Diabetes Flashcards
(112 cards)
1
Q
what is type 1 DM
A
autoimmune disorder resulting in absolute insulin deficiency due to beta cell failure
2
Q
when/how do symptoms occur in type 1 DM
A
acute onset pre-school and during puberty
3
Q
what are the symptoms of type 1 DM
A
severe weight loss ketonuria +/- metabolic acidosis thirst polyuria thrush weakness/fatigue diabetic ketoacidosis
4
Q
what are the investigations of type 1 DM
A
autoimmune markers
raised ketones in urine
low c-peptide levels
5
Q
what are the autoimmune markers of type 1 DM
A
GAD tyrosine phosphates: - IA-2 - IA-2 beta - ZnT8 HLA association - DQ8 - DQ4
6
Q
what is the treatment of type 1 DM
A
insulin dependent
7
Q
what is Autoimmune Diabetes of Adults (LADA)
A
this is late onset of type 1 DM
8
Q
what are the typical symptoms of Autoimmune Diabetes of Adults (LADA)
A
same as type 2 DM symptoms
non-obese
associated autoimmune conditions
9
Q
what is the common age affected by Autoimmune Diabetes of Adults (LADA)
A
25-40
10
Q
what are the investigations of Autoimmune Diabetes of Adults (LADA)
A
autoantibody positive
11
Q
what HbA1c suggest diabetes, what is normal
A
diabetes = 48 and above normal = 41 and lower
12
Q
what fasting glucose suggests diabetes, what is normal
A
diabetes = 7 and above normal = 6 and below
13
Q
what results in a OGTT suggests diabetes, what is normal
A
diabetes = 11.1 and above normal = 7.7 and below
14
Q
what random glucose suggests diabetes
A
11.1
15
Q
what does HbA1c provide a measure of
A
average glucose control over the past 2-3 months
16
Q
who should be tested for diabetes, how often
A
women with GDM = tested every 3 years
pre-diabetes = tested yearly
17
Q
when should repeat testing be carried out for diabetes diagnosis
A
In the absence of unequivocal hyperglycaemia results
18
Q
what is type 2 DM
A
relative insulin deficiency involving hyperinsulinemia and insulin resistance
19
Q
when/how do the symptoms of type 2 DM start
A
middle aged/elderly over a few months - years
20
Q
what are the symptoms of type 2 DM
A
thirst polyuria thrush weakness/fatigue blurred vision weight loss
21
Q
what type of diabetes presents with microvascular disease
A
type 2 DM
22
Q
what tests are done to diagnose diabetes
A
Fasting plasma glucose 2hr plasma glucose during oral glucose tolerance test (OGTT) HbA1C C-peptide (plasma) Random plasma glucose
23
Q
what are the macrovascular complications of type 2 DM
A
heart disease/atheroma
stroke
24
Q
what are the microvascular symptoms of type 2 DM
A
neuropathy
retinopathy
nephropathy
25
how is type 2 DM treated
in order:
lifestyle changes (lower BMI)
treat other CVD risk factors
lower blood glucose via drugs
26
what blood glucose should be aimed for in type 2 DM if >70
53
27
what blood glucose should be aimed for in type 2 DM if <70
48
28
what is the first line drug in type 2 DM if treatment
metformin
29
what is the 2nd line drug treatment of type 2 DM
add a second drug to metformin. usually a sulphonylurea
30
what is the 3rd line drug in treatment of type 2 DM
add a glitazone
31
what is
| Maturity-onset diabetes of the young (MODY)
this is a type of monogenic diabetes with a genetic defect in beta function. familia former early-onset type 2 DM
32
what are the causes of
| Maturity-onset diabetes of the young (MODY), which is more common
autosomal dominant mutation in:
- glucokinases
- transcription factors (MODY) = 75%
33
what would make you suspect Maturity-onset diabetes of the young (MODY)
onset before 25
strong family history
GAD negative
c-peptide positive
34
what is the symptoms of Maturity-onset diabetes of the young (MODY) caused by impaired glucokinase activity
onset at birth
| stable hyperglycaemia
35
what is the treatment of MODY caused by impaired glucokinase activity
diet
36
what is the link between glucokinase and insulin production
Glucokinase acts as the pancreatic glucose sensor
| If glucokinase activity is impaired the blood glucose threshold for insulin secretion is increased
37
what is the symptoms of MODY caused by mutation in transcription factors
onset = adolescence/young adult
progressive hyperglycaemia
frequent complications
38
what is the treatment of MODY caused by mutation in transcription factors
diet, medication, insulin
39
when can sulphonylureas be used to treat MODY
if mutation is in HNFA1
40
what are the two types of neonatal diabetes
transient
| permanent
41
when is transient neonatal diabetes diagnosed, when does it resolve
diagnosed <1wk
| resolved at 12 wks
42
how is transient neonatal diabetes treated
insulin until it resolves
43
when is permanent neonatal diabetes diagnosed
0-6wks
44
what is the treatment of permanent neonatal diabetes
lifelong insulin or sulphonylureas
45
what is the cause of permanent neonatal diabetes
potassium channel gene mutations
46
what symptom must be asked about in a child with suspected diabetes
new bed wetting
47
what symptoms must be asked about in a child with suspected DKA
abdominal pain
vomiting
heavy breathing
48
what is type 3 diabetes
gestational diabetes
49
what is gestational diabetes
any degree of glucose intolerance arising or diagnosed during pregnancy
50
when does gestational diabetes usually occur
2nd or 3rd trimester
51
what is the treatment of gestational diabetes during labour
maintain blood glucose via IV insulin and dextrose
52
what is the treatment of gestational diabetes
lifestyle
metformin
insulin
53
what investigation should be done after giving birth? when?
fasting glucose or OGTT 6wks postnatal to ensure resolution
54
what is type 4 DM
diabetes secondary to another conditions
55
what conditions can cause type 4 DM
```
CF
haemochromatosis
cushing's
acromegaly
Pheochromocytoma
```
56
what drugs can cause type 4 DM
Glucocorticoids
Diuretics
B-blockers
57
what is diabetic ketoacidosis (DKA)
a disordered metabolic state that usually occurs in the context of an absolute or relative insulin deficiency accompanied by an increased in counter-regulatory hormones
58
what conditions can cause DKA, which is more common
Type 1 DM = more common
| type 2 DM
59
what are the symptoms of DKA
```
flushed
vomting
abdominal pain/tenderness
breathless
coma
```
60
what are the biochemical markers that should be checked in a diagnosis of DKA
```
ketoaemia
significant ketonuria (++)
blood glucose
Bicarb
Venous pH
CK
Sodium
K
Blood ketones
```
61
what Bicarb would you suspect in DKA
<15
| severe <10
62
what venous pH would you suspect in DKA
<7.3
63
what ketoaemia would you suspect in DKA, what else could you measure
>3
| OR significant ketonuria (++)
64
what Blood Glucose would you suspect in DKA, when would you not need this
>11
| BG is not needed if the patent is already known diabetic
65
what CK would you suspect in DKA
raised
66
what Na and K would you suspect in DKA
Na = low
| K >5.5
67
what blood ketones would you suspect in DKA
>5
68
what amylase and lactate levels would you suspect in DKA
raised
69
what is the treatment of DKA
```
replace losses:
- fluid (0.9% NaCl, switch to dextrose once glucose <15)
-insulin
-K
prophylactic LMWH
monitor ketones
```
70
how are ketones monitored in DKA
measure beta-hydroxybutyrate (optimum meter) in blood
| measure acetoactate in urine
71
what is hyperglycaemic hyperosmolar syndrome
a complication of diabetes in which high blood sugar results in high osmolarity without significant ketoacidosis
72
what are the risk factors to getting hyperglycaemic hyperosmolar syndrome
elderly
type 2 DM
steroids
73
what are the biochemical markers of hyperglycaemic hyperosmolar syndrome
```
Hypovolaemia (usually marked)
Hyperglycaemia >30
No/mild ketonaemia
Bicarb >15
Venous pH >7.3
```
74
what causes alcoholic ketoacidosis
excessive consumption of alcohol
75
what biochemical markers would you expect to find in alcoholic ketoacidosis
```
dehydrated
ketonaemia >3
significant ketonuria (++)
Bicarb <15
venous pH <7.3
glucose normal but may be low
```
76
what causes lactic acidosis
build up of lactate resulting in a low pH
77
treatment of alcoholic ketoacidosis
```
IV pabrinex = high dose vitamins
IV fluids = particularly dextrose
IV anti-emetics
Insulin may be required on occasion
Address alcohol dependency
```
78
what are the symptoms of alcoholic ketoacidosis
Abdominal pain
Vomiting
Hypotensive
tachypnoeic
79
what are the types of lactic acidosis
A and B
80
what is type A lactic acidosis associated with
tissue hypoxaemia (infarct, sepsis, haemorrhage)
81
when might type B lactic acidosis occur
liver disease
diabetes/ DKA
leukaemic states
82
what is the treatment of lactic acidosis
Treat underlying condition
Fluids
Antibiotics
Withdraw offending medication
83
what are the symptoms of lactic acidosis
Hyperventilation
Confused
Coma if severe
84
what biochemical markers would you expect in lactic acidosis
Reduced bicarb
Glucose variable (often raised)
Absence of ketonaemia
Raised phosphate
85
when should diabetes tested for in asymptomatic patients
if they are >45 with a BMI >25 (or >23 if asian) and have 1 risk factor
86
what risk factors would make you consider screening for diabetes
```
First degree relative with diabetes
High-risk ethnicity (non-white)
History of CVD
Hypertension
high HDL cholesterol
Polycystic ovary syndrome
```
87
how often should diabetes testing be carried out in those with risk factors
minimum of every 3 years
88
how often should a woman who had gestational diabetes be tested
minimum of every 3 years
89
what class of drugs metformin
biguanides
90
what is the mechanism of action of metformin
stimulates AMP-activated protein kinase (AMPK) to reduce hepatic gluconeogenesis.
this decreases insulin resistance and reduces hepatic glucose output
91
what are the contraindications to metformin
Significant hepatic disease
Significant renal disease (CKD)
Excessive alcohol consumption = risk of lactic acidosis
92
give examples of Sulfonylureas
gliclazide, glipizide
93
what is the mechanism of action of Sulfonylureas
cause pancreatic beta cells to secrete insulin by displacing the binding of ADP from the SUR1 subunit which blocks the KATP channel
increases secretion of insulin
94
what are the side effects of Sulfonylureas
weight gain
hypoglycaemia
abnormal LFTs
95
what are the contraindications of Sulfonylureas
pregnancy
| CDK
96
give examples of glinides
repaglinide
97
what are the contraindications to glinides
hepatic impairment
pregnancy
breast feeding
98
when would glinides be used
if the patient has CKD
99
give examples of SGLT2 inhibitors
dapagliflozin, canagliflozin, empagliflozin
100
what is the mechanism of SGLT2 inhibitors
selectively blocks the reabsorption of glucose by SGLT2 un the proximal tubule of the kidneys
101
what is the side effect of SGLT2 inhibitors
aids weight loss
UTI
thrush
102
give an example of a glitazone
pioglitazone
103
when is gliazones used the treatment of type 2 DM
3rd line
104
what are the side effects of gliazones
weight gain
fluid retention
increased incidence of bone fracture
105
what is the mechanism of action of gliazones
enhance the action of insulin at target tissues but do not directly affect insulin secretion i.e. they reduce insulin resistance
106
give examples of incretin analogues
extenatide, liraglutide
107
what is the mechanism of action of incretin analogues
mimic the action of GLP-1, bind to receptors to increase intracellular cAMP concentrations which stimulates insulin expression and release.
108
how is incretin analogues administered
SC
109
what are the side effects of incretin analogues
nausea
pancreatitis
NO hypoglycaemia
110
what is the mechanism of action of gliptins
competitively inhibits GLP-1 and GIP by the enzyme DPP-4 causing the plasma tireless insulin
111
give examples of gliptins
sitagliptin (most common), saxagliptin, vildagliptin, linagliptin, alogliptin
112
what are the side effects of gliptins
nausea
