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Flashcards in Diabetes Deck (37):
1

Features of metabolic syndrome?

Increased BP
Increased waist circumference
Increased TGs
Increased fasting glucose
Reduced HDL

2

Catabolic hormones that are involved in diabetic ketoacidosis?

Glucagon
Catecholamines
Cortisol
GH

3

What type of diabetics get DKA?

Type 1 only

4

Process of ketoacidosis development in T1DM?

1) Glucagon = Increased PEPCK = more gluconeogenesis = less oxaloacetate

2) Therefore acetyl CoA accumulates

3) In T1DM, no insulin = hormone sensitive lipase activation = lipolysis = ketogenesis

5

Main complications of diabetes?

• Retinopathy

• CVD (2-3x risk of CHD or stroke)

• Nephropathy (leading cause of kidney transplants)

• Erectile dysfunction (~50% of men with long term diabetes)

• Foot problems

6

What is charcot arthropathy?

Bone & joint destruction from minimal trauma, common in diabetics

7

In what situations should metformin not be used?

Patients with AKI

Acutely unwell/dehydrated patients (lactic acidosis risk)

8

Mode of action of the sulphonylureas? example of one?

Stimulate the pancreas to release insulin, gliclazide.

9

Example of a GLP-1 agonist?

Exanatide

10

Mode of action of GLP-1 agonists

Stimulate the release of insulin from the pancreas and delay gastric emptying.

11

When should you not use GLP-1 Agonists?

suspended in patients with N&V, due to delay in gastric emptying

12

Problems with Sulphonylureas?

Risk of hypos. cannot be used in renal impairment.

13

Mode of action of SGLT2 antagonists?

Cause raised glucose excretion in kidneys.

14

Cautions with using SGLT2 inhibitors?

- Increased UTI risk
- Used with caution with diuretics
- Suspended in dehydration
- Patients on an SGLT2 will always have positive urine dipsticks

15

What is the target for pre-meal glucose in diabetics?

4-12mmol/L

16

What is the target for bedtime glucose in diabetic inpatients?

8-10mmol/L

17

Minimum target for elderly/ill diabetics?

6mmol/L

18

Symptoms of hyperglycaemia?

• Thirst
• Polyuria
• Blurred vision
• Nausea
• Fatigue
• Headaches
• Drowsiness

(imagine being drunk)

19

Blood glucose level to be considered a hyper- or a hypoglycaemia?

>12mmol/L hyper

20

Symptoms of hypoglycaemia?

• Sweating
• Palpitations
• Shaking
• Hunger
• Confusion
• Drowsiness
• Speech difficulty
• Headache
• Nausea

21

What other conditions are usually present in metabolic syndrome?

Obesity
NAFLD
Vascular and clotting abnormalities

22

Three areas of the body that insulin causes the uptake of glucose?

Muscle, fat, liver

23

How does glucagon and insulin effect hepatic release of glucose?

Glucagon causes the release of PEPCK, which stimulates hepatic glucose release

Insulin directly inhibits hepatic glucose output.

24

How does pancreatic islet destruction lead to hyperglycaemia in T2DM?

Alpha cells hypertrophy and release more glucagon.

Beta cell number decreases, less insulin is released.

25

Biochemical features of DKA?

Ketosis- raised ketone bodies (urine)

Acidosis- reduced pH (blood gases)

Hyperglycaemia- raised blood glucose

26

Causes of diabetic foot ulceration?

Neuropathy

Ischaemia (peripheral vascular disease, small vessel disease)

Infection

27

Two main types of insulin administration regimens?

Premixed insulin - has both a short acting and a basal component

Basal - bolus insulin take long acting once daily and short acting with food.

28

Percentage of inpatients with diabetes?

15-20%

29

hospital actions that can promote safe diabetes care?

Identification of diabetic patients

Appropriate blood glucose monitoring

Action on abnormal BG trends

Care of foot disease

30

If a diabetic patient is eating less, how would you adjust their insulin?

reduce fast one, review long acting, but never withhold

31

How many times do you do BG monitoring for a stable patient with diet controlled diabetes?

Once a week

32

How many times do you do BG monitoring for a patient with insulin/medication controlled diabetes?

Twice a day

33

Causes of hyperglycaemia in diabetic patients?

Missed medication

DKA or HHS

Infections

Steroid/antipsychotic medication

Other pancreatic disease

34

Actions to consider in a hyperglycaemic attack?

Assess the patient (Drowsy, vomiting)

Insulin dose right?

Exclude DKA/HHS

check ABG, VBG, U&E etc

perform full exam for sepsis

35

When might you use a variable rate IV insulin infusion? (sliding scale)

Recurrent vomiting

Severe illness

36

Causes of hypoglycaemia in hospital?

Missed, smaller or delayed meals

Change in timing of the usual largest meal of the day, snacks

Nausea & vomiting

? Gastric surgery

Reduced appetite

Excess insulin (wrong dose given etc.)

37

What is lipohypertrophy?

Build up of fat in the skin due to repeated use of same injection sites