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Endocrine System (HIGH) > Diabetes > Flashcards

Diabetes Flashcards

(90 cards)

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1
Q

What is persistent hyperglycaemia?

A

A condition characterized by elevated blood glucose levels over time.

It can be caused by deficient insulin secretion, insulin resistance, pregnancy, or certain medications.

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2
Q

What are the causes of persistent hyperglycaemia?

A
  • Deficient insulin secretion (type 1)
  • Resistance to insulin (type 2)
  • Pregnancy (gestational)
  • Medications (e.g., steroids) (secondary)

These causes highlight the different mechanisms leading to diabetes.

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3
Q

What must all drivers on insulin do regarding the DVLA?

A

Notify the DVLA.

This is necessary for safety assessments related to driving capabilities.

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4
Q

What is required for Group 1 (regular car) drivers with diabetes?

A
  • Adequate awareness of hypoglycaemia
  • No more than 1 episode of severe hypoglycaemia while awake in the preceding 12 months

Group 1 drivers refer to regular car drivers.

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5
Q

What must Group 2 (bus/lorry) drivers report regarding hypoglycaemia?

A
  • All episodes of severe hypoglycaemia (requiring assistance)
  • Full awareness of hypoglycaemia
  • No episode of severe hypoglycaemia in the preceding 12 months
  • Must use a blood glucose meter with sufficient memory
  • Any visual complications must be notified to DVLA and not drive

Group 2 drivers include bus and lorry drivers.

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6
Q

What is the blood glucose level that should be maintained while driving?

A

Above 5mmol/litre.

Drivers should take a snack if their blood glucose falls below this level.

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7
Q

What should a driver do if they experience hypoglycaemia while driving?

A
  • Stop the vehicle and switch off the engine
  • Move from the driver’s seat
  • Eat/drink a source of sugar
  • Wait 45 minutes after blood glucose returns to normal before continuing the journey
    drivers must not drive if hypoglycaemia awareness has been lost and DVLA must be notified (if they could not pull over safely

Safety is paramount when dealing with hypoglycaemic events.

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8
Q

What are the typical features of Type 1 Diabetes Mellitus?

A
  • Hyperglycaemia (>11mmol/litre)
  • Ketosis
  • Rapid weight loss
  • BMI <25kg/m2
  • Age <50yrs
  • Family history of autoimmune disease

These features help differentiate Type 1 from other forms of diabetes.

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9
Q

How often should blood glucose be monitored for Type 1 Diabetes?

A

At least 4 times a day (including before each meal and before bed).

Regular monitoring is crucial for managing diabetes effectively.

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10
Q

What is the first-line insulin regimen for Type 1 Diabetes?

A

Basal-bolus regimen.

This involves long/intermediate acting insulin once or twice daily plus short/rapid acting insulin before meals.

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11
Q

What are the characteristics of short-acting insulin?

A
  • Onset: 30-60 minutes
  • Peak action: 1-4 hours
  • Duration: up to 9 hours

Short-acting insulin is typically soluble insulin injected before meals.

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12
Q

What is the definition of prediabetes according to HbA1c levels?

A

HbA1c = 42-47mmol/mol.

diabetes = 48mmol/mol

Lifestyle advice may help prevent progression to diabetes.

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13
Q

What is the treatment for low risk of CVD in Type 2 Diabetes?

A
  • Assess HbA1c, kidney function, and CVD risk
  • Treat with metformin aiming for an individually agreed threshold

Add DPP-4i (gliptins), pioglitazone, SU or SGLT2-i

If HbA1c still above threshold start triple therapy or swap classes of diabetics

Metformin is often the first-line treatment for Type 2 Diabetes.

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14
Q

What is the mechanism of action of Metformin?

A

Decreases gluconeogenesis and increases peripheral utilization of glucose.

It is a first-line treatment for Type 2 Diabetes.

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15
Q

What are the side effects of Sulfonylureas?

A
  • High risk of hypoglycaemia
  • Avoid in acute porphyria
  • Avoid in hepatic and renal failure

These medications augment insulin secretion.

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16
Q

What is the risk associated with Pioglitazone?

A
  • Increased risk of bladder cancer
  • Avoid in history of heart failure
    report haematuria, dysuria or urinary urgency
  • Increased risk of bone fractures
  • Increased risk of liver toxicity (report nausea, vomiting, abdo pain, fatigue, jaundice and dark urine)

Pioglitazone reduces peripheral insulin resistance.

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17
Q

What is Diabetic Ketoacidosis (DKA)?

A

A severe hyperglycaemic condition characterized by symptoms like polyuria, thirst, and confusion.

It is a medical emergency requiring immediate treatment.

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18
Q

What is a key treatment step for DKA if systolic BP is less than 90?

A

Restore volume with 500 IV NaCl 0.9%.

This is crucial for stabilizing the patient before further treatment.

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19
Q

What are the SICK DAY RULES for diabetes management?

A

Sugar levels – blood glucose should be checked regularly

Insulin – carry on taking insulin

Carbohydrates – keep eating and stay hydrated

Ketones – check ketones regularly

These rules help manage diabetes during illness.

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20
Q

What are common symptoms of hypoglycaemia?

A
  • Sweating
  • Lethargy
  • Dizziness
  • Hunger
  • Tremor

Recognizing these symptoms is vital for prompt treatment.

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21
Q

What should you always carry according to DVLA advice?

A

A glucose meter and blood-glucose strips

This is essential for monitoring blood glucose levels while driving.

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22
Q

How often should blood-glucose be checked while driving?

A

Every 2 hours while driving

It is also advised to check blood-glucose no more than 2 hours before driving.

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23
Q

What is the minimum blood glucose level that should be maintained while driving?

A

Above 5mmol/litre

If blood glucose falls below this level, a snack should be taken.

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24
Q

What type of carbohydrate should be available in the vehicle?

A

Fast acting carbohydrate

This is crucial for quickly addressing low blood glucose levels.

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25
What is the target blood glucose level for waking in type 1 diabetes?
5-7mmol/litre
26
What is the target fasting blood glucose level before meals in type 1 diabetes?
4-7mmol/litre
27
What is the target blood glucose level 90 minutes after eating in type 1 diabetes?
5-9mmol/litre
28
What is the target blood glucose level when driving in type 1 diabetes?
>5mmol/litre
29
What are 3 examples of rapid-acting insulin?
Lispro, Aspart and Glulisine (NO LAG)
30
What are 2 examples of intermediate-acting insulin?
Biphasic isophane, biphasic aspart/lispro
31
what are 3 examples of long-acting insulin and how often are they injected?
determir, glargine, degludec once daily (determir = BD)
32
If a diabetic patient at any point develops high risk of CVD which class of medication should be started?
SGLT2-i (flozins)
33
What are some side effects of metformin?
 Lactic acidosis – avoid if eGFR <30ml/minute/1.73m2  GI side effects – increase dose slowly or give MR preparation  Can reduce vitamin b12 STOP medication if patient experiences acute kidney injury
34
Give 2 examples of short-acting and long-acting sulfonylureas
short acting: gliclazide tolbutamide long-acting: glibenclamide glimperiride
35
Why should sulfonylureas be avoided in elderly pts?
They are associated with prolonged and fatal cases of hypoglycaemia
36
What are DPP-4 Inhibitors?
Medications that inhibit dipeptidylpeptidase-4 to increase insulin secretion and lower glucagon secretion ## Footnote Examples include Linagliptin, Alogliptin, Sitagliptin, Saxagliptin, and Vildagliptin.
36
What can DPP-4 Inhibitors cause?
Pancreatitis discontinue if symptoms of acute pancreatitis occur e.g persistent abdo pain ## Footnote Discontinue and refer if symptoms of acute pancreatitis occur, such as persistent abdominal pain.
37
What is the MOA of SGLT-2 inhibitors?
inhibit sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule ## Footnote Examples include dapagliflozin, canagliflozin, and empagliflozin.
38
What are the MHRA warnings for SGLT-2 inhibitors?
* Life-threatening and fatal cases of diabetic ketoacidosis * Monitor ketones if treatment interrupted for surgical procedures or illness * Fournier’s gangrene * Canagliflozin only: risk of lower-limb amputation (mainly toes)
39
What precautions should be taken before starting SGLT-2 inhibitors?
Correct hypovolaemia due to increased urine frequency and potential for volume depletion ## Footnote Monitor renal function.
40
What is the MOA of GLP-1 Agonists?
increase insulin secretion, suppress glucagon secretion, and slow gastric emptying ## Footnote Examples include Dulaglutide, exenatide, liraglutide, and lixisenatide.
41
What is a risk associated with GLP-1 Agonists?
Diabetic ketoacidosis when concomitant insulin is rapidly reduced ## Footnote Be aware of potential for misuse.
42
What should patients be warned about when taking GLP-1 Agonists?
Risk of acute pancreatitis and dehydration ## Footnote Warn of severe abdominal pain and advise precautions to avoid fluid depletion.
43
What is the mechanism of action for Acarbose?
Delays digestion and absorption of starch and sucrose ## Footnote High risk of gastrointestinal side effects may necessitate dose reduction.
44
What do Meglitides do?
Stimulate insulin secretion ## Footnote Stress exposure may require treatment interruption and replacement with insulin to maintain glycaemic control.
45
what are examples of DPP-4 inhibitors?
linagliptin, alogliptin, sitagliptin,
46
What are 3 examples of SGLT2i?
dapagliflozin, empagliflozin, canagliflozin
47
what are examples of GLP-1 agonists?
dulaglutide, exenatide, liraglutide, lixisenatide
48
What is the MHRA warning for GLP-1 agonists?
risk of DKA when concomitant insulin was rapidly reduced
49
Which antidiabetics cause weight gain?
pioglitazone + sulfonylureas ## Footnote These medications are associated with an increase in body weight.
50
Which antidiabetics have a neutral effect of weight gain
DPP-4i + metformin ## Footnote These medications do not significantly affect body weight.
51
Which antidiabetic medications are associated with weight loss?
GLP-1 and SGLT-2 inhibitors ## Footnote These classes of medications can lead to a reduction in body weight.
52
When should low dose atorvastatin be considered for type 1 diabetes patients?
In all type 1 patients ## Footnote It is recommended especially for those aged 40+, diabetic for over 10 years, or with nephropathy or other CVD risk factors.
53
What is the role of ACE inhibitors in diabetic patients?
Reduces CVD risk ## Footnote ACE inhibitors are beneficial regardless of age or ethnicity and are indicated for diabetic patients.
54
What treatment should be given to patients with nephropathy causing proteinuria?
ACE-I or ARB ## Footnote These medications help manage kidney-related complications in diabetic patients.
55
How can ACE-I affect diabetic drugs?
Potentiate hypoglycaemic effect ## Footnote ACE inhibitors may enhance the effectiveness of insulin and other diabetic medications.
56
What is a recommended treatment for painful peripheral neuropathy?
Antidepressants, gabapentin, or pregabalin ## Footnote These medications are effective in managing neuropathic pain.
57
How is diarrhoea in autonomic neuropathy treated?
Codeine or tetracyclines ## Footnote These medications can help manage diarrhea associated with autonomic neuropathy.
58
What can be done for neuropathic postural hypotension?
Increase salt intake or use fludrocortisone ## Footnote These measures help manage blood pressure issues related to neuropathy.
59
What is the treatment for gustatory sweating?
Antimuscarinic (propantheline bromide) ## Footnote This medication can help reduce excessive sweating triggered by eating.
60
What is the recommended treatment for erectile dysfunction in diabetic patients?
Sildenafil ## Footnote Sildenafil is commonly prescribed for erectile dysfunction in men with diabetes.
61
How often should diabetic patients have an eye test?
Yearly ## Footnote Regular eye examinations are crucial for early detection of visual impairment in diabetes.
62
One DKA is being treated with IV insulin with NaCL, what rate do we want ketone and glucose conc to fall at?
ketone conc should fall at 0.5mmol/L/hr blood glucose conc should fall at 3mmol/L/hr
63
In a pt with DKA where BP is over 90 what should be the maintenance treatment?
IV NaCl 0.9%
64
How should a pts long acting OD insulin be managed if they have elective minor surgery with good glycaemic control
Day before surgery: Reduce OD long-acting dose by 20% - rest as usual ## Footnote This adjustment helps maintain stable blood glucose levels during the surgical procedure.
65
How should a pts long acting OD insulin be managed if they have elective major surgery or poor glycaemic control
Day before surgery: Reduce OD long-acting dose by 20% - rest as usual ## Footnote This approach is crucial for managing insulin needs during and after surgery.
66
What type of intravenous infusion is administered during major elective surgery?
IV infusion of KCL + glucose + NaCL ## Footnote This infusion helps maintain electrolyte balance and energy levels during surgery.
67
What type of insulin is given via pump during major elective surgery?
Variable rate IV insulin (soluble human) in NaCL0.9% ## Footnote This method allows for precise control of blood glucose levels during the procedure.
68
How often should blood glucose measurements be taken on the day of major elective surgery?
Hourly blood glucose measurements for first 12 hours ## Footnote Regular monitoring is essential to prevent hypoglycemia or hyperglycemia.
69
What action should be taken if blood glucose dips under 6mmol/L during surgery?
Give IV glucose 20% ## Footnote This is a critical step to quickly correct low blood sugar levels.
70
When should subcutaneous insulin be converted back post-surgery?
When patient can eat/drink without vomiting ## Footnote This ensures that the patient is stable enough to resume normal insulin administration.
71
A pt on basal-bolus regimen has just had a surgery when can their insulin be restarted
It should be restarted with their first meal. ## Footnote This regimen helps manage blood glucose effectively after the patient resumes eating.
72
How much should long-acting insulin regimen be reduced post-surgery?
20% reduced until patient leaves hospital ## Footnote This gradual reduction helps stabilize blood glucose levels as the patient recovers.
73
When should a twice daily insulin regimen be restarted post-surgery?
At breakfast or evening meal ## Footnote This timing aligns with the patient's eating schedule to ensure effective insulin management.
74
What is the protocol for infusions after the first meal post-surgery?
Infusions carried on till 30-60 mins after first meal ## Footnote This ensures that the patient's insulin needs are met immediately after eating.
75
What is the target HbA1c level before pregnancy for women with diabetes?
Target HbA1c < 48mmol/mol
76
What supplement should women take before pregnancy if they have diabetes?
Folic acid 5mg
77
What should be done with oral antidiabetics before pregnancy?
All oral antidiabetics except metformin should be stopped and replaced with insulin
78
What is the first choice for long-acting insulin during pregnancy?
Isophane insulin
79
What medications should be discontinued in diabetic pregnant women?
Statins, ACE inhibitors, ARBs
80
What is gestational diabetes?
Diabetes that develops during pregnancy; treatment stops after birth
81
What is the initial treatment for gestational diabetes if fasting blood glucose is < 7mmol/L?
Diet and exercise
82
What medication can be used if diet and exercise are insufficient for gestational diabetes with fasting BG < 7mmol/L?
Metformin
83
What is the treatment approach if fasting BG > 7mmol/L in gestational diabetes?
Diet and exercise + insulin +- metformin
84
What is the treatment for fasting BG 6-6.9mmol/L with complications?
Insulin +- metformin
85
In gestational diabetes where fasting BG <7mmol/L, and metformin is not tolerated or effective what is the next option?
insulin
86
What are examples of fast acting carbohydrates a person should take if they are experiencing hypoglycaemia?
* 4-5 glucose tablets * 3-4 heaped teaspoons of sugar * 150-200ml fruit juice * Repeat every 15min for 3 cycles
87
If a person is experiencing hypoglycaemia and oral administration is not possible or pt is unconscious what should be used as treatment?
* IM glucagon and if unresponsive after 10 minutes = IV glucose
88
What is blunted hypoglycaemia?
when hypoglycaemia symptoms do not occur do to pt taking other medication E.G BETA BLOCKERS PREVENT TREMOR
89
What level of blood glucose is considered as hypoglycaemia?
<4mmol/L

Endocrine System (HIGH) (4 decks)

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