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Diabetes mellitus Flashcards

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1
Q

List 3 causes of T3DM?

A

pancreatic damage, endocrine disease, or hepatic cirrhosis.

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2
Q

What 3 factors decide whether DVLA is notified in those with diabetes?

A

Type of treatment recieiving, presence of complications, and type of license held.

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3
Q

What should someone with a BG reading of <4mmol/L or experiencing hypoglyceamia symptoms do if driving?

A
  • Pull over, remove keys from ignition, remove themselves from drivers seat.
  • Check CBG with meter if continuous BG system present.
  • Take snack
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4
Q

What BG level should be if driving?

A

> 5mmol/L

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5
Q

If having to pull over due to hypoglycaemia, how long after until the person can start driving again?

A

45 minutes later and must have a BG of >5mmol/L

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6
Q

What should those on insulin therapy always bring with them when driving?

A

A CBG meter and a fast-acting glucose snack

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7
Q

Other than insulin, which other hypoglyaceamics may require a person to inform the DVLA if on?

A

Meglitinides and sulphonylureas

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8
Q

When should a person with diabetes stop driving indefinetely?

A

If awareness of hypogylceamia is lost.

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9
Q

Why should those with diabetes drink alcohol in moderation?

A

Alcohol can mask symtpoms of hypoglyceamia

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10
Q

Which type of diabetes can HbA1c be used for disgnosis?

A

T2DM

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11
Q

Which groups of people should HbA1c not be used for diagnosis of diabetes in?

A

Children, those with suspected T1DM, pregnancy or up to 2 months post-partum, if symptoms <2 months, end-stage CKD, HIV infection, those with high risk of diabetes and acutely unwell, recieving treatment that may cause hypergylceamia

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12
Q

What medications may cause hyperglycaemia?

A

Anti-virals, steroids, and anti-psychotics

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13
Q

What is HbA1c?

A

Glyceated haemaglobin forms when RBC is exposed to glucose in the plasma. It is the average plasma glucose over 2-3 months

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14
Q

When is the oral glucose tolerance test used?

A

In less severe sympotms when a measurement e.g., fasting glucose, cannot establish/exclude a diagnosis of diabetes.
In gestational diabetes

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15
Q

Describe the oral glucose tolerance test?

A

Fasting glucose is measured, then glucose is measured 2 hours after an anhydrous glucose drink.

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16
Q

When should the oral glucose tolerance test not be used?

A

In those with severe symptoms of hyperglycaemia

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17
Q

What is a fasting bood glucose value of 6.1-6.9mmol/l indicating?

A

Pre-diabetes

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18
Q

What is a fasting bood glucose value of <6mmol/L indicating?

A

A normal blood glucose reading in a healthy person

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19
Q

What is a fasting blood glucose value of >7mmol/l indicating?

A

Diabetes

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20
Q

How often should a T1DM patient have their HbA1c measured?

A

Every 3- 6 months (more frequently if suspicion BG changing rapidly)

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21
Q

How often should a T2DM patient have their HbA1c measured?

A

Every 3 -6 months until their medication and HbA1c is stable- can then be reduced to 6 monthly.

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22
Q

What is the HbA1c target for a patient on a single drug for control of their diabetes that is NOT associated with hypoglycaemia?

A

<48mmol/mol (6.5%)

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23
Q

What is the HbA1c target for a T2DM patient that is controlling their diabetes through diet and lifestyle?

A

<48mmol/mol (6.5%)

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24
Q

What is the HbA1c target for a T2DM patient on a single drug for control of their diabetes that IS associated with hypoglycaemia?

A

<53mmol/mol (7.0%)

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25
What HbA1c value suggests treatment should be intensified in a T2DM patient?
>58mmol/mol (7.5%)
26
1st line in T2DM with established CHF or atherosclerotic CVD
Metformin/Metformin MR AND SGLT-2 inhibitor once tolerability confirmed
27
1st line in T2DM with no high CVD risk
Metformin/Metformin MR
28
1st line in T2DM with QRISK >10% or elevated lifetime risk?
Metformin/Metformin MR AND CONSIDER SGLT-2 I once tolerability confirmed
29
Renal cut-off for metformin
30ml/min
30
CI of metformin
Acute metabolic acidosis
31
What conditions should metformin be avoided in?
chronic HF, liver impairment if hypoxia expected, respiratory failure, recent MI, severe infection, shock
32
MHRA alert for metformin
Causes low B12, particularly on high doses
33
Maximum dose of metformin
2g OD
34
SEs of metformin
low b12, nausea, adbominal pain, diarrhoea, taste alteration, apetite decrease
35
HbA1c target for a T1DM patient?
<48mmol/mol
36
Which DPP-4 inhibitor requires no dosing adjustment in renal impairment?
Lingaliptin
37
Which 2 DPP-4 inhibitors are better in hepatic impairment?
Sitagliptin and lingaliptin
38
List the SEs of DPP-4 inhibitors
Dizziness, headaches, nasopharyngitis, hepatic impairment
39
What are the contra-indications to DPP-4 inhibitors?
Ketoacidosis
40
What target has to be reached in 6 months to continue DPP-4 treatment?
>5mmol/mol reduction in HbA1c
41
What target has to be reached in 6 months to continue pioglitazone treatment?
>5mmol/mol reduction in HbA1c
42
DPP-4 inibitors effect on insulin and glucagon levels
Increased insulin secretionl reduced glucagon release
43
Which treatments used for glycaemic control have a higher risk of hypoglycaemia?
Sulphonylureas and insulin
44
CI to sulphoylureas
ketoacidosis, severe hepatic and renal impairement
45
Which 2 sulphoylureas are CI in acute porphyria?
tolbutamide and gliclazide
46
Which group of patients are particularly sensitive to hypoglycaemia caused by sulphonyureas?
The elderly
47
Which diabetic treatments cause weight gain?
Sulphonylureas, insulin, pioglitazone
48
Which diabetic oral treatment has a common side effect of bone fractures?
Pioglitazone
49
CI with pioglitazoine use
HF, previous or active bladder cancer, uninvestigated macroscopic haematuria, ketoacidosis
50
Which class of diabetic treatment requires counselling on the signs of pancreatitis?
GLP-1 agonists and GLP-1/GIP agonists
51
Which GLP-1 agonist is better in renal impairment?
Dulaglutide- renal cut off of 15ml/min
52
Which diabetic treatments cause weight loss?
SGLT-2 Inhibitors, GLP-1 agonists, GLP-1/GIP agonists
53
Which type of diabetes are GLP-1 agonists used in?
T2DM
54
What class does Tirzepatide belong to?
GLP-1/GIP agonist
55
Brand name of Tirzepatide
Mounjaro
56
What target has to be reached in 6 months to continue GLP-1 agonist treatment?
3% reduction in body weight and >1mmol/mol reduction in HbA1c
57
Key interactions for GLP-agonists and why?
Warfarin- can increase risk of hypoglycaemia BBs- can mask symptoms of hypoglycaemia
58
BG target for T1DM when fasting
5-7mmol/L
59
BG target for T1DM at least 90 minutes after eating?
5-9mmol/L
60
Normal BG range for T1DM at any time of the day (not fasting or after a meal)
4-7mmol/L
61
Actions of endogennous insulin
Increase adipose and muscle cell uptake of glucose and reduce glucose production from the liver
62
When should rapid-acting analogue insulin be administered?
Immediately before meals
63
When should short-acting analogue insulin be administered?
20 minutes before food
64
Which insulin is usually used to treat emergency hypoglycaemia?
IV soluble insulin (short-acting)
65
When should mixed insulin be administered?
Immediately before meals
66
Which long-acting inuslin is given BD?
Insulin detemir
67
What does a basal-bolus regime consist of?
Long/intermediate acting insulin OD or more + a short-acting insulin
68
What insulin is used in a biphasic insulin regime?
Intermediate acting + short-acting given 1-3 times daily
69
What type of insulin is usually used in a continuous insulin pump?
rapid-acting analgoue or soluble insulin
70
Describe the licensing for a continouos infusion pump in diabetes?
For: - Those on multiple daily injections and a HbA1c of >69mmol/mol - Those suffering with disabling hypoglycaemia whilst trying to achieve HbA1c target
71
Which insulin is most appropriate in a T1DM patient experiencing nocturnal hypoglycaemia?
OD admnistration of delegudec
72
When is ultra-long acting insulin indicated?
If a patient needs help administering from HCP or carer
73
1st line recommended insulin regime in T1DM?
Basal bolus
74
Which insulin should be tried 1st line as part of a basal bolus regime in T1DM?
BD insulin detemir
75
Which insulin should be tried 1st line as part of a basal bolus regime in T1DM?
Insulin detemir BD
76
2nd line recommended insulin regime in T1DM?
Biphasic regime with BD dosing when mu;tiple injections not possible
77
What is the preferred insulin in pregnancy?
Isophane insulin
78
Dose of folic acid in pregnancy in a woman with pre-existing diabetes?
5mg pre-conception up until 12 weeks.
79
1st line therapy for diabetes in pregnancy in women with pre-exisiting diabetes?
Insulin therapy- all oral diabetic meds shsould be stopped except metformin
80
2nd line therapy for diabetes in pregnancy in women with pre-exisiting diabetes?
Metformin alone/ in addition to insulin
81
What is used in a hypoglycaemic medical emergency for a concious patient?
Glucose 15g-20g- either 150-200ml of fruit juice, 4-5 glucose tablets, 15-20g of glucose liquid, 1.5-2 tubes of glucose 40% gel
82
What is used in a hypoglycaemic medical emergency for a concious but uncooperative patient?
Buccal administration of 1.5-2 tubes of glucose 40% gel
83
What is used in a hypoglycaemic medical emergency for an unconcious patient where the oral route isn't available?
IM glucagon
84
What is used in a hypoglycaemic medical emergency for an unconcious patient who hasn't responded to glucagon after 10 minutes?
IV glucose 10-20% glucose infusion
85
What are the key differences in labs at presentation of DKA and HHS?
HHS= no marked hyperketonaemia or acidosis HHS presents with marked hypovolaemia and hyperosmolarity Often surgars are much higher in HHS
86
Difference in treatment between DKA and HHS
DKA- focused on correcting hyperglycaemia HHS- focus on correcting osmotic state- insulin added in later unless ketonemia/ketonuria
87
What can be added to optimal nephropathy treatment in a T2DM patient with end-stage CKD and albuminuria?
Finerenone
88
First line for nephropathy treatment in diabetes if ACR >3mg/mol?
ACE I or ARB, even if BP normal
89
Interaction between oral antidiabetic meds/insulin with ACE I/ARBs?
ACE I/ARBs potentiate the hypoglycaemic effect, specially in the first few weeks of combined treatment
90
1st line options for diarrhoea in autonomic neuropathy?
Tetracycline or opioid such as codeine
91
1st line for gastroparesis in autonomic neuropathy
IV erythromycin
92
Treatment options for neuropathic posutral hypotension in a diabetes patient
Fludrocortisone, flurbiprofen and ephedrine in combination with fludrocortisone, midodrine
93
1st line options for neuropathic pain
Amirtiptyline, imipramine, venlafaxine, duloxetine, gabapentin, pregabalin
94
2nd line options for neuropathic pain
Gabapentinoids in combination with opioids such as codeine
95
1st line treatment option for gustatory sweating
propantheline bromide
96
How often should BG be checked if the patient is unwell and usually self-monitors BG?
Every 3-4 hours, including through the night
97
What advice should be provided if a diabetic patient is unable to eat/ is vomiting?
Replace meals with high carbohydrate drinks such as milk, milkshakes, fruit juices.
98
Symptoms of HSS
Hypotension, dry mucous membranes, tachycardia, polydipsia, polyuria, weight loss, poor skin turgor, shock
99
Symptoms of DKA
Peadrop breath, polydipsia, polyuria, irregular heart rate, deep + rapid respiratory rate, N&V, abdominal pain, blurred vision, confusion

Endocrine (8 decks)

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