[diabetes] Flashcards by Johannes Staufenberg

[diabetes][Dx]: What is HBa1c

Glycated haemoglobin

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[diabetes][Dx]: HbA1c is a marker of average glucose levels over what prior time period

8 weeks (RBC t1/2)

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[diabetes][Dx]: What symptoms are signs of DM according to WHO criteria for Dx. (6)

Polyuria
Polydipsia
Visual blurring 
Genital thrush
lethargy
Unexplained wt loss

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[diabetes][Dx]: Symptoms of DM + raised venous glucose once of …. (fasting)

> = 7mmol/L

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[diabetes][Dx]: Symptoms of DM + raised venous glucose once of …. (random)

> =11.1 mmol/L

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[diabetes][Dx]: Raised venous glucose on 2 occasions of … (fasting)

> = 7 mmol/L

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[diabetes][Dx]: Raised venous glucose on 2 occasions of … (random)

> = 11.1 mmol/L

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[diabetes][Dx]: On 2 occasions a raised OGTT after 2hrs of …. is Dx

> = 11.1 mmol/L

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[diabetes][Dx]: an HbA1c of … mmol/L is Dx of DM

> =48 mmol/L

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[diabetes][Dx]: an HbA1c of …. % is Dx of DM

6.5%

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[diabetes][Dx]: An HbA1c of lower than the cut off for DM does exclude DM: T/F

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[diabetes][Dx]: HbA1c measurements are avoided in (3)

Children
Pregnancy
DM 1

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[diabetes][Dx]: pathophysiology behind DM1

Autoimmune destruction Beta cells

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[diabetes][Dx]: What does LADA stand for

Latent autoimmune diabetes of adults

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[diabetes][Dx]: What is LADA?

Late onset DM 1

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[diabetes][Dx]: Cause of DM2 (2)

decreased insulin secretion

increased insulin resistance

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[diabetes][Dx]: Impaired fasting or glucose tolerance in a marker for progression in to which DM ?

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[diabetes][Dx]: When would lifestyle intervention be most crucially indicated?

DM 2

during impaired fasting glucose/tolerance

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[diabetes][Dx]: What does MODY stand for

Maturity onset DM of the young

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[diabetes][Dx]: MODY genetic inheritance pattern?

Autosomal Dominant

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[diabetes][Dx]: Explain MODY

Autosomal dominant DM2 affecting the young with a family Hx

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[diabetes][Dx]: Genetic concordance in DM1?

30% - strong environmental factors

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[diabetes][Dx]: Genetic concordance in DM2?

80% - F Hx!

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[diabetes][Dx]: what are the criteria to have impaired glucose tolerance?

a fasting glucose of < 7 mmol/L

OGTT of 7.8 mmol/L

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[diabetes][Dx]: what are the criteria to have a raised fasting glucose?

6.1 mmol/L

[diabetes][Dx]: what Ix is indicated if pt has impaired fasting glucose

OGTT

[diabetes][Dx]: pancreatic destruction can cause DM. Name 2 diseases apart from surgery?

haemochromatosis | Cystic fibrosis

[diabetes][Dx]: Name 4 categories of drugs known to cause DM

Steroids Anti HIV Thiazides New anti-psychotics

[diabetes][Dx]: 5 endocrinological diseases that can cause DM ?

``` Phaechromocytoma Hyperthyroidism Pregnancy Acromegaly Cushings ```

[diabetes][pregnancy]: what % of pregnant women develop new-onset gestational DM

3.5%

[diabetes][pregnancy]: what advice can you offer the pt

control weight

[diabetes][pregnancy]: what supplement can you offer?

folic acid 5mg/day

[diabetes][pregnancy]: when should the pt take supplements until

12 weeks into the pregnancy

[diabetes][pregnancy]: All oral hypoglycaemics should be stopped apart from

metformin

[diabetes][pregnancy]: 6 weeks post partum?

Fasting glucose

[diabetes][pregnancy]: what % of GDM pts go on to develop DM

50% (regardless of post partum glucose)

[diabetes][pregnancy]: metformin can be used in conjunction (or alone) with what Tx for GDM

insulin

[diabetes]: DM 1 is associated with what gene

HLA D3 D4

[diabetes]: ketosis only occurs in

DM 1

[diabetes]: DM2 can be asymptomatic T/F

[diabetes][syndromeX]: what is metabolic syndrome aka

syndrome X

[diabetes][syndromeX]: defined as BMI .... or ^ waist circumference

>30 (central obesity)

[diabetes][syndromeX]: cut off for BP in Dx?

>130/85

[diabetes][syndromeX]: Cut off for TAGs in Dx?

=>1.7 mmol/L

[diabetes][syndromeX]: cut off for HDL in men?

1.03 mmol/L

[diabetes][syndromeX]: cut off for HDL in Females?

1.29 mmol/L

[diabetes][syndromeX]: cut off for fasting glucose?

>=5.6 mmol/L

[diabetes][syndromeX]: Presence of .. is Dx if increased BMI?

[diabetes][syndromeX]: what 5 criteria do you need 2 of with an increased BMI to be Dx

``` BP TAGs HDL Fasting glucose DM ```

[diabetes][syndromeX]: which cancer are you at risk from

pancreas (+other)

[diabetes][syndromeX]: decreased fertility affects which gender

M and F

[diabetes][syndromeX]: you are at increased risk of vascular event t/F?

[diabetes][syndromeX]: What very broad neurological disorder are you at risk of

neurodegeneration

[diabetes][syndromeX]: Lifestyle advice Tx? (2)

Exercise | Mediterranean diet

[diabetes][syndromeX]: Drug Tx same as DM?

Yes - metformin

[diabetes][syndromeX]: microalbuminuria risk in increased? T/F

[diabetes][syndromeX]: How might the bile duct be at risk?

Gallstone risk increased

[diabetes]: which ethnicity is at increased risk of insulin resistance

asians

[diabetes]: which drugs may causes insulin resistance (2)

SSRIs | anti TB drugs

[diabetes][Tx]: what lifestyle advice should be given (3)

exercise diet smoking

[diabetes][Tx]: How would yo lower triglycerides

Statin

[diabetes][Tx]: 1st line tx for triglycerides

Simvastatin 40mg nocte

[diabetes][Tx]: how does simvastatin work

Inhibits HMG-CoA reductase

[diabetes][Tx]: What is HMG-CoA redutase

rate limiting step in endogenous production of cholesterol

[diabetes][Tx]: When is Simvastatin not used in lowering triglycerides

if triglycerides are >4.5 mmol/L

[diabetes][Tx]: what is used if there is a triglyceride level of cut off for simvastatin?

Bezalip 200mg/8hr

[diabetes][Tx]: what is the target BP for DM management

<140/80 mmHg

[diabetes][Tx]: what advice should be given about driving

do not drive if hypoglycaemic spells

[diabetes][Tx]: DM1: mainstay of Tx?

Insulin

[diabetes][Tx]: DM1: what is the danger with binge drinking

delayed hypoglycaemia

[diabetes][Tx]: DM1: name 2 ultra fast acting insulins

Humalog | Novarapid

[diabetes][Tx]: DM1: what is the usual dose of insulin in 1 injection regardless of speed of action?

100u/mL

[diabetes][Tx]: DM1: when is ultra fast acting used

before or after a meal

[diabetes][Tx]: DM1: medium acting insulin?

Isophane insuling

[diabetes][Tx]: DM1: What is Novomix?

30% ultrafast | 70% long acting

[diabetes][Tx]: DM1: what are the 2 long acting insulins

Insulin glargine | Insulin Detemir

[diabetes][Tx]: DM1: when is insulin glargine used

night time

[diabetes][Tx]: DM1: why is insulin glargine used before bed

prevent nocturnal hypoglycaemia

[diabetes][Tx]: DM1: there are 3 main regimens. name them

BD biphasic QDS regimens Once before bed

[diabetes][Tx]: DM1: describe BD biphasic

2x daily Novamix

[diabetes][Tx]: DM1: describe QDS

long acting before bed | ultra rapid before meal

[diabetes][Tx]: DM1: Describe once before bed

Long acting before bed

[diabetes][Tx]: DM1: if switching from metformin in type 2 DM to injections of insuling. Which regimens is most appropriate.

once before bed

[diabetes][Tx]: DM1: what advice about autonomy in insulin regimens should you give

Promote autonomy i.e react to meals/exercise/illness

[diabetes][Tx]: DM1: what effect does illness have on insulin requirements

increases insulin requirements (despite reduced food)

[diabetes][Tx]: DM1: if ill how frequently should you check blood glucose

4 times a day

[diabetes][Tx]: DM1: in illness what may be a sign of rising glucose levels other than blood glucose

ketouria

[diabetes][Tx]: DM2: what class of drug is metformin

biguanide

[diabetes][Tx]: DM2: what SE does metformincrucially not have

hypoglycaemia

[diabetes][Tx]: DM2: what SE does metformin have (3)

Nausea diarrhoea abdominal pain

[diabetes][Tx]: DM2: metformin CI is an eGFR of ...

<36mL/min

[diabetes][Tx]: DM2: what is the worry with using metformin if the is reduced eGFR?

lactic acidosis

[diabetes][Tx]: DM2: what and when is the dose with metformin (2)

500mg | after food

[diabetes][Tx]: DM2: what indications are the which make you stop metformin (3)

Tissue hypoxia (MI/sepsis for e.g.) morning of GA iodine contrast

[diabetes][Tx]: DM2: for how long is metformin alone given before you give another drug

16 weeks

[diabetes][Tx]: DM2: after 16 weeks on metformin what is measured to learn if another drug is required

HbA1c

[diabetes][Tx]: DM2: after 16 weeks what is the HbA1c cut off for adding another drug on top of metformin

=>53mmol/L

[diabetes][Tx]: DM2: what drug is added is after 16 weeks HbA1c is too high

Gliclazide 40mg/d

[diabetes][Tx]: DM2: what class is gliclazide

sulfonylurea

[diabetes][Tx]: DM2: how does gliclazide work

Binds to sulfonylurea-r on beta cells closes K+ channels = depolarisation Ca++ open, exocytosis of insulin

[diabetes][Tx]: DM2: how does metformin work

supresses hepatic gluconeogenesis

[diabetes][Tx]: DM2: what is a SE of gliclazide (2)

hypoglycaemia | increased weight

[diabetes][Tx]: DM2: After metformin and sulfonylurea when next do you measure HbA1c?

6 months

[diabetes][Tx]: DM2: what is the HbA1c cut off for addition of a 3rd anti-diabetic drug (post metformin+gliclazide)?

=>57 mmol/L

[diabetes][Tx]: DM2: if HbA1c after 2 drugs reaches the cut off for a 3rd drug, what 2 drugs might you try?

Insulin | Pio-Glitazone 15-45 mg/24hrs

[diabetes][Tx]: DM2:how does glitazone work?

increase insulin sensitivity

[diabetes][Tx]: DM2: does using glitazone for DM2 after 6 months mean you stop metformin and sulfonylurea?

YES

[diabetes][Tx]: DM2: if after 6 months you do not use a glitazone but insulin, in what case can you keep metformin

if unable to use BD regimens

[diabetes][complications]: what effect does exercise have on cells with regard to insulin?

increase their sensitivity

[diabetes][complications]: what is the target BP

<140/80

[diabetes][complications]: what is the target BP if renal disease (microalbuminuria)

<75 | ensure ACEi

[diabetes][complications]: what effect may insulin have at the injection site (apart from ^risk of infection)

lipohypertrophy

[diabetes][complications]: chief cause of death is

Vascular event

[diabetes][complications]: what should ALL DM patients be put on regardless of blood levels of triglycerides

Statin (simvastatin unless > 4.5 mmol/L: bezalip)

[diabetes][complications]: ... mg aspirin is prescribed to reduce vascular event

75mg

[diabetes][complications]: define microalbuminuria

urine dipstick -ve for protein | urineACR is =>3 mmol

[diabetes][complications]: what does microalbuminaemurea indicate

early renal damage/disease

[diabetes][complications]: when is an ACEi indicated even if BP is normal

if urine ACR is >3 mmol

[diabetes][complications]: why is an ACEi indicated even if BP is normal?

Renal protective

[diabetes][complications]: Diabetic retinopathy: how frequent is mandatory screening?

annual

[diabetes][complications]: retinopathy: if pre-symptomatic and cotton wool spot/haemorrhages/aneurysms seen what intervention is used to prevent retinopathy?

laser photocoagulation

[diabetes][complications]: Diabetic retinopathy: what does laser photocoagulation do?

stops angiogenic factor production from ischaemic retina

[diabetes][complications]: what happens in retinopathy

angiogenic proliferation

[diabetes][complications]: diabetic retinopathy: what are the hard exudates seen early on?

lipid deposits

[diabetes][complications]: diabetic retinopathy: what would a retinal infarct look like/be described as?

cotton wool spot

[diabetes][complications]: diabetic retinopathy: if new vessel formation is seen what should you do?

urgent referral to ophthalmologist - blindness.

[diabetes][complications]: diabetic retinopathy: what is responsible for new vessel formation

ischaemia

[diabetes][complications]: diabetic retinopathy: hyperglycaemia causes high blood flow and capillary pericyte damage leading to aneurysms and occlusion T/F?

[diabetes][complications]: diabetic retinopathy: new vessel formation proliferate, bleed and fibrose and can cause the retina to ....

detach

[diabetes][complications]: diabetic retinopathy: is aspirin safe to take?

yes

[diabetes][complications]: diabetic retinopathy: what is new vessel formation on iris called

rubeosis iridis

[diabetes][complications]: diabetic retinopathy: what may rubeosis iridis lead to

glaucoma

[diabetes][complications]: diabetic retinopathy: Class of drug for Tx for maculopathy if surgery not an option?

intra-vitreal steroids

[diabetes][complications]: diabetic retinopathy: cataracts can be reversed with normoglycaemia? T/F

[diabetes][complications]: if the pt has reached the target BP of <140/80 and no microalbuminurea how frequently should BP check be

every 6 months

[diabetes][neuropathy]: how would you identify peripheral foot neuropathy cf. ischaemia

infection or injury over pressure points = neuropathy

[diabetes][neuropathy]: how would ischaemia present cf. neuropathy

absent dorsalis pedis

[diabetes][neuropathy]: what is the classical distribution of peripheral neuropathy

glove and stocking

[diabetes][neuropathy]: how would you measure sensation in the foot

10g monofilament

[diabetes][neuropathy]: decreased sensation and absent jerks indicates neuropathy or ischaemia

peripheral neuropathy

[diabetes][neuropathy]: if there is an absent dorsalis pedis what is the ext step?

doppler to measure flow

[diabetes][neuropathy]: is foot ulceration painful or painless

painless

[diabetes][neuropathy]: what investigation is specific to ulcers

depth probe (osteomyelitis/cellulits risk)

[diabetes][neuropathy]: Mx of foot non-pharm? (2)

``` regular chiropody (remove calluses) comfortable shoes ```

[diabetes][neuropathy]: 1st line empirical drug Mx of cellulitis

``` benzylpenicillin 1.2g/6hr IV + Flucloxacillin 1g/6hrs IV +- metronidazole 500mg/8hrs IV ```

[diabetes][neuropathy]: what are the 4 indications for amputation/surgery?

abscess/deep infection gangrene (pain at rest) suppurative arthritis spreading anaerobic infection

[diabetes][neuropathy]: diabetic neuropathy symptoms (2)

pain | numbness

[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 1st line Tx?

paracetamol

[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 2nd line Tx?

amitriptyline 10-25mg at night (TCA)

[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 3rd line Tx? (2)

Duloxetine (SNRI) | Gabapentin

[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 4th line Tx?

opiates

[diabetes][neuropathy]: Mononeuritis multiplex Tx (3 and 6 CNs can be affected)

corticosteroids

[diabetes][neuropathy]: what is amyotrophy?

painful wasting | of quadriceps

[diabetes][neuropathy]: autonomic neuropathy may present with? (5)

``` Postural BP drop urine retention erectile dysfunction diarrhoea gastroparesis ```

[diabetes][neuropathy]: 1st line drug Tx for autonomic induced postural BP drop?

fludrocortisone

[diabetes][neuropathy]: 1st line drug Tx for autonomic induced diarrhoea?

Codeine phosphate 15mg/8hrs

[diabetes][neuropathy]: what is charcots joint

neuropathy --> loss of pain sensation. | repeated unimpeded mechanical stress --> deformity.

[diabetes][neuropathy]: 1st line Tx for charcots ?

total rest of joint

[diabetes] Flashcards

(158 cards)