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Diabetes Flashcards

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1
Q

What is C-peptide indicative of?

A

Endogenous insulin production

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2
Q

Ketosis is characteristic of Type _ diabetes

A

type 1

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3
Q

What is the use of HbA1c in diabetes monitoring?

A

HbA1c is a measure of blood glucose control over past 2-3 months

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4
Q

What can be used in diagnosis of Diabetes?

A

Oral Glucose tolerance test

Fasted blood glucose

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5
Q

What is T1DM?

A

A state of absolute insulin deficiency

-autoimmune destruction of pancreatic Beta cells in response to an environmental trigger in a generically susceptible individual

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6
Q

What mutations are present in a large proportion of T1DM patients?

A

HLA gene mutations

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7
Q

What is the management of T1DM?

A

insulin injections

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8
Q

What is monitored in T1DM patients?

A

Blood glucose and ketone
HbA1c - check glycaemic control
Renal function
Lipids

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9
Q

In T1DM management, what is the aim of basal bolus insulin injections?

A

Mimicking endogenous insulin production

-inject insulin before meals

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10
Q

Insulin resistance does not always result in diabetes (T/F)

A

True

-insulin resistance must be coupled with loss of compensatory beta-cell hyperplasia

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11
Q

What are the 3 main risk factors for T2DM?

A

genetics
obesity
lack of activty

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12
Q

What is the main action of Metformin?

A

reduction of hepatic gluconeogenesis

increases peripheral glucose uptake

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13
Q

What are the main side effects of Metformin?

A

GI upset

lactic acidosis

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14
Q

Metformin is weight neutral (T/F)

A

True

-can be used in obese patients

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15
Q

How do Sulfonylurea drugs work?

A

-block Katp potassium channels, inducing insulin secretion

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16
Q

What is the Incretin effect?

A

Increased stimulation of insulin secretion elicited by oral absorption

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17
Q

What is the mode of action of Gliptins?

A

aka DPP-4 inhibitors

-reduce glucagon and blood glucose levels by promoting incretin production

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18
Q

How do SGLT-2 inhibitors work?

A

Reduce blood glucose by blocking the sodium/glucose cotransporter, SGLT-2.

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19
Q

How does Glitazone work?

A

Enhance peripheral glucose uptake

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20
Q

What are the adverse effects of Glitazide?

A
  • increased fracture risk (fatty marrow)

- weight gain

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21
Q

What is the appropriate T2DM treatment for patients with CV disease risk?

A

metformin + SGLT2 antagonists

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22
Q

What are the types of neuropathy present in diabetes?

A
  • peripheral: pain/loss of feeling in feet, hands
  • autonomic: changes in bowel and bladder function, sexual response. sweating heart rate, blood pressure
  • proximal: pain in the thighs, hips, buttocks, leading to weakness in legs
  • focal neuropathy: sudden weakness of one nerve/group of nerves, causing muscle weakness/pain
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23
Q

Neuropathy is more common in T2DM than in T1DM(T/F)

A

False

more common in T1DM

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24
Q

How can painful diabetic neuropathy be managed?

A

Amitryptyline
Gabapentin
Preganalin

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25
Proximal neuropathy is mor common in T2DM (T/F)
True | -elderly patient with T2DM
26
What important GI complication can arise due to Autonomic Neuropathy?
Gastroparesis | -slow stomach emptying
27
What are the characteristics of Gastroparesis?
Nausea, vomiting, bloating, loss of appetite -blood glucose levels fluctuate widely
28
How is gastroparesis managed?
Diet: small frequent meals, low in fat and fibre Promotility drugs: metocopramide, Anti-nausea: Ondansetron Botulim toxin Gastric pacemaker
29
What are the risk factors for progression of Diabetic nephropathy?
- hypertension (target 130/70) - cholesterol - smoking - glycaemic control (target HbA1c <53mmol/mol) - albuminuria (start on ACE inhibitor) Control these!
30
What is a cataract?
Clouding of the lens
31
What is glaucoma?
increase in fluid pressure in the eye, cauing optic nerve damage
32
List abnormalities that cane be present on a retinal image of a diabetic patient?
HICH Haemorrhages: red dots/blots/flames IRMA: intra-retinal microvascular abnormalities Cotton Wool Spots: ischaemic areas Hard exudates: lipid breakdown products
33
What treatment is available for diabetic retinopathy?
Laser treatment Vitrectomy (vitreus gel removal) Anti-VEGF injections (inhibit angiogenesis)
34
Erectile dysfunction is a rare complication of diabetes (T/F)
False present in 50% diabetic men
35
How can diabetic erectile dysfunction be treated?
Anti-hypertensive drugs Cyclic Antidepressants Tranquilizers Sedatives Analgesics
36
What are the macrovascular complications of diabetes?
TIAs and stroke Angina and MI Cardiac failure Peripheral Vascular disease
37
What are the microvascular complications of diabetes?
Diabetic retinopathy Micro/macro-albuminuria Renal disease Erectile Dysfunction Autonomic nueropathy Peripheral neuropathy Osteomyleitis Amputation
38
What is the main purpose of dietary change in Type 2 diabetes?
weight management
39
How is glycaemic control achieved in T2DM?
-reduce total energy intake; food groups not important
40
What is the role of diet in glycaemic control for Type 1 diabetes patients?
Carbohydrate counting allows to adjust insulin dosage appropriately
41
Hypoglycaemia is likely to arise in Type __ diabetics. Why?
Type 1 - missed meals - wrong dose of insulin - high physical activity - alcohol
42
What is Glycaemic index?
Rate at which food induces a rise in blood glucose
43
What are the biochemical characteristics of blood results during Diabetic ketoacidosis?
Ketonaemia (.3mmol/L) High blood glucose (>11mmol/L) Low Bicarbonate (,15mmol/L)
44
What are the signs and symptoms of Diabetic ketoacidosis?
``` Thirst and polyuria Dehydration Flushed Vomiting Abdo pain and tenderness Breathlessness (compensation for acidosis) ```
45
What complication of diabetic ketoacidosis, occuring in young patients, can affect the brain?
Cerebral oedema -can be fatal
46
What DKA complication can arise in the lungs?
RDS (respiratory distress syndrome)
47
What DKA complication can arise in the heart?
Ventricular tachycardia
48
What GI complication of DKA can arise?
Severe stomach dilatation
49
What must be replenished as part of DKA management?
Fluid Insulin Potassium
50
What medication can exacerbate the Hyperglycaemic Hyperosmolar Syndrome in diabetic patients?
Steroids
51
What patients tend to get Hyperglycaemic Hyperosmolar Syndrome?
Elderly (or african) patients with Type 2 diabetes | -treated by diet alone
52
What are the biochemical features of Hyperglycaemic Hyperosmolal Syndrome?
High Glucose Renal impairment (creatinine) Raised sodium Raised Osmolality (~400)
53
Hyperglycaemic Hyperosmolal Syndrome is treated as DKA: fluids, insulin and potassium. (T/F)
False-ish - give fluids, but avoid fluid overload - give Insulin, but slowly - may need sodium
54
What is Type A lactic acidosis associated with?
Tissue hypocaemia | infarcts, cardiogenic shock
55
What is Type B Lactic Acidosis associated with?
Liver disease | Diabetes
56
What are the lab findings for lactic acidosis? | What is the clinical picture?
Reduced bicarbonate Raised Phosphate Raised anion gap Hyperventilation Confusion Stupor/coma
57
What is HbA1c?
Component of glycosylated haemoglobin | -formed by non-enzymatic glycation of gaemooglobin on exposure to glucose
58
What happens to glucagon in Type 1 diabetics?
It stops being produced 5 years after diagnosis
59
What is the treatment of severe hypoglycamia?
Glucagon injection | -1mg, into buttock/arm
60
What is the risk for pregnant diabetics?
- High blood glucose impairs foetal organogenesis - Babies are large - risk at delivery - Post partum hyperglycaemia - baby used to high glucose
61
Carbimazole is used for Hyperthyroidism. What's the issue in pregnancy?
Causes embryopathy
62
What should be done for a pregnant hypothyroid patient?
Increase thyroxine dosage

my Endocrinology (23 decks)

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