FALSE

A

TRUE

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29
Q

Name the 4 different types of insulin

A

Short/Rapid acting
Intermediate (1st line)
Long acting analogues
Biphasic combinations

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30
Q

What is the lifespan of a RBC? THEREFORE over what time period do HbA1c (glycosylated haemoglobin) levels show us average diabetes control for?

A

2-3 months

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31
Q

What is the optimal HbA1c target (% and mmol/mol) for those with type 2 diabetes and not at risk of hypo?

A

6.5% (48mmol/mol)

32
Q

Q risk calculator calculates what?

A

Risk of having stroke over next 10 years

33
Q

What is the HbA1c target for those at risk of hypos?

A

7% (53mmol/mol)

34
Q

What should we be aware of that can possibly cause low HbA1c/hypos?

A

Deteriorating renal function

35
Q

Why is the dose of Metformin gradually increased over a period of several weeks rather than starting at the higher dose?

A
  • To reduce the risk of GI side effects
36
Q

What is the second line treatment of type 2 diabetes?

A
  • Metformin and…
  • DPP-4 Inhib (gliptin)
  • Pioglitazone
  • Sulfonylurea
  • SGLT-2 Inhib
37
Q

In adults with type 2 diabetes, review the dose of metformin if the estimated glomerular filtration rate (eGFR) is below __ ml/minute/1.73m2:
Stop metformin if the eGFR is below __ ml/minute/1.73m2.

A

1) 45 (3a) moderately reduced

2) 30 (3b) moderately reduced

38
Q

What type of insulin is NPH insulin?

A

Intermediate

39
Q

Name an SGLT-2i…

A
  • Canagliflozin
40
Q

List some implications of poor control of bloody glucose levels…

A
  • Microvascular damage e.g neuropathy, retinopathy, nephropathy
  • Hyperglycaemia
  • Hypoglycaemia
41
Q

List the common symptoms of hyperglycaemia (4)

A
  • Passing more urine than normal, especially at night
  • Being very thirsty
  • Headaches
  • Tiredness and lethargy.
42
Q

Oral anti-diabetic drugs should only be initiated if the patient has failed to respond to __ months restriction of energy and carb intake with increased exercise.

A

3 months

43
Q

NICE has recommended that treatment with pioglitazone and sita and vildagliptin is continued only if HbA1c concentration is reduced by at least 0.5 percentage points within _ months of starting treatment.

A

6

44
Q

What do you need to fill in a Q-RISK assessment form?

4 things…

A
  • Details about the person — age, sex, ethnicity, postcode, smoking status, and selected medical and family history.
  • Values of current blood pressure
  • Body mass index (BMI).
  • The total cholesterol/high-density lipoprotein (HDL)-cholesterol ratio from a non-fasting blood sample.
45
Q

What are the drinking guidelines for men and women?

A

MEN = 21 units per week (maximum of 4 units on any one day)

WOMEN = 14 units per week (maximum of 3 units on any one day)

46
Q

In what circumstance might it be appropriate to use waist circumference as a measurement instead of BMI?
- How do you take a waist measurement?

A
  • In an athlete

- Tape measure just above hip bone, measure circumference

47
Q

How does Orlistat work?

A
  • Inhibits breakdown of fat causing it to be excreted rather than digested
48
Q

What are some side effects of Orlistat?

A
  • Steatorrhea (fatty stools)

- Impaired abs of fat soluble vitamins

49
Q

Give two examples of GLP-1 agonists (incretins)…

- What is an advantage of these?

A
  • Liraglutide
  • Exenatide
  • Cause weight loss
50
Q

What plasma glucose level qualifies as a diagnosis for diabetes 2 hours after administration of 75g anhydrous glucose in an oral glucose tolerance test?

A

Greater than 11mmol/l (should be around 5)

51
Q

Which three drugs cause insulin secretion from pancreas?

A
  • Sulfonylureas (glicazide, glipazide)
  • Meglitinides
  • Incretins (GLP-1 agonists and DPP-4 antagonists)
52
Q

Which two drugs reduce hepatic glucose output (gluconeogenesis)?

A
  • Metformin

- Thiazolidinediones (pioglitazone)

53
Q

Which two drugs increase glucose uptake and utilisation?

A
  • Metformin

- Thiazolidinediones (pioglitazone)

54
Q

Which group of drugs reduce glucose reabsorption?

A
  • SGLT2 inhibitors (Canagiflozin, Dapagliflozin)
55
Q

Which drug controls appetite?

A
  • Incretin
56
Q

Can metformin be used in those with renal impairment?

A
  • Do not use in those with eGFR less than 60ml/min/1.72m2

- Because may cause lactic acidosis due to reduce uptake of lactate by liver

57
Q

What must be taken with a sulfonylurea?

Why?

A
  • Must take it with food to prevent hypoglycaemia
58
Q

If Metformin alone is not controlling blood sugar levels adequately then what should be done?

A

ADD…

  • DPP-4 inhibitor
  • Pioglitazone (Thiozoladinedione)
  • Sulfonylurea (Gliclazide, Glipizide)

TO METFORMIN

59
Q

What do DPP-4 inhibitors do?

A
  • Reduce breakdown of GLP-1 by DPP-4
  • Means more GLP-1
  • GLP-1 released after food, tells body full and causes insulin secretion from pancreas
  • GLP-1 reduces hepatic glucose output
60
Q

What is an advantage of DPP-4 inhibitors?

When are they used?

A
  • Weight neutral

USED if Metformin not tolerated or if treatment with Metformin alone is inadequate (Step up)

61
Q

If Metformin with…

  • Pioglitazone
  • Sulfonylurea
  • DPP-4 inhibitor

Is inadequate, what happens next?

A
  • Use…
  • metformin, a DPP‑4 inhibitor and a sulfonylurea
  • metformin, pioglitazone and a sulfonylurea

OR start insulin based therapy

62
Q

When can you use Metformin with a sulfonylurea and a GLP-1 analogue (incretin mimetic)?

A
  • BMI of 35 kg/m2 or higher
    AND
  • Specific psychological or other medical problems associated with obesity

-BMI lower than 35 kg/m2
AND
-insulin therapy would have significant occupational implications or
-weight loss would benefit other significant obesity‑related comorbidities.

63
Q

What are the conditions for continuing a GLP-1 analogue (incretin mimetic)?

A
  • Beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c
    AND
  • Weight loss of at least 3% of initial body weight in 6 months)
64
Q

What are the effects of insulin?

A
  • Promotes peripheral utilisation of glucose
  • Suppresses hepatic glucose production
  • Limits postprandial glucose elevation
65
Q

What is the first line recommendation for insulin therapy?

A
  • OD or BD NPH insulin e.g Humulin - intermediate
  • Keep on metformin unless contraindicated
  • Monitor for hypos
66
Q

A waist circumference of less than ___ is considered low risk for comorbidities in women

A waist circumference of less than ___ is considered low risk for comorbidities in men

A

80 women

94 men

67
Q

What are some risk factors for type 2 diabetes? (9)

A
  • Being overweight or obese (especially around the waistline)
  • Poor diet
  • Lack of physical activity
  • Family history of type 2 diabetes
  • Increasing age
  • Hypertension or cardiovascular disease
  • South Asian, African or African-Caribbean ethnicity
  • High socioeconomic deprivation
  • Impaired glucose regulation and/or raised HbA1c
68
Q

Each patient should receive the ___ healthcare essentials set out by the NHS.

A

15

69
Q

What are the 15 healthcare essentials?

A

1- HBA1c monitoring 2-3months unstable 6 months stable
2- Annual blood pressure monitoring
3- Annual retinopathy
4- Annual foot checks (doctor, podiatrist)
5- Weight monitoring
6- Annual kidney function tests (urine test protein, blood test)
7- Annual cholesterol monitoring
8- Input into own care
9- Opportunity to attend a Diabetes course
10- Smoking cessation support
11- Care from specialist paediatric team if young person
12- Specialist care if admitted to hosp
13- Specialist care if planning to have a baby
14- Care from specialist diabetes healthcare professionals
15- Psychological support

70
Q

How often should Adults exercise a week?

A
  • Aim to be active daily.

- Week = 2 1⁄2 hours of moderate intensity e.g 30 minutes on at least 5 days a week.

71
Q

What takes place at an NHS health check?

A
  • Questions
    e. g Alcohol, Smoking status, Family history, Exercise
  • Blood pressure taken
  • Height and weight to calc BMI
  • Cholesterol levels
  • If at risk of type 2 then blood sugar level test
72
Q

What is a disadvantage of Liraglutide (GLP-1 agonist)?

A
  • Administration by subcut injection
73
Q

Waist measurements can be useful in those with a BMI of under…

A

35kg/m2

74
Q

If you are an overweight women with a waist circumference of less than 80 are you at…
No increased risk
Increased risk
Significantly increased risk
Of health risks associated with being overweight?

A

No increased risk

75
Q

If you are an overweight man with a waist circumference of 94-102 are you at…
No increased risk
Increased risk
Significantly increased risk
Of health risks associated with being overweight?

A

Increased risk

76
Q

If you are an obese woman with a waist circumference of 80-88 are you at…
No increased risk
Increased risk
High risk
Very high risk
Of health risks associated with being overweight?

A

High risk

77
Q

When should you consider adding a biphasic insulin? (NPH and short acting)

A
  • If HbA1C is above 78mmol/L (9%)

DONE CLINICAL (10 decks)

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