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endocrine > diabetes mellitus > Flashcards

diabetes mellitus Flashcards

1
Q

what is the difference between type 1 and type 2 diabetes?

A

type 1 =absolute insulin defiency
type 2 =insulin resistance and relative insulin defiency

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2
Q

what is the pathophysiology of t1dm?

A

autoimmune destruction of beta cells in islets of langerhans leading to absolute insulin deficiency

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3
Q

what can trigger t1dm?

A

viruses eg cocksackie, enterovirus, CMV

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4
Q

which autoantibodies are involved in t1dm?

A

GAD65
islet cell antibodies
insulin antibodies
tyrosine phosphatase (IA2)
zinc transport (znt8)

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5
Q

what is the pathophysiology of t2dm?

A

peripheral insulin resistance strongly linked to obesity and physical inactivity in genetically susceptible individuals

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6
Q

what is the genetic element of t2dm?

A

polygenetic -up to 50 genes influence it -TCF7L2 most powerful

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7
Q

what is LADA?

A

latent autoimmune diabetes in adults
autoantibodies to beta cell antigens, genetic components of t1 and t2. common in scandanavia. variable phenotype -usually not obese or hypertensive

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8
Q

what are the causes of secondary diabetes mellitus?

A

baso pancreas not being able to work properly:
pancreatitis
CF
haemachromatosis (iron deposits in pancreas)
drug induced

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9
Q

which drugs can induce secondary diabetes mellitus?

A

chronic steroid use
calcineurin inhibitors (immunosuppressants-cyclosporin, tacrolimus)
statins
major anti-psychotic agents
HAART ( 3 or more antiretrovirals at once)

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10
Q

what is MODY and its cause?

A

maturity onset diabetes of the young
monogenic -mostly autosomal dominant but can be autosomal recessive

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11
Q

what happens in mitochondrial diabetes mellitus?

A

maternal inheritance
also comes with deafness and cardio/neural problems

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12
Q

what are the risk factors for t1dm?

A

FH
HLA-DR3 and HLA-DR4 genes -you need 3 or 4 doctors to understand diabetes
breastfeeding is protective

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13
Q

what are the risk factors for t2dm?

A

FH (2.4x)
classics -sedentary, obesity, ethnicity, low fibre high glycaemic index, metabolic syndrome)
hx of gestational diabetes
PCOS
genetic conditions -down’s, klinefelter’s, turner’s

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14
Q

what are the clinical features of diabetes mellitus?

A

polyuria
polydipsia
lethargy
DKA at presentation
weight loss (t1)
recurrent infections
recurrent thrush

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15
Q

what are the diagnostic criteria for diabetes mellitus?

A

2 abnormal test in asx or 1 with sx:
-fasting BM 7+
-random BM 11.1+
-OGTT 11.1+ 2h after
-Hba1c 48+

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16
Q

what is the Hba1c values for pre diabetes?

A

42-47

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17
Q

what is the OGTT levels for impaired glucose tolerance?

A

2xOGTT 7.8-11.0

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18
Q

what is the fasting glucose levels of impaired glucose tolerance?

A

> 6.0, <7

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19
Q

which bloods do you need with a new diagnosis of t1dm?

A

FBC
U+E
lab glucose
Hba1c
TFTs and anti-TPO -checking for associated autoimmune thyroid disease
anti-TTG -check for coeliac
insulin antibodies, anti-GAD antibodies, islet cell antibodies -check pathology of diabetes itself

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20
Q

which non pharmacological treatments are needed for t1dm?

A

education and information
healthy balanced diet
30 min exercise 5x a week

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21
Q

what is the main drug treatment for t1dm?

A

insulin. MDI (multiple daily injection) basal bolus is the regimen of choice.

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22
Q

2 examples of fast acting insulin?

A

actrapid
insulin aspart

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23
Q

example of intermediate acting insulin?

A

humulin 1

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24
Q

1 example of long acting insulin?

A

glargine

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25
Q

2 examples of mixed insulin?

A

novomix 30% (30% short acting)
humalog 20%

26
Q

what is the secondline treatment for t1dm after MDI basal bolus?

A

continuous SC insulin infusion (insulin pump)
can be tethered or patch

27
Q

when do you start antihypertensive treatment for people with type 1 DM?

A

if BP >135/85

28
Q

when do you start a statin for people with t1dm?

A

if >40, diabetes for >10y, established nephropathy, or any other CVD RFs

29
Q

what is the target hba1c for people with t1dm?

A

48

30
Q

what additional contacts do children with t1dm need?

A

clinic 4x a year
regular dental examination
eye exam at least every 2y
annual flu vaccine from 6m old
pneumococcal vaccine

31
Q

what is the dietary advice for t1 and t2dm?

A

t1 -healthy balanced diet and carb counting, don’t need to eat low glycaemic index
t2- high fibre, low glycaemic index, low sat fats

32
Q

what is the plan for weight loss in t2dm?

A

step 1- low calorie weight loss -600-800kcal/day
step 2-stepwise return to normal eating -1500kcal/day
step 3 -long term support to limit calorie intake and encourage physical activity

33
Q

what are the exercise suggestions for people with t2dm?

A

150min moderate /75 min vigorous exercise a week

34
Q

what is the target BP for people with t2dm?

A

<140/90 if <80 and <150/90 if 80+

35
Q

what are the hba1c targets for people with t2dm?

A

managed by lifestyle only or lifestyle and metformin-48
on any drug that can cause hypoglycaemia -53
if HbA1c has risen to 58+ -53 initial target

36
Q

how often should hba1c be checked in someone with t2dm?

A

6 monthly

37
Q

how does the stepwise treatment of t2dm work?

A

after adding each drug, check hba1c 3-6 months after and go up a step if they aren’t meeting their target.

38
Q

what is the firstline drug treatment for t2dm?

A

metformin

39
Q

what is the moa of metformin?

A

increases insulin sensitivity, decreases glucose production in liver, decreases glucose production in gut

40
Q

what is a contraindication of metformin?

A

egfr<30

41
Q

what are the main side effects of metformin?

A

GI upset. rare one =lactic acidosis

42
Q

what is the 2nd line drug treatment for t2dm?

A

metformin + either gliptin, sulfonylurea, SGLT2, or pioglitazone.

43
Q

what are gliptins and examples?

A

DDP4 inhibitors
eg alogliptin, sitagliptin

44
Q

what is an uncommon possible adverse effect of glitpins?

A

acute pancreatitis

45
Q

what are 2 examples of sulfonylureas?

A

gliclazide
tolbutamide

46
Q

what are 2 bad side effects and a benefit of sulfonylureas?

A

cause weight gain
can cause hypos
highly effective

47
Q

what drug class is pioglitazone?

A

thiazolidinedones

48
Q

what are some disadvantages of pioglitazone?

A

causes fluid retention which can lead to heart failure
causes weight gain
increased risk of fractures and bladder cancer

49
Q

what are some examples of SGLT2 inhibitors?

A

empagliflozin, dapagliflozin

50
Q

how do SGLT2s work?

A

basically work in your kidney to make you pee out glucose -doesn’t effect insulin

51
Q

what are the advantages and disadvantages of SGLT2s?

A

CV risk reduction, help with heart failure, low risk of hypos, cause weight loss
-ve: can cause DKA and genital thrush is common

52
Q

what is the thirdline drug treatment for t2dm?

A

triple therapy: metformin +SGLT2/pioglitazone/sulfonylurea/glitpin+another one
or start insulin based treatment

53
Q

what is the 4thline drug treatment for t2dm?

A

refer to diabetes specialist team

54
Q

when do you need to inform the dvla with DM?

A

more than 1 episode of severe hypoglycaemia requiring assistance from another person within last 12 months
if you’re on insulin you need to tell them -but can still drive as long as regular glucose monitoring and aware of hypo signs.

55
Q

what is gastroparesis?

A

also called delayed gastric emptying, is a medical disorder consisting of weak muscular contractions of the stomach, resulting in food and liquid remaining in the stomach for a prolonged period of time

56
Q

why does diabetes cause complications?

A

chronic hyperglycaemia damages endothelial cells of blood vessels, causing microvascular and macrovascular complications.

57
Q

what are the microvascular complications of DM and how to monitor?

A

nephropathy -patients w t2dm should be put on ACEi/ARB if no contraindications
retinopathy -should get retinal exam as part of nhs screening programme
peripheral neuropathy -poor healing, ulcers. should get diabetic foot checks
autonomic and peripheral neuropathy -eg gastroparesis, erectile dysfunction
coeliac -screen for anti-TTG antibodies

58
Q

what are the macrovascular complications of DM?

A

CVD
cerebrovascular disease
peripheral arterial disease

59
Q

high metformin dose can lower the levels of which vitamin?

A

b12

60
Q
A

endocrine (6 decks)

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