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Year 3 - Endo > Diabetes & Pituitary - MedEd lecture > Flashcards

Diabetes & Pituitary - MedEd lecture Flashcards

1
Q

Symptoms of Type 1 diabetes + pathophysiology

A

Polyuria (osmotic diuresis due to hyperglycemia)
Polydipsia
Weight loss (no insulin, therefore no feedback mechanism to tell the body to stop breaking down fat and muscle)

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2
Q

DKA symptoms

A

Abdo pain
Nausea and vomiting
Tachypnoea - Kussmaul’s breathing
Coma

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3
Q

Signs/presentation of type 2 DM

A

Picked up on routine investigation/RF being south asian/black/age

Acanthosis nigrans
Infections due to glucose - fungal, cellulits
Fatigue
Polydipsia/polyuria

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4
Q

Normal level for fasting glucose

A

<5.5

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5
Q

Normal level for random glucose

A

<11.1

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6
Q

Normal level for glucose after food

A

<7/.8

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7
Q

Normal HbA1c

A

<42

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8
Q

Random glucose levels in diabetics

A

> or equal to 11.1

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9
Q

Fasting glucose levels in diabetics

A

> or equal to 7

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10
Q

Post prandial glucose levels in unmanaged diabetics

A

> or equal to 11.1

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11
Q

Mx of type 1 diabetes

A

Basal bolus

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12
Q

What does basal bolus mean?

A

Long acting + short acting before meals

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13
Q

Long acting example

A

Glargine SC

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14
Q

Example of short acting

A

Lispro / Aspart SC pre meal

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15
Q

Type 2 DM Mx - step 1 (glycemic control)

A

Diet, exercise, education
Metformin

If HbA1c above 48, give metformin

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16
Q

Type 2 DM Mx - step 2 (glycemic control)

A

If HbA1c still above 48 with metformin, give another drug e.g. DPP4i,

Or also: piogliatazone, SU, SGLT-2i

17
Q

Type 2 DM Mx - step 3 (glycemic control)

A

Add another drug or try insulin

18
Q

T2DM BP Mx

A

Depending on age (below or above 55yrs)

ACEi/ARB
+ CCB/Thiazide Diuretics
ACEi/ARB + CCB + Diuretics

or if afrocarribean, CCB then +ACEi/ARB/Diuretics then all three

19
Q

Step 4 of BP Mx in T2DM

A

If potassium is less than 4.5, add spiro

If more than 4.5, BB

20
Q

Lipid management in T2DM if low risk vs high risk

A

Atorvastatin 20mg if 10 year cardiovascular risk is >10% on QRD

80mg if IHD/Cerebrovascular D/peripheral artery disease

21
Q

If high Qrisk score/evidence of CVD what else do you need to give besides atorvastatin?

A

Antiplatelet - aspirin 75mg

22
Q

Acute complications of DM

A

Hypoglycemia
Diabetic ketoacidosis (DKA)
Hyperosmolar hyperglycemic state (HHS)

23
Q

Long term complications of DM

A

Microvascular

  • Diabetic retinopathy
  • Diabetic nephropathy
  • Diabetic neuropathy

Macrovascular

  • IHD
  • Cerebrovascular disease
  • Peripheral vascular disease
24
Q

Causes of hypoglycemia in diabetics

A 
Missed meals 
Alcohol
SU (sulphonylureas)/SGLT-2i
Unaccustomed exercise 
Inappropriate insulin
25
Q

Hypoglycemia symptoms + BM level

A 
Palpitations
Tremor
Sweating
Pallor
Anxiety
Drowsiness
Confusion
Altered behaviour 
Seizures
Coma
AND Low sugar <3.6
26
Q

Treatment for hypos + why it works

A

If conscious - oral glucose and complex carbs

If unconscious,
1mg GLUCAGON IM AKA PARENTERAL (tells liver to convert glycogen into glucose)

If that fails, IV dextrose (10-20% glucose)

Note: if you give any more glucose, it would damage the tissues.

27
Q

DKA triad

A

Hyperglycemia
Ketonaemia
Metabolic acidosis (due to acidity of ketones)

28
Q

Explain the pathophysiology of DKA - what causes it? What metabolic changes happen?

A

Stress hormones and insulin deficiency cause hyperglcemia.

This in turn causes osmotic diuresis, leading to dehydration.

Reduced flow to kidneys means that hydrogen ions aren’t excreted out well, therefore you get metabolic acidosis.

The pt ends up vomiting in order to deal with the metabolic acidosis, which leads to even more dehydration.

Note: ketonemia also massively contributes towards the metabolic acidosis, causing KUSSMAUL’s BREATHING and VOMITING.

ALSO, as there is no insulin, there is nothing to tell the body to take in potassium, therefore TOTAL BODY POTASSIUM remains LOW, though in the blood it varies.

29
Q

Compare HHS and DKA

A

HHS - caused by hyperglycemia but not ketonemia as pt has some insulin therefore suppressing ketone production

HHS - no abdo pain but other symptoms of DKA like collapse, confusion, vomiting, nausea, kussmaul breathing

HHS - normal ketones <3mmol/L and normal pH, but plasma glucose above 30

DKA - ketones above 3mmol/L, pH below 7.3, plasma glucose above 11

30
Q

Causes of DKA/HHS

A

Infection
Illness
Non-adherence to diabetes meds
May be initial presentation of diabetes

31
Q

Mx of DKA/HHS

A

IV fluids + potassium chloride if below 5.5

THEN IV insulin, only if potassium is above 3.5

If sugar below 14, give dextrose

Treat underlying cause

32
Q

Stages and features of diabetic retinopathy / maculopathy

A

Background: blot and dot haemorrhages/hard exudates (paint first)

Pre-proliferative: background + cotton wool spots (add cotton)

Proliferative: non-proliferative + new vessels on disk (neovascularisation) (add strawberry laces)

Maculopathy: hard exudates (i.e., background retinopathy) happens to be near macula

33
Q

Management of diabetic retinopathy

A

Background - improve sugar control

Pre-proliferative and proliferative - pan-retinal photocoagulation

Maculopathy - grid photocoagulation

Year 3 - Endo (10 decks)

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