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Diabetes Flashcards

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1
Q

What is the requirement for Group 1 T2DM drivers regarding hypoglycemic episodes?

A

No more than 1 hypo in 12 months that required assistance

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2
Q

What monitoring is required for Group 2 T2DM drivers?

A

Monitor BMs twice a day, full hypo awareness, and aware of hypo risk

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3
Q

What is required for IDDM drivers to inform?

A

Need to inform DVLA

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4
Q

What are the licensing conditions for Group 1 IDDM drivers?

A

No restrictions and 1-3 year license if conditions are met

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5
Q

What is the monitoring requirement for Group 1 IDDM drivers before and during driving?

A

BM monitoring 2 hours before driving and every 2 hours whilst driving

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6
Q

What additional requirement is there for Group 2 IDDM drivers?

A

Annual review with diabetes consultant and 3 months of BM readings

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7
Q

Fill in the blank: Group 2 IDDM drivers will need to complete a _______ form.

A

D2

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8
Q

Fill in the blank: Group 2 IDDM drivers must produce a _______ medical examination.

A

D4

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9
Q

True or False: There is no restriction for Group 1 T2DM drivers if they meet specific hypo conditions.

A

True

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10
Q

What is the time frame for monitoring BM readings for Group 2 IDDM drivers?

A

3 months

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11
Q

What are the types of diabetes where auto-antibodies are present?

A

Type 1, LADA

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12
Q

What does LADA stand for?

A

Latent Autoimmune Diabetes in Adults

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13
Q

Which diabetes type is characterized by early insulin deficiency but initially looks like type 2?

A

LADA

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14
Q

What would be two signs that it could be mitochondrial diabetes?

A

Strong maternal family history
Often hearing impairment

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15
Q

What does MODY stand for?

A

Maturity Onset Diabetes of the Young

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16
Q

What does MODY look like?

A

T2 picture in a younger person

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17
Q

What is a possibility in a sick infant regarding diabetes?

A

Neonatal diabetes

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18
Q

If dehydrated what should you stop and not stop?

A

Stop metformin and gliflozins
Never stop or omit insulin

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19
Q

When would you do c-peptide?

A

T1DM suspected but clinical presentation atypical or suspicious Mon of monogenic form

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20
Q

What would the levels of c peptide be in diabetes?

A

Normal to high in T2DM and MODY
Low in TIDM (although can be high in honeymoon periods and LADA

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21
Q

Acute painful neuropathy resulting from rapid improvement in blood glucose control is a self limiting condition that improves with time TRUE or FALSE

A

TRUE

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22
Q

What are the NICE targets for HBA1c

A

48- lifestyle alone or single drug that dosent cause hypos
53- hypo inducing drug or more than one drug

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23
Q

MODY what type do you need to treat and what is the treatment

A

MODY 2 glucokinase problem (don’t need to do anything)
MODY 3- most common (70%) treat with SUR, HNF1a

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24
Q

Gestational diabetes. What would be diagnostic levels?

A

FG >5.5 ans/or 2h glucose >7.8

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25
Gestational diabetes what treatment
If FG <7 then diet exercise and metformin if FG >7 then insulin straight away
26
When do you do OGTT
24-28 weeks
27
What is the primary action of sulfonylureas like gliclazide?
Decrease glucose reabsorption by increasing insulin secretion
28
What are DPP4 inhibitors like linagliptin known for?
They are weak but safe antidiabetic agents. Can use even if eGFR <15 ## Footnote They inhibit the breakdown of GLP-1 and have a low risk of hypoglycemia, but are the least effective for lowering HbA1c.
29
Fill in the blank: SGLT2 inhibitors are ________ but beware of DKA.
cardioprotective ## Footnote They decrease glucose reabsorption in the proximal convoluted tubule and promote significant weight loss.
30
What is a common side effect of SGLT2 inhibitors?
Urinary tract infections and thrush ## Footnote They can also increase the risk of distal limb ischemia, Fournier's gangrene, and DKA.
31
What is the primary benefit of using insulin in diabetes management?
Most effective at lowering HbA1c ## Footnote Insulin has a significant hypo risk and requires good understanding and education for safe use.
32
When should pioglitazones be chosen in diabetes treatment?
If insulin resistance is present (central obesity, high insulin doses) ## Footnote Contraindicated in several conditions.
33
What are GLP-1 agonists like exenatide reserved for according to NICE?
Obesity ## Footnote They are far more potent than DPP4 inhibitors and promote weight loss without hypoglycemia risk.
34
True or False: DPP4 inhibitors pose a high risk of pancreatitis.
False ## Footnote They have a rare risk of pancreatitis.
35
What effect do SGLT2 inhibitors have on heart failure?
Decrease risk of heart failure with positive cardiovascular effects ## Footnote They are also helpful in CKD management.
36
What is a significant side effect of insulin therapy?
Weight gain, lipohypertrophy, hypos ## Footnote Requires careful monitoring and education for safe management.
37
If CKD and diabetes what would be a good drug to use
Dapagliflozin
38
Although SUR work rapidly at lowering HbA1c What are the two main risks with SUR
Gain weight Cause hypos
39
What are the risks of GLP 1
Pancreatitis and gallstones
40
What is the first line drug therapy for diabetes management?
Metformin +/- Gliflozin
41
When should gliflozin be considered in diabetes treatment?
If there is chronic heart failure or high risk of cardiovascular disease.
42
What should be checked before starting gliflozin?
* Risk of DKA * Pregnancy status * Renal function
43
What should be done if Metformin is contraindicated?
Consider gliflozin as monotherapy.
44
What should be assessed if HbA1c remains above target?
* Review target * Lifestyle * Compliance * Intensify drug therapy
45
What should be avoided in patients with heart failure?
Pioglitazone.
46
In cases of significant renal impairment, what treatments should be considered?
* Insulins * Pioglitazone * Some gliptins (e.g., linagliptin)
47
What treatment options should be considered for very obese patients?
* GLP-1 * Gliflozins
48
What should be avoided in patients who need to prevent hypoglycemia?
* Insulins * Sulfonylureas (SURs)
49
What does MACE stand for?
Major Adverse Cardiovascular Events
50
What is the primary cause of diabetic ketoacidosis (DKA)?
Insulin deficiency combined with increased counter-regulatory hormones.
51
True or False: DKA is more common in Type 2 diabetes than in Type 1 diabetes.
False
52
List one key clinical feature of hyperglycemic hyperosmolar state (HHS).
Severe dehydration.
53
What is the typical blood glucose level in HHS?
Usually greater than 30 mmol/L.
54
Fill in the blank: The initial treatment for DKA includes _______.
Fluid resuscitation.
55
What laboratory finding is characteristic of DKA?
Metabolic acidosis with an increased anion gap.
56
Multiple choice: Which of the following is NOT a common precipitating factor for DKA? A) Infection B) Non-compliance with insulin C) Excessive carbohydrate intake D) Myocardial infarction
C) Excessive carbohydrate intake
57
What is the target blood glucose level for DKA resolution?
Below 15 mmol/L.
58
True or False: HHS typically develops more gradually than DKA.
True
59
What is the role of potassium in the management of DKA?
Potassium levels should be monitored and replaced as insulin therapy can cause hypokalemia.
60
Fill in the blank: In DKA, the patient typically presents with _______ breathing.
Kussmaul's
61
What is the recommended intravenous fluid for initial resuscitation in DKA?
0.9% sodium chloride.
62
Multiple choice: Which of the following is a common symptom of HHS? A) Nausea B) Abdominal pain C) Confusion D) All of the above
D) All of the above
63
What is the first-line treatment for hyperglycemia in DKA?
Insulin infusion.
64
True or False: Patients with HHS are usually younger than those with DKA.
False
65
What is the typical serum bicarbonate level in DKA?
Less than 15 mmol/L.
66
Fill in the blank: The anion gap is calculated to assess _______ in DKA.
Metabolic acidosis.
67
What is the recommended rate of insulin infusion for DKA management?
0.1 units/kg/hour.
68
Multiple choice: Which of the following is a late sign of DKA? A) Tachycardia B) Hypotension C) Altered consciousness D) All of the above
D) All of the above
69
What should be done if a patient develops hypoglycemia during DKA treatment?
Administer dextrose.
70
What is the key diagnostic critter is for DKA?
Glucose >11 (or known diabetes) Ketones is >3 pH <7.3 and/or bicarbonate <15
71
Key diagnostic criteria HHS
Glucose >30 Serum osmolality >320 No significant ketones is or acidosis
72
For GLP1 what target do they have to hit in the first 6month to continue
Weight loss of 3% and 11mmol/mol reduction in Hba1c
73
Aside from heart failure what else is a risk with pioglitazone?
Fractures and contraindicated in bladder cancer
74
At what age do you not do Qrisk
>85 (based on age alone high risk)
75
What is the target for lipids in primary prevention?
>40% reduction in non HDL cholesterol
76
What is the target for lipids in secondary prevention?
LDL < 2 (less then or equal to 2) or non-HDLA <2.6 (less than or equal to 2.6)
77
What is the dose of atorvastarin for primary prevention
20mg
78
What is the dose of atorvastatin for secondary prevention?
80mg
79
What is the dose in CKD regardless of primary to secondary prevention?
20mg
80
What is CKD defined as?
ACR >- 3 (greater than or equal to) EGFR <60 on two occasions at least 3 months apart Structural kidney disease (e.g. polycystic kidney disease) even if normal eGFR (Only need one)
81
How does the dose of metformin change based on eGFR?
<30- do not use 30-44 max 1g 44-59 max 2g
82
The risk of hypos is greater with renal impairment with gliclazide True or False
True
83
GLP-1 are reserved for obesity. Have to have tried 3 others drugs. AND BE
BMI 35+ and weight related co-morbidity OR BMI <35 if can’t use insulin because of occupation/weight loss desirable

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