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Diabetes Flashcards

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1
Q

What symptoms would make you consider nocturnal hypoglycemia?

A
  • high blood glucose levels (reboud hypoglycemia

- headache (feeling hangover with no alcohol)

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2
Q

How do you confirm diagnosis of nocturnal hypoglycemia?

A

testing glucose at 3am
or
continuous glucose moniotirng sensor whic monitors glucose over 5 days subcutaneously.

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3
Q

Management of nocturnal hypoglycemia?

A
  • analogue insulins
    prebed snack
    change timing of insulin
    insulin pump therapy
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4
Q

level of RPG hyperglycemia in DKA?

A

14 mmol/L

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5
Q

bicarbonate value in DKA

A

<15 mmol

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6
Q

pH value in DKA

A

<7.3

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7
Q

what are the three things you need to measure to confirm DKA

A
  • pH (acidotic)
  • low bicarbonate
  • high plasma glucose
  • ketones in serum or urine
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8
Q

In DKA, what physiological change leads to trygliceride breakdwon to free FA and gycerol?

A

unopposed catecholamine excess

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9
Q

DKA clinical features

A

kussmaul breathing (deep sighting inspiration due to acidosis)
ketones on breath
drowisness
dehydration adn tachy

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10
Q

precipitating factors of DKA

A
  • insulin omission
  • pregnancy
  • infection
  • MI
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11
Q

Diagnosis of DKA

A

venous blood gas shows acidosis
capillary blood glucose over 14UNLESS euglycemic ketosis or alcoholic ketosis
raised urea and creatining
raised urine or plasma ketone

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12
Q

what things define a SEVERE DKA

A 
Blood ketones > 6 mmol/L  
Bicarbonate < 5 mmol/L  
pH < 7.1 
 Potassium < 3.5 mmol/L 
 GCS <12 
 O2 sats < 92% 
 Systolic BP < 90 mmHg 
 Pulse >100 or < 60 bpm
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13
Q

do people in severe DKA need thromboprophylactic?

A

Yes. give them LMWH

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14
Q

Fluid therapy in DKA?

A

1- start wtih 0.9% naCl
2- 1 L potassium chloride- if patient K is above 5.5, do NOT give more potassium
3. when CBG is less than 12, give 5% glucose at 125 mL/hr
4. Insulin infusion by intravenous syringe (50 units Actrapid up to 50mL in NaCL 0.9%) - FIXED RATE IV insulin infusion (0.1 u /kg – around 6-8 u / hr for most patients)
5. aim for bicarb rise of 3 mmol/hr and glucose fall bu 3 mmol/hr
if not achieved you increase by 1unit per hour

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15
Q

when do you convert to subcutaneous insulin?

A

once eating and drinking reliably?

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16
Q

what is the commonest cause of death from DKA in children? how do you treat it

A

cerebral edema

Treated with dexamethasone or mannitol

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17
Q

with what type of diabetes doy ou get hyperosmolar hyperglycemia syndrome

A

type 2

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18
Q

what glycemia level is diagnostic of HHS

A

over 40

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19
Q

what osmolality level is diagnostic of HHS

A

over 340

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20
Q

how can you estimate osmolality in patient with HHS

A

2x[Na+K]+Ur+Glu

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21
Q

in HSS are patients hyper or hyponatremic

A

hypernatremic

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22
Q

HHS treatment

A

IV as for DKA
no insulin bolus to start
correct BG at maximum of 2 mmol/L/hr
give LMWH

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23
Q

does HSS require thromboprophylaxis

A

yes give LMWH

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24
Q

why should a rapid shift of glucose be avoided in HSS

A

can cause central pontine myelinolysis.

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25
what should a sick pateint do if they are on insulin
- drink lots of fluid - if they dont eat, drink - DO NOT stop insulin - if unable to keep fluids down, come to hospital
26
how often should patients with diabetes be reviewed=
twice a year.
27
BP aim in patients with diabetes
Aim for 140/80 mmHg (130/80 mmHg if CVD or Renal d)
28
BP drugs for diabetes
First line –ACEI, calcium channel blockers (often need >2 BP treatments)
29
should all diabetic patients get statins?
Diabetic > 40 years, or diabetic < 40years + 1 risk factor = statin
30
cholesterol and LDL aim in diabetes
< 4.0 mmol/L, LDL < 2.0 mmol/L
31
what three organs are screened for in diabetic pateints
1- eyes - digital retinal photography yearly 2. feet - pulses and nerves 3. kidneys )yearly ACR and estimated GFR ie. serum creatinie
32
well controlled HbA1c
53 mmol
33
what do you use to monitor diaebtes in people with hemoglobinopathies or no speen OR PREGNANCY
fructosamine
34
what patients need daily monitoring of BG
insulin therspy Preprandial aim for around 4-7 mmol/L Post parandial 2 hour glucose aim for around 5-9 mmol/L
35
exercise recommendation for people with diabetes
10 min vigorous exercise 3x a week
36
weight reduction for people with diabetes
3-5%
37
Insulin secretagogues (sulfonylureas/PGR) MOA
stimulate insulin release from B cells.
38
biguanides (metformin) MOA
improve insulin sensitivity in liver and muscle AND reduce haptic glucose output
39
Alpha-glucosidase inhibitors: MOA
reduce intestinal absoprtion of glucose
40
Thiazolidinediones (glitazone): MOA
improve insulin sensitivity
41
GLP1 receptor AGONISTS like EXENATIDE MOA
stimulates insulin secretion adn decreases glucagon secretion delays gastric emotying decreases food intake and induces satiety ONLY FOR BMI OVER 35 and poor glucose control
42
DPP-IV inhibitiors (AKA GLIPTINS) MOa
``` inhibiit breakdwon of GLP1 hence increase endogenous GLP1 oral once daily well tolerated. INCRETIN RELEASE ```
43
first line med for diabetes
metformin
44
if metformin contraindicated, whts first line
sufonylurea
45
when to take metformin
after meals
46
at what level of egfr should you stop metformin
belwo 30
47
second line med
sulfonykrea (gliclazide). consider PGR if erratic lifestul
48
third line med if above 58 Hba1c
add a glitazone or gliptin or insulin. or glp1 analogue if obese.
49
fourth line if above 58 hba1c
insulin plus metformin plus sulfonylurea
50
fifth line
intensify insulin ro add glitazoe --> risk of edema
51
side effect of biguanides (metformin)
Nausea, diarrhoea, lactic acidosis in pts with renal failure
52
side effect of sulfonylureas (gliclazide) and PGR (repaglinide)
Hypoglycaemia, weight gain
53
Glitazone (prioglitazone)
Weight gain, oedema, heart failure, post menopausal fractures, ?? Bladder cancer
54
alpha glucosidase inhibitors (acarbose) SE
faltulance diarrhoea
55
DPP4 inhibiotrs (sitagliptin) SE
nasopharyngitis, pancreatitis
56
GLP 1 agonits (exenatide) SE
nauseam diarrhoea, pancreatitis, pancreatic cancer
57
what are incretins and what is their role in glucose metabolism
protein hormones | stimulates the release of insulin by the β cells and inhubits the release of glucagon by pancreatic α cells.
58
what are some indications of insulin therapy
- tpe 1 diabetes - pregnancy symptomatic hyperglycemia nfecitn/foot ulcer... contraindication to tablets. (nil by outh etc)
59
types of insuline
Human insulin Short acting – eg Humulin S Intermediate acting – eg Humulin I Biphasic - mixture of short and intermediate – eg Humulin M3 Analogue insulin Rapid acting – eg Novorapid, Lispro Long acting (basal insulin) – eg Lantus, Levmir Biphasic - mixture of rapid and intermediate eg Novomix 30
60
when should insulin be given
before bed or first thing in the morning
61
to mimic normal insulin physiology waht shoudl you given and when
3 injection of rapid acting and 2 injection of long acting.
62
how to prescribe insulin
write just the number not the units
63
most common complication of diabetes
retinopathy
64
microvascular complication of diabetes
Reitnopahty Nephropahty Neuropathy
65
macrovascular complication of diabetes
MI Coronary heart disease Peripheral vacular disease
66
commonest cause of blindness in people of working age
diabetic retinopaty
67
types of diabetic retinopathy
- non proliferative retinopathy (AKA background retinpaty) | - proliferative retinopathy
68
cahracteritics of non proliferative retinopahy
- microaneurysms Dot hemorrhages Hard exudates (lipid deposits) Mild, moderate, severe (COTTON WOOL SPOTTS, aka soft exudates) --> areas of retinal ischemia
69
characteritics of proliferative retinpathy
Ischemic retina leads to production of growth factors and to new vessel formation (neovascularisation) New vessels on disc New vessels elsewhere
70
diabetic maculopathy
Presence of any retinopathy within 1 disc diameter around macula Can be: Focal or exudative maculopathy – hard exudates around macula which leads to macular oedema and visual loss Diffuse Ischemic – due to retinal vessel closure
71
what can be sight preserving for proliferative retinoapthy or maculopathy
laser photocoagulation
72
Types of diabetic neuropathy
Peripheral sensory neuropathy Autonomic neuropathy Proximal motor neuropathy (amyotrophy) Mononeuropathy Cranial nerve palsies Median nerve (carpal tunnel syndrome)
73
commonest cause of non truamatic amputation
daiebtic neruopathic ulceration
74
diabetic autonomic neuroapthy sx
postural hypotension | erectile dysfns, atonic blader, gastroparesis, constipation, diarrhoea
75
diabetic nephorpathy sx
hypertensino, albumineria, declinc renal function | on renal biospy “kimmelstein wilson lesion”
76
Screening for microalbumineria . how?
Measure albumin: creatinine ration (ACR) Normal is < 2.5 mg/mmol in men or < 3.5 mg/mmol in women If elevated, repeat x2 If 2 out of 3 positive – microalbuminuria present
77
treatment for nephropathy
keep BP low 130/80 | - ACEi even if BP is normal
78
Acute MI in diabetes
Aspirin, primary angioplasty, or thormbolysis Glucose insulin infusion Secondary prevention (ACEi, B blockers, statins, aspirin, improve glycemic control, cardiac rehabilitation)
79
peripheral vascular disease Tx
vasodilatorss, reconstrcutuve surgery, angioplast
80
granuloma nnulare
many
81
necrobiosis lipoidica diabeticorum
1
82
bullosis siabteicorum
bulle
83
diabetic dermoapthy
pathy lesin
84
rhumatological manifestation of diabtes
Charcots neuroarthopathy – a neuropathic joint leads to sever deformity and high risk of ulcers Diabetic cheriroarthorpahty due to limited joint mobility Adhesive capsulitis (froxen shoulder) Diffuse idiopathic skeletal hyperostosis Flexor tendinopathy Diabetic osteoarthroapthy
85
liver problem related to diabetes
non alcoholic fatty lvier disease | rasied ALT and AST >2x the ipper limit of norma.
86
drug used to reduce progression to cirrhosis
pioglitazone.
87
does alcholo cause hypo or hyper
hypoglycemia
88
dibaetic cheriorarthrypahy
hands thigns
89
charcot neuroarthropathy
feet thing
90
test fir someone with acanthosis nigricans
hba1c
91
early sign of diabetic renal disease
albumin in urine.
92
what diabetes drugs are contraindicated in pregnancy
Both gliclazide and liraglutide are contraindicated in pregnancy.
93
Pioglitazone contraindications
hx of bladder cancer
94
gestational diabetes diagnosis
fasting glucose is >= 5.6 mmol/L, or 2-hour glucose level of >= 7.8 mmol/L '5678
95
how does lithium lead to diabetes inspidus
lithium desensitizes the kidney's ability to respond to ADH in the collecting ducts

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