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CMS Revision > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the definition of diabetes?

A

Disorder of the metabolism causing excessive thirst and the production of large amounts of urine
Metabolic disease characterised by hyperglycaemia resulting from defect in insulin secretion, production or both

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2
Q

5 types of diabetes?

A 
Type 1
Type 2 
MODY
Gestational 
Other - caused by steroids
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3
Q

What is type 1?

A

Auto immune - Pancreatic beta cells destruction

Insulin dependant

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4
Q

What is type 1 characterised by?

A

Presence of anti GAD / anti islet cell antibodies

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5
Q

When is a person thought to have type 2 diabetes?

A

When they don’t have the 1, monogenic diabetes or other medical conditions or Tx suggestive of secondary diabetes

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6
Q

What is MODY?

A

Monogenic Diabetes (genetic)

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7
Q

Secondary causes of diabetes?

A

Drugs
Pancreatic pathology
Endocrine causes

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8
Q

Who discovered insulin in the treatment of diabetes and when?

A 
Banting
Best
MacLeod 
Collio 
1922
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9
Q

How did they figure out it helped in diabetes?

A

Dog pancreas removed and treated with insulin injections

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10
Q

Who was the first person to receive insulin to treat their diabetes?

A

Leonard Thompson

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11
Q

When is type one usually diagnosed?

A

Childhood

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12
Q

What do people wit type 1 have high levels of in their blood?

A

Anti islet cell antibodies

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13
Q

What is an insulin pump?

A

It administers short acting insulin through out the day
The rate can vary depending on the demand
Amount of insulin depends on carbohydrate intake

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14
Q

What is a continuous glucose monitor?

A

Takes subcutaneous measurements and sends them to the pump

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15
Q

What does the patient still have to decide on if they have a continuous glucose monitor?

A

How much insulin to take

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16
Q

When is type 2 usually diagnosed?

A

> 40

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17
Q

What is type 2?

A

Insulin resistant

18
Q

What is the underlying physiology of type 2?

A

Insulin resistance

Beta cell dysfunction

19
Q

What happens if you are insulin resistant?

A

Problem with downstream signalling from insulin receptors so the glucose can’t get into the cells and the blood sugar rises

20
Q

What do people have before developing type 2?

A

Impaired glucose tolerance

21
Q

What are the causes of insulin resistance?

A

Ectopic fat accumulation
Increase inflammatory mediators
Reduction in insulin

22
Q

What is insulin resistance associated with?

A 
Intra abdominal obesity
Medication 
Smoking
Genetics
Inactivity 
Fetal malnutrition 
Endothelial disease
Polycystic ovaries 
Ageing 
Hypertension
23
Q

How are you tested for diabetes? (type 2)

A

Fasting glucose level >7

Given a high sugar drink and tested 2 hours later and if level >11.1 = diabetes

24
Q

Treatment for type 2?

A 
Life style changed - can stop need for meds
Oral mono therapy 
Oral combination 
Injectable and oral therapy 
Drugs - metformin / sulphonylurea
25
Q

What is the reference range when monitoring glucose ?

A

~4-6%

26
Q

What is the target range when monitoring glucose levels in diabetics?

A

6.5 - 7.5%

27
Q

What is the target glucose level pre meals and post meals?

A

Pre meal = 4-7

Post meal =

28
Q

What are the aims of therapy in diabetes?

A

Prevent hyperglycaemia
Avoid hypoglycaemia
Reduce chronic complication

29
Q

What are some macrovascular complications?

A

IHD

Stroke

30
Q

What are some microvascular complication ?

A

Neuropathy
Nephoropathy
Retinopathy

31
Q

What is diabetes the leading cause of in the UK?

A

Blindness
Dialysis
Amputation

32
Q

What is done when screening for microvascular complications?

A

Annual urinary albumin creatinine ratio to screen for kidney disease
Annual retinal photograph
Annual foot screening

33
Q

What do the CVR guidelines state about statins?

A

Give them to diabetics >40 regardless of baseline cholesterol

34
Q

What happens when glucose falls?

A

Release of counter regulatory hormones

Stimulate glycogenolysis

35
Q

What is reduced hypoglycaemia awareness?

A

Repeated exposure to hypo reduced warning signs

36
Q

Precipitating factors of hypoglycaemia?

A 
Dosage of insulin 
Error in does administered
Timing of meds
Alcohol 
Exercise
Renal, adrenal, pituitary insufficiency
37
Q

What is DKA?

A

Diabetic Ketoacidosis

38
Q

What is HNC/HONK?

A

Hyperosmolar non ketotic coma

39
Q

What type of diabetes do DKA and HNC/HONK occur?

A 
DKA = type 1
HNC/HONK = type 2
40
Q

Precipitating factors of DKA

A 
Acute illness
Injury or infection 
Medications
Poor compliance or error in compliance with tx
Psychological / social issues
41
Q

What other conditions does diabetes make people at risk to?

A

Stroke
Visual impairment
Renal disease
Cardiovascular disease

42
Q

Why is there an increased risk of a hyper/hypo in patients with tooth ache

A

Poor oral intake
Sepsis
Sleep deprivation
All resulting in pt modifying their normal drug regime

CMS Revision (12 decks)

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