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Diabetes Flashcards

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1
Q

What is a Charcot foot?

A

Charcot foot is a condition of significant nerve damage causing weakening of the bones

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2
Q

What is the cause of charcot foot?

A

Neuropathy

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3
Q

What are symptoms of Charcot foot?

A

Warm to touch
Redness
Swelling
Pain/soreness

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4
Q

What are the signs of charcot foot?

A

Rocker-bottom
Muscle wasting
Hammer/claw/mallet toe

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5
Q

What is Diabetes Mellitus?

A

It is a condition that results from a lack of (T1) or reduced effectiveness of (T2) endogenous insulin

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6
Q

What vascular problems come as a result of DM? (both 1 & 2)

A

Micro: retinopathy, nephropathy, neuropathy

Macro: Stroke, MI, renovascular disease, limb ischaemia

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7
Q

What is T1DM?

A

This is an autoimmune disorder in which there is destruction of insulin-secreting pancreatic ß cells.
This leads to insulin deficiency

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8
Q

When does T1DM usually present?

A

In adolescence but it can present at any age

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9
Q

What treatment do T1DM patients need?

A

Insulin

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10
Q

What problems are T1DM patients prone to?

A

Ketoacidosis

W/L

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11
Q

What is LADA?

A

Latent autoimmune diabetes of adults

Occurs later in life, most likely after trauma/insult to the pancreas and has slow progression

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12
Q

Define T2DM

A

This is a progressive disorder characterised by the deficits in insulin secretion (dysfunction of ß- cell) and action that lead to abnormal glucose metabolism

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13
Q

What is pre-diabetes?

A

This is defined as a single fasting plasma glucose as 5.6-6.9mmol/L
or
HbA1C as 39-46mmol/mol
in the absence of diabetes

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14
Q

How do we diagnose diabetes?

A 
Two confirmed results of:
HbA1C ≥48 (>6.5%)
Fasting glucose ≥6.9
2-hour post load 75mg glucose ≥11.1
Random glucose ≥11.1 + symptoms
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15
Q

What are the risk factors of T2DM?

A 
Old age
High BMI
Gestational diabetes
Pre-diabetes
FH
Inactivity
PCOS
HTN
HLP
CVD
African Hispanic Native American ancestry
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16
Q

What are common symptoms of T2DM?

A 
Fatigue
Blurred vision
Candida (genitalia/skin fold)
Cellulitis/abscesses
UTIs
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17
Q

What other less common symptoms of T2DM are there if the diabetes is progressed?

A 
Polydipsia
Polyuria
Polyphagia
Nocturia
Paraesthesias
Acanthosis nigricans
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18
Q

What is acanthosis nigricans?

A

This is a velvety light brown marking usually on neck/armpits/groin

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19
Q

What proportion of DM is T2?

A

90% is T2DM

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20
Q

By how much does T2DM reduce your life?

A

Men 6 years

Women 7 years

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21
Q

What is metabolic syndrome?

A

Obesity with two of:

T2DM, HTN, DLP

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22
Q

What investigations do we order for suspected DM?

A

HbA1C
Fasting plasma glc
Random plasma glc
OGTT - 2-hour post load 75mg glucose

Consider:
Fasting lipid profile (DLP common in T2DM)
Urine ketones
Random c-peptide (lowest in T1)
ABPI - PAD is high in T2DM
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23
Q

What do the results of a fasting glucose mean?

A

Normal = 5.6
Pre-diabetes = 5.6 - 6.9
Diabetes > 6.9

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24
Q

What do the results of a random glucose mean?

A

Normal < 4.5-8.9
Pre-diabetes 8.9-11
Diabetes > 11.1

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25
What are differentials of DM?
``` T1 T2 Pre-diabetes LADA Gestational diabetes Diabetes Insipidous ```
26
How do we initially manage DM?
Lifestyle changes Metformin (500mg OD) Blood pressure management Statin
27
What are the initial and maximum doses of metformin?
500mg OD | Up to max 2000mg OD
28
What are the options for blood pressure management in initially treating diabetes?
A-C-D TLD (-thiazide) ACE-i (-pril) ARB (-sartan) CCB (-dipine)
29
``` Give an example of 2 of each of the following: TLD ACE-i ARB CCB ```
TLD - indapamide, hydrochlorothiazide ACE-i - ramipril, lisinopril ARB - candesartan, losartan CCS - amlodipine, nifedipine
30
What statin options (and doses) are there?
AT NIGHT Atorvastatin - 10-20mg OD up to 40-80mg OD Simvastatin - 20-40mg OD Rosuvastatin - 5-10mg OD up to 20-40mg OD
31
What should we be careful about with statins?
Check LFTs | Check interactions
32
What do we give DM patients who have CVD?
2ndary prevention for CVD so: Aspirin 75mg OD Clopidogrel 75mg OD
33
What other drugs can we add if metformin alone doesn't seem to be working?
``` Sulphonylurea (secretagogue) SGLT-2 inhibitor DPP-4 inhibitor Thiazolidinedione GLP-1 agonist ``` Basal insulin Alpha-glucosidase inhibitor Bariatric surgery
34
Name some SGLT-2 inhibitors and doses
- gliflozin Empagliflozin - 10mg OD - 25mg OD Canagliflozin - 100mg OD - 300mg OD Dapagliflozin - 5mg OD - 10mg OD
35
Name some GLP-1 agonists . and their doses
Exenatide - 5mcg SC BD Liraglutide - 0.6mg SC OD (-glutide)
36
Name 2 DPP-4 inhibitors and their doses? What does DPP stand for?
(-gliptin) Sitagliptin 100mg OD Saxagliptin 2.5g-5mg OD (Dipeptidyl peptidase)
37
What are the names of sulfonylureas (insulin secretagogues)
(Gl-zide) Glipizide 2.5-5mg Gliclazide 40 - 80mg
38
Name a thiazolidinedione
Pioglitazone
39
What glucose level is classed as a hypo?
≤3.9mmol/L
40
What are the symptoms of a hypo?
``` Tachycardia Sweating Shakiness Intense hunger Confusion ```
41
How do you deal with a hypo?
Immediately eat 15-20g fast release food ``` Sugar tablets x 5 Sweets Lucozade 100ml Juice drink 200ml 20g sugar ``` Follow this up with: sandwich piece of fruit bread
42
What to do if hypos keep occuring?
Speak to health team and reduce insulin Try to keep glucose levels higher than 5mmol/L for 3 weeks/3 months to help restore your hypo symptom sensitivity
43
How often do you assess DM patients?
3-4 months for diabetes Renal, foot function annually
44
What are other causes of DM?
``` Steroids Anti-HIV Pancreatic - itis, ectomy, trauma, cancer, destruction (haemochromatosis, CF) Cushing's PCC >HT Pregnancy ```
45
How does cushing's cause diabetes?
It raises BP and glucose levels
46
Which tests indicate impaired glucose tolerance?
FG | OGTT (2 hr 75mg)
47
What is metabolic syndrome also known as?
Syndrome X
48
Which test do we avoid in pregnancy?
HbA1C
49
What are the main symptoms of T1DM?
``` Unexplained w/l Polydipsia Polyuria Fatigue Ketosis ```
50
What might you find on bloods/urines of T1DM?
Autoantibodies Islet cell antibodies (ICA) Anti-glutamic acid decarboxylase antibodies (GAD) Ketonuria
51
When should diabetics monitor their blood glucose?
Fingerprick before a meal and after a meal
52
What do the different timings of the BM tell you?
Before a meal informs how effective your long-acting insulin has been and after a meal informs about the dose of the short-acting insulin
53
What time frame does HbA1C tell you about?
The past 8 weeks
54
Why might people lose hypoglycaemic awareness?
If control is too tight.
55
What emergency treatment do you give in A&E for hypo?
Glucagon & dextrose This is because there has been too much insulin/not enough sugar. The glucose that has been in blood is now in the cells. Glucagon helps the sugar to be released back into the blood to raise the sugar in the blood. The dextrose also helps to raise the sugar in the blood.
56
What education and lifestyle advice do we give to diabetics?
Reduce sat fats Reduce sugar Increase starch-carb Moderate protein
57
When should diabetics not drive?
If they are having hypoglycaemic spells or have lost their hypo awareness
58
What is the first line treatment for T2DM?
Metformin
59
What are the options for dual therapy? and when do we use it?
If HbA1C rises above 58: Metformin AND 1 OF Sitagliptin (DPP-4i) Pioglitazone (thiazolidinedione) Gliptazide (sulphonylurea) Empagliflozin (SGLT-2i)
60
How does metformin work?
It is a biguanide and increases insulin sensitivity
61
What are the side effects of metformin?
``` Nausea Diarrhoea Abdo pain NOT HYPO Lactic acidosis ```
62
What are the symptoms of lactic acidosis?
Unusual sleepiness Muscles cramps Stomach discomfort Shallow breathing
63
How do DPP-4 inhibs work?
Block the action of DPP-4. DPP-4 would usually destroy incretin. Incretin stimulates insulin release
64
How does piaglitazone work?
Thiazolidinedione | Increases insulin sensitivity
65
What are the size effects of thiazolidinediones?
HYPO Fractures Fluid retention >LFTs
66
What are contraindications for piaglitazone?
CCF | Osteoporosis
67
How do sulphonylureas work?
Increase insulin secretion
68
What are side effects of sulphonylureas?
HYPO | increase in weight
69
How do SGLT-2 inhibitors work?
They inhibit the sodium glucose transporters in the kidney and promote excretion of glucose
70
What is glipazide?
Sulphonylurea
71
What is empagliflozin?
This is a SGLT-2 inhibitor
72
What sitagliptin?
DPP-4 inhibitor
73
Which drugs give you a risk of HYPO?
Sulphonylurea Thiazolidinediones Insulin
74
Which drugs give you a risk of lactic acidosis?
Metformin
75
What do you need to know about the patient's insulin before you prescribe it to them?
``` How many units? How often? Which route? Brand of drug? When they take it? ```
76
What are the side effects of insulin?
Hypoglycaemia Hard lumps/bruises if reused injection site Hypokalaemia
77
Why can you get hypokalaemia with too much insulin?
Insulin transporter also moves K+ into cells
78
How do we reduce the chances of microvascular complication in DM?
Good control of hyperglycaemia
79
List the complications of diabetes that can occur
``` Vascular disease Nephropathy Neuropathy Retinopathy Diabetic feet Metabolic DKA Hypo ```
80
How do we diagnose diabetic CKD?
eGFR of <60 Albuminuria (micro or not) indicates nephropathy
81
How do we treat DKD?
Aggressively manage SBP ACEi ARB Glucose control
82
How much more at risk are diabetes of MI?
Twice more than without diabetes
83
How do we manage/prevent macrovascular diseases?
``` BP (ACEi) Aspirin Diuretics Lipids (statin) Tobacco use ```
84
What is it about the diabetes that increases your risks of complications?
Uncontrolled BP Bad glucose control Lipids Tobacco
85
What is a DKA? and what is an HHS?
Diabetic ketoacidosis is when there is almost no circulating insulin leading to hyperglycaemia but with no glucose in the tissues. Lack of glucose in the tissues leads to both lipids and ketones being released. Ketones are acidic. If there is just enough insulin, the hormones react to produce more glucose from the liver, this leads to a hyperosmolar, hyperglycaemic state. The hyperosmolar state arises from the glycosuria and loss of water from hyperglycaemia.
86
Which tests are performed at an annual review?
``` BP BMI HbA1c UEs Lipids Urinanalysis ```
87
What are the different types of insulin?
Fast acting Rapid acting Slow release Biphasic
88
What does loss of weight mean for the body and insulin in T2 diabetes?
Improve islet cell action Reduces insulin resistance Improves insulin sensitivity with or without weight loss. Reduces BP, Glc and lipids
89
What are the main side effects of insulin?
Weight gain | Hypoglycaemia
90
What do you risk if you don't take your insulin in T1DM?
DKA
91
What do you risk if you don't take your metformin?
HHS
92
What are the main side effects of metformin?
Weight gain Diarrhoea/Nausea/Vomiting Weakness Lactic acidosis
93
What's the drug scaling ladder of T2DM?
Metformin plus exercise plus sulfonylurea/dpp4/GLP1 etc insulin

Endocrinology (8 decks)

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