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MS4 - Endocrine > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

(72 cards)

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1
Q

T1DM presentation

A

polyuria
polydipsia
wt loss
DKA

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2
Q

T1DM genetics?

A

HLA-D3 and –D4

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3
Q

T1DM antibodies?

A

anti-islet,
anti-GAD

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4
Q

T2DM presentation?

A

polyuria
polydipsia
complications

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5
Q

Genetics of T2DM?

A

concordance in 80%

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6
Q

Risk factors for T2DM

A

obesity,
reduced exercise
calorie and alcohol excess

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7
Q

Diagnosis of diabetes if symptomatic

A

One reading of:

Fasting glucose > 7

or random > 11.1

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8
Q

Diagnosis of diabetes if asymptomatic

A

Two readings of:

Raised plasma glucose

or OGTT > 11.1 mM

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9
Q

OGTT: Normal people fasting glucose level?

A

<6.1

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10
Q

OGTT: Normal people 2hrs post 75g sugar glucose level?

A

<7.8

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11
Q

OGTT: diabetes fasting glucose level?

A

>/= 7

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12
Q

OGTT: diabetes 2hrs post 75g sugar glucose level?

A

>/= 11.1

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13
Q

Drugs causing DM?

A

Steroids
Anti-HIV
Atypical neuroletics
Thiazides

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14
Q

Metabolic Syndrome features

A

Central obesity + 2 of:

  • ↑ Triglycerides
  • ↓ HDL
  • HTN
  • Hyperglycaemia: DM, IGT, IFG
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15
Q

Metabolic syndrome risk

A

Increased risk of MI

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16
Q

Principles of monitoring of diabetes?

A

Monitor 4Cs every 6mo/year

  • glycaemic Control
  • Complications
  • Competency (injection)
  • Coping (psychosocial)
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17
Q

Diet modifications for diabetes?

A

↓ total calorie intake
↓ refined CHO, ↑ complex CHO
↑ soluble fibre
↓ fat (esp saturated)
↓Na

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18
Q

Statins in pts with DM?

A

if >40yrs regardless of lipids

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19
Q

Aspirin in pts with DM?

A

if >50yrs

or <50 with other CVD RFs

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20
Q

Oral hypoglycaemics?

A
  • Biguanide
  • Sulfonylurea
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21
Q

Biguanide example

A

Metformin

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22
Q

Solfonylurea example and dose?

A

gliclazide MR 30mg with breakfast

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23
Q

Side effects of metformin?

A
  • nausea
  • diarrhoea
  • abdo pain
  • lactic acidosis
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24
Q

CIs to metfromin?

A
  • GFR < 30
  • tissue hypoxia (sepsis, MI)
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25
SE of gliclazide?
- hypoglycaemia - wt gain
26
1st line treatment of T2DM?
Oral hypoglycaemics + insulin
27
2nd line treatment of T2DM
Biguanide + Sulfonylurea + DPP-4 inhibitor / Thiazolidinedione
28
When to use 2nd line mx of DM
If insulin unacceptable
29
3rd line treatment of T2DM?
Biguanide + Sulfonylurea + GLP-1 agonist
30
When to use 3rd line mx of DM
If insulin unacceptable or BMI\>35
31
DPP-4 inhibitor example
Linagliptin
32
DPP-4 inhibitor mechanism of action
Inhibits incretin breakdown Increases insulin production Inhibits glucagon release
33
Thiazolidinedione example
Pioglitazone
34
Thiazolidinedione mechanism of action
Lowers insulin resistance
35
GLP-1 agonist example
Exenatide
36
GLP-1 agonist mechanism of action
Glucagon Like Peptide 1 Incretin analogue
37
Benefit of GLP-1 agonist
Weight loss
38
Common insulin regimes?
- BD biphasic regime - basal-bolus regime - OD long-acting before bed
39
BD biphasic insulin regime?
BD insulin mixture 30min before breakfast and dinner (for regular lifestyle eg elderly)
40
Basal-bolus regime?
- Bedtime long-acting + short acting before each meal - T1DM allowing flexible lifestyle
41
OD Long-Acting Before Bed
Initial regime when switching from tablets in T2DM
42
Short acting insulin example
Actrapid
43
Long acting insulin example
insulatard
44
SGLT-2 inhibitor example
Dapaglifozin
45
SGLT-2 inhibitor mechanism of action
Reduce glucose absoption in kidney
46
Insulin requirements during illness?
- Insulin requirements increase (even if low food intake) - (liver always making glucose even when not eating)
47
Side effects of insulin therapy?
- hypoglycaemia - lipohypertrophy - wt gain in T2DM (give metformin to reduce wt)
48
Lipohypertrophy definition
Lump in skin from fat accumulation At site of multiple insulin injections
49
Diabetes complications?
- Hyperglycaemia: DKA, HHS - Hypoglycaemia - Infection - Macrovascular - Microvascular
50
Macrovascular complications of diabetes?
MI Stroke Peripheral vascular disease Ulcers
51
Feature of MI in DM
May be silent due to autonomic neuropathy
52
Features of ischaemic diabetic feet
- critical toes - pulseless - painful ulcers
53
Features of neuropathic diabetic feet
- loss of sensation - deformity - painless ulcers
54
Deformities seen in neuropathic diabetic feet
Charcot's joints Pes cavus Claw toes
55
Abx of diabetic foot infection?
benpen + fluclox ± metronidazole
56
Nephropathy pathophysiology in DM?
Hyperglycaemia → nephron loss and glomerulosclerosis
57
Feature of nephropathy in DM?
Microalbuminuria - urine albumin:Cr (ACR) ≥30mg/mM
58
Eye complications of diabetes?
- Retinopathy and maculopathy - Cataracts - Rubeosis iris - CN palsies
59
Rubeosis iris definition
new vessels on iris → glaucoma
60
Ix for diabetic retinopathy?
fluorescein angiography
61
Background diabetic Retinopathy features?
- Dots: microaneurysms - Blot haemorrhages - Hard exudates: yellow lipid patches
62
Pre-proliferative diabetic Retinopathy features?
- Cotton-wool spots (retinal infarcts) - Venous beading - Haemorrhages
63
Proliferative diabetic Retinopathy features?
- New vessels - Pre-retinal or vitreous haemorrhage
64
Stages of diabetic retinopathy
Background Pre-proliferative Proliferative
65
Diabetic Maculopathy features?
- ↓ acuity may be only sign - Hard exudates w/i one disc width of macula
66
Neuropathy pathophysiology?
Metabolic glycosylation, Reactive Oxygen Species (ROS), Ischaemia: loss of vasa nervorum
67
Diabetic neuropathy signs and symptoms?
Symmetrical Glove and stocking loss Absent ankle jerks Numbness, tingling, pain
68
Treatment of Diabetic neuropathy?
- Paracetamol - Amitriptylin, Gabapentin, SSRI - Capsaicin cream - Baclofen
69
Diabetic Autonomic neuropathy
1. Postural hypotension 2. Gastroparesis 3. Diarrhoea 4. Urinary retention 5. Erectile dysfunction
70
Sx of gastroparesis
Early satiety GORD Bloating
71
Rx of Postural hypotension?
fludrocortisone
72
Dose of metformin?
500mg after evening meal Increasing to 2g max.

MS4 - Endocrine (7 decks)

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