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Diabetes Flashcards

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1
Q

What is Diabetes Insipidus?

A

Reduced ADH secretion/kidney response to ADH causes passage of large volumes of dilute urine

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2
Q

Give 3 symptoms of Diabetes Insipidus

A

Polyuria
Polydipsia
Dehydration

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3
Q

Give 3 causes of Cranial DI

A

Congenital (ADH genetic defects)
Tumour
Trauma

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4
Q

GIve 3 causes of Nephrogenic DI

A

Inherited
Chronic Renal Disease
Drugs (Lithium, Demeclocycline)

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5
Q

What 4 investigations could you do if you suspected DI?

A

Us and Es
Glucose (rule out DM)
Urine Osmolality (rule out primary polydipsia)
8hr Deprivation Test

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6
Q

How would you treat Cranial DI?

A

Desmopressin

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7
Q

How would you treat Nephrogenic DI?

A

Treat underlying causes
NSAIDs (Prostaglandins locally inhibit ADH)
Bendroflumethiazide (inducing hypovolaemia may kickstart RAAS)

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8
Q

Describe the pathophysiology of Type 1 DM

A

Onset in childhood
Autoimmune destruction of pancreatic B cells
HLA association

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9
Q

Describe the pathophysiology of Type 2 DM

A

Decreased insulin secretion/increased insulin resistance
Associated with obesity/sedentary lifestyle
No HLA association
There is an autosomal dominant form affecting young people

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10
Q

Give 4 other causes of DM

A

Steroids
Pancreatitis
Cushings Disease
Glycogen Storage Disease

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11
Q

What is the triad of DM symptoms

A

Polyuria
Polydipsia
Weight Loss

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12
Q

What are the parameters for diagnosing DM in terms of Venous Glucose?

A

Fasting >7mmol/l

Random >11.1mmol/l

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13
Q

What is the parameter for diagnosing DM using the OGTT?

A

> 11.1mmol/l

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14
Q

What is the parameter for diagnosing DM using HbA1c?

A

> 48mmol/l

>6.5%

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15
Q

What are the parameters for ‘Pre-Diabetes’?

A

Fasting glucose of 5.5-6.9mmol/l

HbA1c of 42-47mmol/l (6-6.4%)

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16
Q

What is required for a Diabetes diagnosis?

A

Either
Symptoms and ONE positive blood result
Or
Positive bloods on two separate occasions

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17
Q

What advice would you give patients who are diagnosed with Type 1 DM? Give 4 points.

A

Review and research diet
Try to limit other things contributing to CVS risk
Ensure foot care
Avoid binge drinking (delayed hypoglycaemia)

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18
Q

Name one ultrafast, one medium and one long acting insulin

A

Ultrafast - Novorapid
Medium - Isophane Insulin
Long - Insulin Glargine

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19
Q

Name a premixed insulin

A

Novomix (30% short, 70%long)

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20
Q

Describe 2 different regimens to manage T1DM

A

BD - Twice Novomix daily

QDS - Ultrafast at meals, long acting at night (more flexible)

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21
Q

What could you give patients if they struggle with the insulin regime?

A

Insulin Pump

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22
Q

Give three important pieces of advice for T1DM regarding insulin

A

Vary injection site
Change needles
Continue insulin if ill (and replace lost calories with milk)

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23
Q

Describe the 4 step (up) therapy for T2DM

A

1) Lifestyle and Diet
2) Metformin
3) Dual Therapy (Metformin + another)
4) Triple Therapy or Insulin Therapy

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24
Q

What is Metformin’s action?

A

Biguanide that increases insulin sensitivity

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25
Give 3 SE of Metformin
Nausea, Abdo Pain, Lactic Acidosis (in renal impairment)
26
Name a DPP4 Inhibitor. What is it's action?
Sitagliptin | DPP4 destroys incretins which enhance insulin release
27
Name a Glitazone. What is it's action?
Pioglitazone | Increases insulin sensitivity
28
When are Glitazones contraindicated? What are their side effects?
CI - Osteoporosis, CCF | SE - Hypoglycaemia, Fractures
29
Name a Sulphonylurea? What is it's action?
Gliclazide | Increases insulin secretion by binding to ATP sensitive potassium channels, closing them
30
Name an SGLT2 inhibitor. What is it's action?
Dapaglifozin | Blocks glucose reabsorption in the PCT
31
Name a GLP1 analogue. What is it's action?
Exenatide | Incretin mimics
32
Name four complications of Diabetes
Vascular disease Nephropathy Retinopathy Neuropathy
33
Give two eye diseases associated with Diabetes
Diabetic Retinopathy | Cataracts
34
Describe the pathophysiology of Diabetic Retinopathy
Microvascular occlusion causes retinal ischaemia | Leads to AV shunts, Neovascularisation and Oedema
35
Describe 3 characteristic features of Diabetic Retinopathy
Microaneurysms - physical weakening of vascular walls Haemorrhages - when weakened vessels rupture, can be small or large (AKA Flame - track along nerve-fibre bundles in superficial retinal layers) Cotton Wool Spots - Build up of axonal debris
36
How would Diabetic Retinopathy present?
Often gradual painless visual deterioration | If haemorrhages - sudden onset of dark, painless floaters which may resolve over several days.
37
Most Diabetic Retinopathies are not treated, however if they are, give 2 treatment options
Laser Treatment - aim is to induce regression of new blood vessels and reduce central macular thickening Intravitreal Steroids
38
Give 4 possible features of foot neuropathy
Reduced sensation in stocking distribution Absent ankle jerks Charcot Joint Claw Toes
39
How would a diabetic ulcer present?
Punched out ulcer in area of thick callus
40
Describe 3 non surgical managements of 'Diabetic Foot'
Regular Chiropody Bisphophonates Antibiotics
41
Hypoglycaemia is classified as <3mmol/l glucose. Majority of times it's a diabetic cause, but using the mnemonic EXPLAIN, state 7 non diabetic causes.
``` Exogenous Drugs (ACEI, B Blockers) Pituitary Insufficiency Liver Failure Addisons Insulinoma Non pancreatic Neoplasms ```
42
Give 3 autonomic and 3 neuroglycopenic symptoms of Hypoglycaemia.
Autonomic - Sweating, Anxiety, Hunger | Neuroglycopenic - Confusion, Drowsiness, Coma
43
What is Whipple's Triad?
Symptoms + Hypoglycaemia + Resolution as plasma glucose rises
44
Describe the pathophyiology of DKA
Without insulin to drive glucose into the cells, the body is forced into starvation state, using ketones for energy and causing acidosis
45
Name three triggers of DKA
Infection Non Compliance Chemo
46
Name 5 symptoms of DKA
``` Drowsiness Vomiting Dehydration Abdo Pain Polydipsia ```
47
Describe 3 diagnostic classifications of DKA
VBG pH<7.3 Glucose>11.1mmol/l Ketonaemia (>3mmol/l) or Ketonuria
48
Describe a four step management plan of DKA
1) IV insulin (without stopping normal regime) 2) IV fluid bolus 3) Add K+ to second bag of fluid 4) Catheterise?
49
Give 3 complications of DKA
Cerebral Oedema Hypokalaemia Aspirational Pneumonia
50
What is a Hyperosmolar Hyperglycaemic State?
Seen in unwell patients with T2DM Hx of a weeks dehydration with glucose>30mmol/l NO KETONE METABOLISM
51
How would you manage Hyperglycaemic Hyperosmolar State?
Rehydrate slowly Replace K+ when urine starts to flow Only use insulin if glucose isn't reducing
52
Describe the different between Dry and Wet Gangrene
Dry Gangrene - Black 'mummified' toes that often autoamputate Wet Gangrene - indicates infection
53
Describe four features indicating Necrotising Fasciitis from Diabetic Foot
Spreading Cellulitis Black Spots Dishwater Fluid Appearance Crepitus (tissue paper sound when pressing - gas gangrene)
54
Describe two features you are looking for on an X-Ray of a diabetic foot
Osteomyelitis | Gas Gangrene
55
Why is ABPI generally done on right arm?
Steal Syndrome is more common on the left | You generally stand to the right of the patient
56
Explain the ABPI value indicating Diabetic Foot
>1.2 Due to calcification of the peripheral arteries increasing the pressure (NOT because they have superior blood flow to PAD)
57
Describe the Doppler Sounds of vessels
Monophasic Biphasic Triphasic Monophasic is diseased, and triphasic is healthy (you can hear the elastic recoil in competent vessels)
58
Using the mnemonic SWOMPD, how would you manage a diabetic foot?
``` Sepsis Wound Management Offloading (Orthotics) Mechanical (Orthopaedics input) Perfusion (Lifestyle, Meds, Surgical) Diabetic Control ```
59
What antimicrobials would you use for MILD Diabetic Foot?
Flucloxacillin
60
What antimicrobials would you use for MODERATE Diabetic Foot?
Flucloxacillin, Ciprofloxacin and Metronidazole
61
What antimicrobials would you use for SEVERE Diabetic Foot?
Piperacillin, Tazobactam and Vancomycin

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