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ENDOCRINE - RIA > diabetes > Flashcards

diabetes Flashcards

(56 cards)

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1
Q

name a SULFONYUREA

A

gliclazide

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2
Q

how do sulfonyureas (e.g. gliclazide) work?

A

They work by increasing pancreatic insulin secretion

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3
Q

Common side effects of sulfonyureas?

A

weight gain and hypoglycaemic episodes

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4
Q

Name a THIAZOLIDINEDINOE and how do they work?

A

Pioglitazone

Agonists to PPAR-gamma recepor and reduce peripheral resistance to insulin

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5
Q

Common side effects of thiazolidinediones?

A

weight gain, liver impairment, fluid retention

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6
Q

what is Myxoedema coma

A

acute medical emergency defined by extremely low thyroid hormone levels

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7
Q

presenting symptoms of myxoedema coma

A
  • LoC
  • hypothermia
  • confusion
  • coma
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8
Q

precipitating factors for myxoedema coma

A
  • infection
  • hypothermia
  • CHF
  • trauma
  • electrolyte imbalance
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9
Q

management of myxoedema coma

A

1) resuscitation: ventilation, IV fluid resus, vasoactive agents,
2) for acid base and electrolytes: supportive care, glucose, manage Na

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10
Q

specific therapy for management myxoedema coma

A

Hydrocortisone 100mg 6 hourly

replacement of thyroid hormone

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11
Q

what is T1DM characterised by

A

inability to produce/secrete insulin due to autoimmune destruction of the beta cells in the pancreatic islets of Langerhan

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12
Q

what is T2DM characterised by

A

combination of peripheral resistance & inadequate insulin secretion

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13
Q

human leucocyte antigens assoc with T1DM

A

HLA-DR4

HLA-DR3

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14
Q

what are the 3 main insulin regimes for T1DM

A

1) Basal-bolus regime
2) One, Two or three injections per day regime
3) Continuous insulin infusion via a pump

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15
Q

frequency of blood glucose monitoring per day in T1 diabetic

A

at least 4 times a day e.g. 3 times, before each meal & before sleeping

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16
Q

T1 diabetic target on waking?

A

5-7 mmol/L (fasting)

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17
Q

T1 diabetic target before meals

A

4-7 mmol/L

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18
Q

T1 diabetic post meals

A

test after 90 minutes: 5-9 mmol/L

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19
Q

what is HbA1c

A

measure of glycated haemoglobin, indicative of average blood glucose over 3 months

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20
Q

HbA1c target in T1 diabetic

A

< 48 mmol/L

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21
Q

annual screening in T1 diabetic for what?

A
  • Retinopathy
  • Nephropathy (eGFR & ACR
  • Diabetic foot problems
  • CV risk factors
  • Thyroid disease
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22
Q

Name the non-proliferative features of diabetic retinopathy

A

Background: dot & blot haemorrhages, hard exudates, cotton wool spots

Pre-proliferative: intraretinal microvascular abnormalities, venous beading

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23
Q

Proliferative diabetic retinopathy features?

Study These Flashcards
A

New vessels at the disc, fibrosis, traction retinal detachment

24
Q

Maculopathy diabetic retinopathy features

Study These Flashcards
A

Exudates, oedema & NVE

25
how to manage proliferative diabetic retinopathy?
Photocoagulation
26
marker of systemic microvascular damage to kidneys?
microalbuminuria
27
what is gastoparesis
delayed gastric empyting leading to vomiting
28
complex neuropathic arthropathy that results from loss of sensation & subsequent repeated micro-trauma to foot
Charcot's joint
29
triad of DKA
- Hyperglycaeamia - Ketonaemia - Acidosis 1) Glucose > 11.0 or known DM 2) Ketones >3 or sig on dipstick 3) venous pH < 7.3 or bicard <15.0
30
precipitants for DKA?
- infection - non compliance - inappropriate dose alteration - new diagnosis of DM - MI
31
sweat pear drop smell
ketotic breath
32
DKA bedside tests
- urine pregnancy - unrinanalysis +/- MSU - ECG
33
Blood tests for DKA
- FBC - U&E - CRP - LFTs - blood cultures - Trop
34
management of DKA (3)
1) Fluid resuscitation 2) Potassium replacement 3) Fixed rate IV insulin infusion
35
how is IV insulin infusion set up for DKA?
mixing 50 units of short acting insulin (actrapid) with 50 mls of 0.9& normal saline
36
clinically significant hypoglycaemia is defined as?
Glucose < 3.0 mmol/L
37
what should a formal diagnosis of hypoglycaemia be based on?
Whipples triad
38
what is whipples triad
1) Low blood glucose concentration 2) symptoms of hypoglycaemia 3) reversal of symptoms when blood glucose conc is restored to normal
39
which T2DM are at risk of hypoglycaemia?
those being treated with insulin or sluphonylureas
40
symptoms of low glucose
- anxiety - tremor - palpitatons - sweating - hunger - paraesthesia
41
environmental risk factors for T2DM
- poor dietary habit (low fiber, high GI diet) - low birth weight - medications - PCOS - history of GDM
42
role of GLUT-4 & where are they located
activation of insulin receptor initiates translocation of glucose receptor which is found in the cytosol of adipose & striated muscle (allowing movement of glucose intracellularly)
43
when is HbA1c a non reliable investigation?
- EPO use - Iron deficiency - CKD - alcoholism - haemolysis - splenectomy -
44
mechanism of metformin
biguanide. inhibition of hepatic gluconeogenesis whilst peripheral insulin sensitivity & enhancing peripheral uptake of glucose
45
when should dual therapy for T2 diabetics be introduced?
HbA1c > 58
46
name groups of antidiabetic medications
1) Sulfonyurea 2) Dipeptidyl peptidase-4 inhibitor (DPP-4i) 3) Thiazodidinediones e.g. Pioglitazone 4) SGLT-2i
47
HbA1c aim in a T2DM patient with lifestyle mod & single antidiabetic emd
< 48
48
HbA1c aim in a T2DM patient on a medx associated with hypoglycaemia
< 53
49
2 major acute complications with T2DM
1) Hypoglycaemia | 2) HHS - Hyperosmolar hyperglycaemic state
50
HHS characterised by? (4)
1) Hypovolemia 2) Hyperglycaemia 3) Mild/absent ketonaemia 4) High osmolality
51
diagnosis of HHS (3)
- marked hyperglycaemia - raised serum osmolality - mild/absent ketonaemia
52
example and side effects of sulfonyureas? & mechanism
Gliclazide: augments insulin secretion se: weight gain & increased hunger
53
side effects of metformin?
- N& v - diarrhoea - abdo pain - decreased B12 absorption
54
DDP4 inhibitor - example - mechanism - side effects
- gliptins - increase incretin levels which inhibit glucagon secretion & reduce blood glucose - headaches, dizziness, nausea
55
Thiazolidinedione - example - mechanism - side effects
Glitazones - decrease peripheral insulin resistance to decrease blood glucose - weight gain, eyesight
56
GLP-1 agonists mechanism
increase insulin secretion and decrease insulin degradation

ENDOCRINE - RIA (7 decks)

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