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Diabetes Flashcards

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1
Q

Give 3 complications of pregnancy that are associated with diabetes

A
  1. Congenital abnormalities
  2. Accelerated growth
  3. IUGR (intrauterine growth restriction
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2
Q

Which anabolic hormone is principally involved in intermediary metabolism?

A

Insulin

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3
Q

Define intermediary metabolism

A

The intracellular process by which nutritive material is converted into cellular components

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4
Q

Name the 4 catabolic hormones that are involved in intermediary metabolism

A
  1. Glucagon
  2. Catecholamines
  3. Cortisol
  4. Growth hormone
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5
Q

Name the 3 processes by which inadequate insulin action (leading to hyperglycaemia) may occur

A
  1. Reduced insulin production
  2. Reduced insulin target organ sensitivity
  3. Overwhelming increase in catabolic hormones
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6
Q

Define Diabetes Mellitus

A

A reduction in insulin action significant enough to cause a level of hyperglycaemia that, over time, will result in diabetic specific, microvascular (capillary) pathologies in the eyes, kidneys and nerves.

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7
Q

What is non diabetic hyperglycaemia?

A

Reduced insulin action resulting in hyperglycaemia but not of a sufficient degree to cause microvascular damage

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8
Q

What is the most common cause of end stage kidney disease (ESKD)?

A

Diabetes

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9
Q

Roughly, what is the ratio between type 1 and type 2 diabetics?

A

1:9

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10
Q

What % of patients with non diabetic hyperglycaemia (NDH) are thought to progress to T2DM each year?

A

5-10%

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11
Q

What level of HbA1c is considered diagnostic for Diabetes Mellitus?

A

> 48mmol/mol

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12
Q

Give the HbA1c range for those individuals considered to have non diabetic hyperglycaemia

A

42-47 mmol/mol

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13
Q

What is MODY?

A

Maturity onset diabetes of the young - autosomal dominates genetic defect that leads to hereditary diabetes. Distinct from either type 1 or type 2 diabetes

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14
Q

Name 3 diseases of the exocrine pancreas that can result in diabetes

A
  1. Pancreatitis
  2. Cancer
  3. Cystic fibrosis
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15
Q

Name 3 endocrinopathies that can cause diabetes

A
  1. Cushing’s
  2. Acromegaly
  3. Pheochromocytoma
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16
Q

Give 2 classes of drugs that can give rise to drug induced diabetes

A
  1. Steroids

2. Antipsychotics

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17
Q

Briefly differentiation between the pathophysiology of type 1 and type 2 diabetes

A

Type 1 - beta cell destruction + organ specific autoimmunity
Type 2 - Insulin resistance and beta cell dysfunction

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18
Q

Contrast the appearance of ketosis in Type 1 and Type 2 diabetes

A

Type 1 - Ketosis prone

Type 2 - Ketosis resistant

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19
Q

Give 3 non modifiable risk factors for the development of insulin resistance

A
  1. Age
  2. Family history
  3. Ethnicity
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20
Q

Give 2 ethnicities that have a greater susceptibility to developing type 2 diabetes

A
  1. Afro-carribean

2. South east asian

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21
Q

Give 3 modifiable risk factors that are associated with the development of insulin resistance

A
  1. Diet composition
  2. Lack of exercise
  3. Overweight/ Obesity
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22
Q

Give 3 potential causes of polyuria

A
  1. Diabetes mellitus
  2. Diabetes Insipidus
  3. Hypercalcaemia
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23
Q

Define diabetes insipidus

A

Deficiency or resistance to the action of vasopressin leadings to excessive water loss (polyuria) accompanied by polydipsia.

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24
Q

Name the 2 types of diabetes insipidus

A
  1. Central

2. Nephrogenic

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25
What is the pathophysiology of central diabetes insipidus?
Either as a result of pathology in the pituitary gland resulting in inhibited vasopressin release from the posterior pituitary or a congenital abnormality that affects the synthesis of the hormone.
26
What is the pathophysiology of nephrogenic diabetes insipidus?
Resistance to the action of vasopressin in the kidney resulting in excessive water loss from the renal tubule
27
Give 3 potential causes of nephrogenic diabetes insipidus
1. Electrolyte disturbance 2. Renal disease 3. Drug toxicity (particularly lithium)
28
What blood concentration is used to define hypercalcemia?
10.5 mg/dL
29
Define the hyperglycaemic emergency associated with type 1 and type 2 diabetes respectively
Type 1 - Diabetic ketoacidosis | Type 2 - Hyperosmolar hyperglycaemic state
30
What are the 3 main treatment goals for diabetes?
1. Minimise treatment side effects 2. As near normal blood glucose as possible 3. Cardiovascular risk management
31
Give 3 patient psychological factors which are important when considered treatment adherence
1. Locus of control 2. Motivation 3. Self esteem
32
Compare the possible routes of administration of quick and slow acting insulins
Quick acting - Subcutaneous or IV | Long acting - can only be administered subcutaneously
33
Give an example of a biguanide drug used in the treatment of T2DM
Metformin
34
Name a thiazolidenedione
Pioglitazone
35
Broadly, what is the mechanism of action of Pioglitazone?
Reduces degree of insulin resistance
36
Name 2 drug classes which act by increasing beta cell activity
1. Sulphonylureas | 2. Meglitinides
37
Give 3 examples of sulphonylureas drugs
1. Gliclazide 2. Glipizide 3. Glibenclamide
38
Give 2 examples of meglitinides
1. Nateglinide | 2. Repaglinide
39
Name 2 drug classes that act by increasing GLP1 activity
1. DPP4 inhibitors | 2. Incretins
40
Name 4 DPP4 inhibitors
1. Sitagliptin 2. Vildagliptin 3. Linagliptin 4. Alogliptin
41
Give 2 examples of GLP1 agonists
1. Exenatide | 2. Liraglutide
42
Classify the drug Acarbose
alpha-glucosidase inhibitor
43
What is the mechanism of action of Acarbose?
alpha-glucosidase inhibitor which serves to slow the absorption of glucose
44
Which drug class serves to increase glucose excretion?
SGLT2 antagonists
45
Give 3 examples of SGLT2 antagonists
1. Dapagliflozin 2. Canagliflozin 3. Empagliflozin
46
Which medication class used in the treatment of T2DM is associated with increased incidence of UTI?
SGLT2 inhibitors
47
Give 3 drug classes used in the treatment of T2DM which can be associated with weight loss
1. Metformin 2. Incretins 3. SGLT2 inhibitors
48
Which T2DM drug is associated with the development of osteoporosis as a potential side effect?
Pioglitazone
49
What are the 7 annual checks required in all patients with diabetes?
1. Lipids - Total cholesterol 2. Lipids - HDLC 3. Lipids - Total cholesterol/HDLC 4. UACR 5. eGFR 6. Foot exam: intact pulses, palpable pulses and no deformities 7. Diabetic eye screening program
50
Define secondary prevention of diabetic complications
Preventing early manifestations of tissue damage progressing to the point of threatening organ function
51
What are the aims of complex (salvage) therapies for advanced diabetic complications?
To restore or reproved function to a functionally impaired organ
52
What are the 4 main eye diseases that have an increased incidence in diabetic patients?
1. Diabetic retinopathy 2. Diabetic macula oedema 3. Glaucoma 4. Cateracts
53
Name the 2 principle stages of diabetic retinopathy
1. Non-proliferative | 2. Proliferative
54
What are the primary prevention methods for preventing blindness in diabetic patients?
1. Blood Glucose control | 2. Control BP
55
What is the salvage therapy for blindness secondary to diabetes for some patients?
Vitrectomy
56
Kidney failure in the context of chronic kidney disease is define at what eGFR value?
<15
57
What is diabetic cheiroarthropathy?
Skin thickening and limiting mobility in the hands and figures secondary to uncontrolled diabetes. Often identified by a positive prayer sign on clinical examination.
58
Give an ethnic group in which heart failure has been identified as a more common presentation that in the general population
South Asian
59
Classify and give an indication for the drug Tropicamide
Acts as a mydriatic agent, often used to dilate the pupil before fundoscopy
60
What are the 3 main diabetic emergencies?
1. DKA 2. HHS 3. Severe Hypoglycaemia
61
What are the 3 principle physiological components of DKA?
1. Hyperglycaemia 2. Hyperketonemia 3. Acidosis
62
What are the 5 principle clinical features of DKA?
1. Hyperventilation (due to metabolic acidosis) 2. Vomiting (due to ketosis and hyperglycaemic gastric stasis 3. Dehydration (Osmotic diuresis and vomiting) 4. Hypotension with warm peripheries (dehydration and vasodilation) 5. Decreased conscious level (due to severe hypotension)
63
Outline the 5 metabolic characteristics of DKA?
1. Water deficiency 2. Hyponatraemia 3. Hypokalaemia 4. Hyperglucaemia 5. Metabolic acidosis
64
What are the 2 pathophysiological causes of raised urea and creatine levels seen in DKA?
1. Muscle breakdown | 2. Hypotensive AKI
65
Recall the '6 ways to prevent disaster' when either DKA or HHS has developed
0. NEVER STOP BASAL INSULIN 1. Fluid resuscitation - to prevent hypovolemic shock 2. Airway protection if the patient is comatosed - prevent aspiration pneumonitis 3. Careful IF fluid titration - in order to avoid cerebral oedema 4. Monitor/ replace K+ - to prevent fatal arrhythmia 5. Prophylactic LMWH - to prevent PE
66
Give 3 clinical characteristics of neuroglycopenia
1. Paraesthesiae 2. Blurred vision 3. Confusion
67
Outline 7 risk factors for severe hypoglycaemia
1. Alcohol excess 2. Extremes of age 3. Long duration DM 4. History of sever hypoglycaemic episodes 5. Pregnant 6. Autonomic neuropathy 7. Renal or hepatic impairment
68
Give 3 hormones which oppose the action of insulin
1. Glucagon 2. Cortisol 3. Noradrenaline
69
Classify the drug Irbesartan and give a potential risk factor associated with its use
Angiotensin II receptor antagonist - Can cause hyperkalemia
70
Give 3 side effects associated with insulin
1. Hypoglycaemia 2. Weight gain 3. Lipodystrophy
71
List 5 associated factors for NASH (non-alcoholic steatohepatitis)
1. Obesity 2. T2DM 3. Hyperlipidemia 4. Jejunileal bypass 5. Sudden weight loss/ starvation
72
Give 4 clinical features associated with non-alcoholic steatohepatitis
1. Usually asymptomatic 2. Hepatomegaly 3. ALT is typically greater than AST 4. Increased echoegenicty on ultrasound
73
Which 3 components are reported on an enhanced liver fibrosis (ELF) blood test
1. Hyaluronic acid 2. Procollagen III 3. Tissue inhibitor of metalloproteinase 1
74
Give 2 examples of insulin sensitising drugs
1. Metformin | 2. Pioglitazone
75
List 6 drugs which are known to cause impaired glucose tolerance
1. Thiazide diuretics 2. Steroids 3. Tacrolimus, cyclosporin 4. Interferon-alpha 5. Nicotinic acid 6. Antipsychotics
76
Name 2 pathological processes that affect the pancreas and can lead to secondary diabetes developing
1. Chronic pancreatitis | 2. Haemochromatosis
77
Give 3 side effects associated with long term insulin use
1. Hypoglycaemia 2. Weight gain 3. Lipodystrophy
78
Give 2 side effects associated with thiazolidinediones
1. Fluid retention | 2. Weight gain
79
Which drug class works by inhibiting glucose reabsorption in the kidneys?
SGLT-2 inhibitors
80
What is the mechanism of action of thiazolidinediones?
Work by activating PPAR - gamma receptors in adipocytes to promote adipogenesis and fatty acid uptake
81
Give 3 side effects associated with sulphonylureas
1. Hypoglycaemia 2. Weight gain 3. Hyponatremia

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