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Year 3 Medicine > Diabetes > Flashcards

Diabetes Flashcards

(90 cards)

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1
Q

What is Diabetes Insipidus?

A

Reduced ADH secretion/kidney response to ADH causes passage of large volumes of dilute urine

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2
Q

Give 3 symptoms of Diabetes Insipidus

A

Polyuria
Polydipsia
Dehydration

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3
Q

Give 3 causes of Cranial DI

A

Congenital (ADH genetic defects)
Tumour
Trauma

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4
Q

Give 3 causes of Nephrogenic DI

A

Inherited
Chronic Renal Disease
Drugs (Lithium, Demeclocycline)

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5
Q

What 4 investigations could you do if you suspected DI?

A

Us and Es
Glucose (rule out DM)
Urine Osmolality (rule out primary polydipsia)
8hr Deprivation Test

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6
Q

How would you treat Cranial DI?

A

Desmopressin

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7
Q

How would you treat Nephrogenic DI?

A

Treat underlying causes
NSAIDs (Prostaglandins locally inhibit ADH)
Bendroflumethiazide (inducing hypovolaemia may kickstart RAAS)

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8
Q

Describe the pathophysiology of Type 1 DM

A

Onset in childhood
Autoimmune destruction of pancreatic B cells
HLA association

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9
Q

Describe the pathophysiology of Type 2 DM

A

Decreased insulin secretion/increased insulin resistance
Associated with obesity/sedentary lifestyle
No HLA association
There is an autosomal dominant form affecting young people

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10
Q

Give 4 other causes of DM

A

Steroids
Pancreatitis
Cushings Disease
Glycogen Storage Disease

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11
Q

What is the triad of DM symptoms

A

Polyuria
Polydipsia
Weight Loss

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12
Q

What are the parameters for diagnosing DM in terms of Venous Glucose?

A

Fasting >7mmol/l

Random >11.1mmol/l

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13
Q

What is the parameter for diagnosing DM using the OGTT?

A

> 11.1mmol/l

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14
Q

What is the parameter for diagnosing DM using HbA1c?

A

> 48mmol/l

>6.5%

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15
Q

What are the parameters for ‘Pre-Diabetes’?

A

Fasting glucose of 5.5-6.9mmol/l

HbA1c of 42-47mmol/l (6-6.4%)

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16
Q

What is required for a Diabetes diagnosis?

A

Either
Symptoms and ONE positive blood result
Or
Positive bloods on two separate occasions

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17
Q

What advice would you give patients who are diagnosed with Type 1 DM? Give 4 points.

A

Review and research diet
Try to limit other things contributing to CVS risk
Ensure foot care
Avoid binge drinking (delayed hypoglycaemia)

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18
Q

Name one ultrafast, one medium and one long acting insulin

A

Ultrafast - Novorapid
Medium - Isophane Insulin
Long - Insulin Glargine

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19
Q

Name a premixed insulin

A

Novomix (30% short, 70%long)

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20
Q

Describe 2 different regimens to manage T1DM

A
  • BD biphasic regimen - Twice Novomix daily

- QDS - Ultrafast at meals, long acting at night (more flexible - can adjust dose with meal size and exercise)

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21
Q

What could you give patients if they struggle with the insulin regime?

A

Insulin Pump

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22
Q

Give three important pieces of advice for T1DM regarding insulin

A

Vary injection site
Change needles
Continue insulin if ill (and replace lost calories with milk)

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23
Q

Describe the 4 step (up) therapy for T2DM

A

1) Lifestyle and Diet
2) Metformin
3) Dual Therapy (Metformin + another)
4) Triple Therapy or Insulin Therapy

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24
Q

What is Metformin’s action?

A

Biguanide reduce hepatic glucose output and increases insulin sensitivity
do not stimulate insulin = do not cause hypoglycaemia

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25
Give 4 SE of Metformin
Nausea Abdo Pain Lactic Acidosis (in renal impairment) modest weight loss
26
Name a DPP4 Inhibitor. What is it's action?
Sitagliptin DPP4 destroys incretins which enhance insulin release so by inhibiting this = lower blood glucose by preventing incretin degradation incretin action is glucose dependent so do not stimulate inuslin secretion at normal glucose concentrations = unlikely to cause hypoglycaemia
27
Name a Glitazone (thiazolidinediones). What is it's action?
Pioglitazone Increases insulin sensitivity in muscle and adipose tissue decrease insulin resistance and decrease hepatic glucose
28
When are Glitazones contraindicated? What are their side effects?
CI - Osteoporosis, CCF | SE - Hypoglycaemia, Fractures
29
Name a Sulphonylurea? What is it's action?
Gliclazide | Increases insulin secretion by binding to ATP sensitive potassium channels, closing them
30
Name an SGLT2 inhibitor. What is it's action?
Dapaglifozin | Blocks glucose reabsorption in the PCT = decrease blood glucose by passing urine
31
Name a GLP1 analogue. What is it's action?
Exenatide | Incretin mimics
32
Name four complications of Diabetes
Vascular disease Nephropathy Retinopathy Neuropathy
33
Give two eye diseases associated with Diabetes
Diabetic Retinopathy | Cataracts
34
Describe the pathophysiology of Diabetic Retinopathy
capillary basement membrane thickening leading to leaky vessels, occluded vessels and macular oedema
35
Describe 3 characteristic features of Diabetic Retinopathy
Microaneurysms - physical weakening of vascular walls Haemorrhages - when weakened vessels rupture, can be small or large (AKA Flame - track along nerve-fibre bundles in superficial retinal layers) Cotton Wool Spots - Build up of axonal debris
36
How would Diabetic Retinopathy present?
Often gradual painless visual deterioration | If haemorrhages - sudden onset of dark, painless floaters which may resolve over several days.
37
Most Diabetic Retinopathies are not treated, however if they are, give 2 treatment options
Laser Treatment - aim is to induce regression of new blood vessels and reduce central macular thickening Intravitreal Steroids
38
Give 4 possible features of foot neuropathy
Reduced sensation in stocking distribution Absent ankle jerks Charcot Joint Claw Toes
39
How would a diabetic ulcer present?
Punched out ulcer in area of thick callus
40
Describe 3 non surgical managements of 'Diabetic Foot'
Regular Chiropody Bisphophonates Antibiotics
41
Hypoglycaemia is classified as <3mmol/l glucose. Majority of times it's a diabetic cause, but using the mnemonic EXPLAIN, state 7 non diabetic causes.
``` Exogenous Drugs (ACEI, B Blockers) Pituitary Insufficiency Liver Failure Addisons Insulinoma Non pancreatic Neoplasms ```
42
Give 3 autonomic and 3 neuroglycopenic symptoms of Hypoglycaemia.
Autonomic - Sweating, Anxiety, Hunger | Neuroglycopenic - Confusion, Drowsiness, Coma
43
What is Whipple's Triad?
Symptoms + Hypoglycaemia + Resolution as plasma glucose rises
44
Describe the pathophyiology of DKA
Without insulin to drive glucose into the cells, the body is forced into starvation state, using ketones for energy and causing acidosis
45
Name causes/ triggers of DKA
``` Infection Non Compliance Surgery/trauma undiagnosed T1D drugs affecting carbohydrate metabolism Chemo ```
46
Name 5 symptoms of DKA
Drowsiness Abdo Pain, N&V Dehydration Polydipsia, Polyuria
47
Describe 3 diagnostic classifications of DKA
Acidaemia - pH<7.3 hyperglycaemia - >11.1mmol/l Ketonaemia (>3mmol/l) or Ketonuria (>2+)
48
Describe a four step initial management plan of DKA
A-E and IV access - 2 large bore 1. 1L 0.9% saline bolus 2. 50 units act rapid in 50ml fluid at 0.1 unit/kg/hr (fixed rate insulin infusion) 3. add potassium to second bag 4. once glucose <14 mmol/L start dextrose infusion Ref ITU input
49
Give 3 complications of DKA
Cerebral Oedema Hypokalaemia Aspirational Pneumonia
50
Describe the different between Dry and Wet Gangrene
Dry Gangrene - Black 'mummified' toes that often autoamputate Wet Gangrene - indicates infection
51
Describe four features indicating Necrotising Fasciitis from Diabetic Foot
Spreading Cellulitis Black Spots Dishwater Fluid Appearance Crepitus (tissue paper sound when pressing - gas gangrene)
52
Describe two features you are looking for on an X-Ray of a diabetic foot
Osteomyelitis | Gas Gangrene
53
Why is ABPI generally done on right arm?
Steal Syndrome is more common on the left | You generally stand to the right of the patient
54
Explain the ABPI value indicating Diabetic Foot
>1.2 Due to calcification of the peripheral arteries increasing the pressure (NOT because they have superior blood flow to PAD)
55
Describe the Doppler Sounds of vessels
Monophasic Biphasic Triphasic Monophasic is diseased, and triphasic is healthy (you can hear the elastic recoil in competent vessels)
56
Using the mnemonic SWOMPD, how would you manage a diabetic foot?
``` Sepsis Wound Management Offloading (Orthotics) Mechanical (Orthopaedics input) Perfusion (Lifestyle, Meds, Surgical) Diabetic Control ```
57
What antimicrobials would you use for MILD Diabetic Foot?
Flucloxacillin
58
What antimicrobials would you use for MODERATE Diabetic Foot?
Flucloxacillin, Ciprofloxacin and Metronidazole
59
What antimicrobials would you use for SEVERE Diabetic Foot?
Piperacillin, Tazobactam and Vancomycin
60
name 4 short acting insulins - Rapid acting and soluble
rapid acting - novorapid & humalog | soluble - humulin S & actrapid
61
name 4 intermediate acting insulins
Isophane Insulatard Humulin 1 Insuman basal
62
name 4 long acting insulins
insulin glargine - lantus insulin detemir - levemir insulin degludec - tresiba
63
name 4 symptoms of hyperglycaemia
polyuria polydipsia blurring of vision urogenital infections - thrush
64
name 4 symptoms of inadequate energy utilisation
tiredness weakness lethargy weight loss
65
what insulin regimen is good to use when switching from tablets to insulin in T2DM?
once-daily before-bed long-acting
66
why is insulin given SC?
insulin is inactivated by GI enzymes
67
where is best to inject insulin and why?
plenty of SC fat - abdomen | quick absorption
68
why is it important to rotate injection sites?
prevent lipohypertrophy | which causes erratic absorption leading to poor glycaemic control
69
what do you have to check injection sites for?
swelling bruising infection lipohypertrophy
70
what advice should you give someone taking insulin regarding sickness?
do not stop taking insulin maintain calorie intake with milk check blood glucose at least 4 times a day monitor for ketonuria increase insulin if blood glucose increases
71
what are some dangers of taking insulin
``` hypoglycaemia allergy hypokalaemia painful injections heart failure lipohypertrophy ```
72
what are the 2 functions of insulin?
Cause cells to absorb glucose from blood and use it as fuel | Cause muscle and liver cells to absorb glucose and store it as glycogen
73
side effects of DPP4 inhibitor - sitagliptin
GI upset | headache
74
side effects of sulphonylureas - glicazide
hypoglycaemia - stimulation of insulin secretion weight gain gi upset
75
side effects of SGLT2 inhibitors - dapagliflozin
increased risk of UTI and genital tract infections
76
what are the microvascular complications of diabetes?
diabetic retinopathy nephropathy neuropathy
77
what are the macrovascular complications of diabetes?
PVD, stroke, MI, intermittent claudication
78
how does diabetic neuropathy come about?
multiple mechanisms - including damage to small blood vessels nourishing the peripheral nerves and abnormal sugar metabolism
79
what are the manifestations of diabetic neuropathy?
peripheral sensory neuropathy - progresses from loss of vibration to glove and stocking sensory loss mononeuropathies amyotrophy - painful wasting of thigh muscle autonomic neuropathy
80
what is autonomic neuropathy
damage to the autonomic nerves from high levels of blood glucose leading to postural hypotension, bladder dysfunction, sweating, temperature regulation issues, and other orthostatic symptoms like nausea, palpitations, light-headedness, tinnitus, SOB
81
what is nephropathy?
hypoglycaemia leads to increased glomerular capillary pressure, podocyte damage. albuminuria is first sign
82
how is nephropathy diagnosed?
microalbuminuria = A:Cr 3-30mg/mmol | not detected on urine dip stick at this stage
83
how is nephropathy treated?
``` good DM control BP <130/80 ACEi - reduce proteinuria sodium restriction statin ```
84
what medications should be used with caution in CKD?
sulfonylureas Biguanides SGLT2i Exenatide
85
signs of DKA
``` volume depletion - dry mucous membranes - poor skin turgor - sunken eyes - tachycardia - hypotension kussmaul respiration - rapid and deep respiration due to acidosis acetone breath ```
86
further management of DKA - not initial steps
monitor blood ketone levels and blood glucose levels consider catheter check VBG at 2 4 8 12 and 24 hours
87
What is a Hyperosmolar Hyperglycaemic State?
Seen in unwell patients with T2DM Hx of a weeks dehydration with glucose>30mmol/l NO KETONE METABOLISM as insulin levels are sufficient to prevent this
88
How would you manage Hyperglycaemic Hyperosmolar State?
A-E + access Rehydrate slowly - 0.9% NaCl Replace K+ when urine starts to flow Only use insulin if glucose is falling at rate < 5 mmol/L/hr despite adequate fluid replacement - start low 0.05units/kg/hr
89
what causes HHS?
poor diabetic control infection - sepsis dehydration
90
features of HHS
hypovolaemia - volume depletion hyperglycaemia - >30mmol/L without ++ ketones hyperosmolarity - >320mosmol/kg much longer hx than DKA

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