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MS4 - Endocrine > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

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
Q

SE of gliclazide?

A
  • hypoglycaemia
  • wt gain
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26
Q

1st line treatment of T2DM?

A

Oral hypoglycaemics

+ insulin

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27
Q

2nd line treatment of T2DM

A

Biguanide

+ Sulfonylurea

+ DPP-4 inhibitor / Thiazolidinedione

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28
Q

When to use 2nd line mx of DM

A

If insulin unacceptable

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29
Q

3rd line treatment of T2DM?

A

Biguanide

+ Sulfonylurea

+ GLP-1 agonist

30
Q

When to use 3rd line mx of DM

A

If insulin unacceptable or BMI>35

31
Q

DPP-4 inhibitor example

A

Linagliptin

32
Q

DPP-4 inhibitor mechanism of action

A

Inhibits incretin breakdown

Increases insulin production

Inhibits glucagon release

33
Q

Thiazolidinedione example

A

Pioglitazone

34
Q

Thiazolidinedione mechanism of action

A

Lowers insulin resistance

35
Q

GLP-1 agonist example

A

Exenatide

36
Q

GLP-1 agonist mechanism of action

A

Glucagon Like Peptide 1

Incretin analogue

37
Q

Benefit of GLP-1 agonist

A

Weight loss

38
Q

Common insulin regimes?

A
  • BD biphasic regime
  • basal-bolus regime
  • OD long-acting before bed
39
Q

BD biphasic insulin regime?

A

BD insulin mixture

30min before breakfast and dinner

(for regular lifestyle eg elderly)

40
Q

Basal-bolus regime?

A
  • Bedtime long-acting + short acting before each meal
  • T1DM allowing flexible lifestyle
41
Q

OD Long-Acting Before Bed

A

Initial regime when switching from tablets in T2DM

42
Q

Short acting insulin example

A

Actrapid

43
Q

Long acting insulin example

A

insulatard

44
Q

SGLT-2 inhibitor example

A

Dapaglifozin

45
Q

SGLT-2 inhibitor mechanism of action

A

Reduce glucose absoption in kidney

46
Q

Insulin requirements during illness?

A
  • Insulin requirements increase (even if low food intake)
  • (liver always making glucose even when not eating)
47
Q

Side effects of insulin therapy?

A
  • hypoglycaemia
  • lipohypertrophy
  • wt gain in T2DM (give metformin to reduce wt)
48
Q

Lipohypertrophy definition

A

Lump in skin from fat accumulation

At site of multiple insulin injections

49
Q

Diabetes complications?

A
  • Hyperglycaemia: DKA, HHS
  • Hypoglycaemia
  • Infection
  • Macrovascular
  • Microvascular
50
Q

Macrovascular complications of diabetes?

A

MI

Stroke

Peripheral vascular disease

Ulcers

51
Q

Feature of MI in DM

A

May be silent due to autonomic neuropathy

52
Q

Features of ischaemic diabetic feet

A
  • critical toes
  • pulseless
  • painful ulcers
53
Q

Features of neuropathic diabetic feet

A
  • loss of sensation
  • deformity
  • painless ulcers
54
Q

Deformities seen in neuropathic diabetic feet

A

Charcot’s joints

Pes cavus

Claw toes

55
Q

Abx of diabetic foot infection?

A

benpen + fluclox ± metronidazole

56
Q

Nephropathy pathophysiology in DM?

A

Hyperglycaemia → nephron loss and glomerulosclerosis

57
Q

Feature of nephropathy in DM?

A

Microalbuminuria
- urine albumin:Cr (ACR) ≥30mg/mM

58
Q

Eye complications of diabetes?

A
  • Retinopathy and maculopathy
  • Cataracts
  • Rubeosis iris
  • CN palsies
59
Q

Rubeosis iris definition

A

new vessels on iris → glaucoma

60
Q

Ix for diabetic retinopathy?

A

fluorescein angiography

61
Q

Background diabetic Retinopathy features?

A
  • Dots: microaneurysms
  • Blot haemorrhages
  • Hard exudates: yellow lipid patches
62
Q

Pre-proliferative diabetic Retinopathy features?

A
  • Cotton-wool spots (retinal infarcts)
  • Venous beading
  • Haemorrhages
63
Q

Proliferative diabetic Retinopathy features?

A
  • New vessels
  • Pre-retinal or vitreous haemorrhage
64
Q

Stages of diabetic retinopathy

A

Background

Pre-proliferative

Proliferative

65
Q

Diabetic Maculopathy features?

A
  • ↓ acuity may be only sign
  • Hard exudates w/i one disc width of macula
66
Q

Neuropathy pathophysiology?

A

Metabolic glycosylation,
Reactive Oxygen Species (ROS),
Ischaemia: loss of vasa nervorum

67
Q

Diabetic neuropathy signs and symptoms?

A

Symmetrical

Glove and stocking loss

Absent ankle jerks

Numbness, tingling, pain

68
Q

Treatment of Diabetic neuropathy?

A
  • Paracetamol
  • Amitriptylin, Gabapentin, SSRI
  • Capsaicin cream
  • Baclofen
69
Q

Diabetic Autonomic neuropathy

A
  1. Postural hypotension
  2. Gastroparesis
  3. Diarrhoea
  4. Urinary retention
  5. Erectile dysfunction
70
Q

Sx of gastroparesis

A

Early satiety

GORD

Bloating

71
Q

Rx of Postural hypotension?

A

fludrocortisone

72
Q

Dose of metformin?

A

500mg after evening meal

Increasing to 2g max.

MS4 - Endocrine (7 decks)

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