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DM Flashcards

1
Q

Type 1 is also known as juvenile onset diabetes or

______

A

insulin dependent diabetes mellitus (IDDM).

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2
Q

Type 2 is also known as maturity onset diabetes

or ________

A

non-insulin dependent diabetes mellitus

NIDDM

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3
Q

The onset of type 2 diabetes can be subtle and by
stealth. Studies have demonstrated that it takes, on
average,______ before a patient is diagnosed.

A

7–9 years

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4
Q

In Australians older than 25 years the prevalence
of diabetes is _____, with another ____ having
impaired glucose tolerance

A
  1. 5%

10. 6%

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5
Q

About 30% of these people will develop clinical

diabetes within _____

A

10 years

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6
Q

Type 2 diabetes is not a mild disease. About _____
of those surviving 15 years will require insulin
injections to control symptoms or complications

A

onethird

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7
Q

Endocrine disorders causing secondary DM

A

Cushing syndrome
Acromegaly
Phaeochromocytoma
Polycystic ovarian syndrome

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8
Q

Pancreatic disorders causing secondary DM

A

Haemochromatosis

Chronic pancreatitis

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9
Q

Drug induced DM

A

Thiazide diuretics
Oestrogen therapy (high dose—not with low-dose HRT)
Corticosteroids

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10
Q

Other possible Sx of DM

What is the cause?

  • vulvovaginitis
  • pruritus vulvae
  • balanitis
A

Candida albicans

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11
Q

Investigations for DM

A

• Initial: fasting or random blood sugar, follow-up
oral glucose tolerance test (OGTT) if indicated
• Other tests according to clinical assessment (e.g.
glycated haemoglobin (HbA1c), lipids, kidney
function, ECG)

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12
Q

Screening for Type 2 DM

  • People with impaired_____
  • Age >40 years
  • Age >30 years with: _______
  • Age >20 years_______
A

fasting glucose/impaired glucose tolerance

family history (firstdegree relative with type 2), obesity (BMI >30), hypertension

from high prevalence ethnic groups (e.g. ATSIs, Pacific Islanders)

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13
Q

Screening for Type 2 DM

• People on long-term steroids
• People on \_\_\_\_\_
• \_\_\_\_\_\_\_, especially if
overweight
• Cardiovascular disease and other risk factors
A

atypical antipsychotics

Polycystic ovarian syndrome

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14
Q

Dx of DM

If symptomatic (at least two of polydipsia,
polyuria, frequent skin infections or frequent
genital thrush):

• \_\_\_\_\_\_\_\_
or
• \_\_\_\_\_\_\_\_\_
or
• HbAIc >6.5%
A

fasting venous blood glucose (VBG)
≥ 7.0 mmol/L on two separate occasions

random VBG (at least 2 hours after last eating)
≥ 11.1 mmol/L on two separate occasions
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15
Q

If asymptomatic:

at least two separate elevated values, either
_____, ______, ________

A

fasting, 2 or more hours post-prandial, or the
two values from an oral glucose tolerance test
(OGTT)

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16
Q

If random or fasting VBG lies in an uncertain
range (5.5–11.0 mmol/L) in either a symptomatic
patient or a patient with risk factors (over 50 years,
overweight, blood relative with type 2 diabetes or
high blood pressure), perform an ________

A

OGTT

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17
Q

The cut-off point for further testing has now been reduced to ___

A

5.5 mmol/L.

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18
Q

The ________ is still the
gold standard for the diagnosis of uncertain diabetes,
i.e. >11.1 mmol/L

A

2 hour blood sugar on an OGTT

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19
Q

The OGTT should be reserved for ________

A

true borderline

cases and for gestational diabetes.

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20
Q

A screening (oral glucose challenge) test at _______ weeks gestation is sometimes used during pregnancy.

A

26–30 (usually 28)

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21
Q

2 states of Pre DM

A
  • impaired fasting glucose (IFG)

* impaired glucose tolerance (IGT)

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22
Q

A study by Sinah and colleagues detected impaired
glucose tolerance in ____ of 55 obese children (4 to
10 years of age) and ______ of 112 obese adolescents
(11 to 18 years of age

A

25%

21%

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23
Q

However, over 30% of
newly diagnosed diabetes in children and adolescents
is upon presentation with _____

A

diabetic ketoacidosis

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24
Q

Children with type 1 diabetes usually exhibit the

classic features of _____

A

polyuria, polydipsia, weight loss

and lethargy

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25
Q

UNusual presentations of DM in children

A

enuresis or daytime
wetting accidents when a misdiagnosis of urinary
infection or some other condition is sometimes
forthcoming.

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26
Q

Dx of DM in children

A

elevated random or fasting blood sugar

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27
Q

_____tests are inappropriate in the very young

A

Oral glucose

tolerance

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28
Q

_________ is the onset or initial
recognition of abnormal glucose tolerance during
pregnancy

A

Gestational diabetes

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29
Q

The WHO definition of gestational diabetes is ____

A

fasting blood sugar of ≥ 7 mmol/L or a

2-hour level of ≥ 7.8 mmol/

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30
Q

COD for Type 1 DM

A

diabetic
nephropathy and vascular disease (myocardial
infarction and stroke).

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31
Q

An analysis of patients with type 2 diabetes in
the HOPE study 11, 12 showed a benefit of ramipril to
reduce the risk of:

  • _____ (24%)
  • myocardial infarction (22%)
  • ______(33%)
  • cardiovascular death (37%)
  • _______ (24%)
A

death

stroke

overt nephropathy

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32
Q

In younger patients it takes about _______after diagnosis for the problems of diabetic
retinopathy, neuropathy and nephropathy to manifest

A

10 to 20 years

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33
Q

Impt dxtic test for DM Nephropathy

A

Early detection of the yardstick,
which is microalbuminuria, is important as the
process can be reversed with optimal control

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34
Q

T or F, the dipstick method is reliable

A

F

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35
Q

Screening of DM Nephropathy

A

Screening is done
simply by an overnight collection (10–12 hours) of all
urine, including the first morning sample

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36
Q

Microalbuminuria is _____ (two

out of three positive collections).

A

20–200 mcg/minute

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37
Q

Its prevalence is related
to the duration of illness but up to 20% of people with
type 2 diabetes

A

Retinopathy

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38
Q

The European multicentre study 13, 14
showed that diabetes is the single most common
cause of blindness in European adults in the _____age groups

A

16–64

years

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39
Q

Assessment of DM Retinopathy

A

by direct ophthalmoscopy (with
dilated pupils), retinal photography and fluorescein
angiography (depending on the state of the patient’s
fundi).

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40
Q

Common skin infections in DM

A

mucocutaneous candidiasis (e.g. balanitis,
vulvovaginitis), staphylococcal infections (e.g.
folliculitis)

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41
Q

Common urinary tract infections in DM

A

urinary tract: cystitis (women), pyelonephritis

and perinephric abscess

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42
Q

Common pulmo infections in DM

A

staphylococcal, streptococcal

pneumonia), others; tuberculosis

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43
Q

What is the SNAP Guidelines for DM Prevention

A

(Smoking, Nutrition, Alcohol, Physical activity).

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44
Q

The main objectives for the GP in the optimal
management of the diabetic patient, in order to
prevent the development of cardiovascular disease
and other complications, are:

1 to achieve strict glycaemic control as measured
by (most importantly) \_\_\_\_\_ and \_\_\_
2 to achieve blood pressure control
\_\_\_\_\_\_
3 to achieve control of\_\_\_\_
A

glycated haemoglobin
(HbA 1c ) and by blood glucose

(≤130/80 mmHg, supine)

blood cholesterol level

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45
Q

Criteria for Metabolic syndrome:

• Upper truncal obesity (waist circumference)
\_\_\_\_\_\_ (European population)
plus any 2 or more of the following
• ↑ triglycerides\_\_\_\_\_
• ↓ HDL cholesterol\_\_\_\_\_\_
• fasting glucose ≥ 5.5 mmol
• BP \_\_\_\_\_
A

> 102 cm : >88 cm

> 1.7 mmol/L

<1.0 : <1.3 mmol/L

≥ 130/85

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46
Q

This syndrome is associated with increased
risk for the development of type 2 diabetes and
atherosclerotic vascular disease. Aggressive treatment
is required.

A

Metabolic syndrome:

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47
Q

BMI for DM

A

18–25 where

practicable

48
Q

Urinary albumin excretion for DM

A

<20 mcg/min: timed overnight

<20 mg/L spot collection

49
Q

Albumin creatinine ratio for DM

A

<2.5 mg/mmol—men

<3.5 mg/mmol— women

50
Q

Alcohol intake for DM

A

≤2 standard drinks,
20 g/day (men and
women

51
Q

Exercise for DM

A 
at least 30 minutes
walking (or equivalent)
5 or more days/week
(total 150 minutes/
week)
52
Q

Monitoring of CBG for Type 1

A

Type 1 diabetes:
— four times a day (before meals and before
bedtime) at first and for problems
— twice a day (at least once)
— may settle for 1–2 times a week (if good
control

53
Q

Monitoring of CBG for Type 2

A

Type 2 diabetes:
— twice a day (fasting and 2–3 hours postprandial)
— if good control—once a week or every
2 weeks

54
Q

The major form
of glycohaemoglobin is haemoglobin A 1c , which
normally comprises __________-of the total haemoglobin

A

4–6%

55
Q

What are the insulin regimens for Type 1

• rapid-acting and short duration (ultra-short)—
_____________-
• short-acting—neutral _____________
• intermediate-acting—______

  • long-acting—_____________
  • pre-mixed short/intermediate—__________
A

insulin lispro, insulin aspart

(regular, soluble)

isophane (NPH) or lente

ultralente, insulin detemir, insulin
glargine

biphasic
(neutral + isophane)

56
Q

How to give insulin?

The pre-mixed 2 injection (biphasic) system

________________

A

Give twice daily, 30 minutes before breakfast
and before evening meal (e.g. Mixtard 30/70,
Humulin 30/70—the most common)
• Typical starting dose: 0.3 IU/kg/day—for a
70 kg person use 10 units bd

57
Q

When insulin is given as 3 injections per day:

• _________before breakfast and
lunch
• ___________before
evening mea

A

Short-acting insulin

Intermediate- or long-acting insulin

58
Q

How to give insulin 4 injections (basal-bolus) system

A 
• Short-acting insulin before breakfast, lunch
and dinner (bolus)
• Intermediate-acting or long-acting insulin at
bedtime (basal)
59
Q

How to give Insulin injections?

A

The injection should be given at a different place
each time, keeping a distance of 3 cm or more from
the previous injection

60
Q

CX OF insulin SQ injection

A

Lipodystrophy

61
Q

Available insulin

Ultra-short-acting (peak 1 hour, duration 3.5–4.5 hours)

Insulin lispro ____
Insulin aspart ____
Insulin glulisine ____

A

Humalog*

NovoRapid**

Apidra*

62
Q

Short-acting (peak 2–5 hours, duration 6–8 hours)

Neutral (regular)

  1. 2
    3
A

Actrapid**
Humulin R*
Hypurin Neutral

63
Q

Intermediate-acting (duration 12–24 hours)

Isophane (NPH)
1
2
3

A

Humulin NPH*
Protaphane**
Hypurin Isophane

64
Q

Long-acting (analogues

Insulin glargine (duration
24–36 hours\_\_\_\_\_
Insulin detemir (duration up to
24 hours\_\_\_\_
A

Lantus

Levemir

65
Q

What to do during sick days?

Never omit the insulin dose even if the illness
is accompanied by nausea, vomiting or marked
anorexia. More ______required
(rapid/fast acting).

A

top-up insulin is usually

66
Q

Glycaemic targets for adults with
type 1 diabeites

  • HbA1c — _____
  • Blood glucose —
A

53 mmol/mol

fasting preprandial 4–7 mmoL/L
postprandial 5–10 mmoL/L

67
Q

First line if tx for T2DM

A

First-line treatment (especially if obese):
• diet therapy
• exercise program

68
Q

Consider _________as the first-line agent for
all patients with type 2 diabetes, irrespective of
their weight, unless contraindicated

A

metformin

69
Q

Starting dose of Metformin

A

500 BID

70
Q

If monotherapy does not
provide adequate glycaemic control, a combination
of ______ and _____or other agent is recommended.

A

metformin with a sulfonylurea

71
Q

The ________can be used as monotherapy but are used more often
in combination with metformin, sulfonylureas or
insulin but not rosiglitazone.

A

glitazones

72
Q

The newest treatment
options in type 2 diabetes include:

• \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
known as gliptins, such as sitagliptin
• \_\_\_\_\_\_\_\_\_\_\_\_\_
e.g. dapagliflozin,
canagliflozin
• \_\_\_\_\_\_\_\_\_\_\_, liraglutide) given by SC injection
A

dipeptidyl peptidase-IV (DDP-IV) inhibitors

sodium glucose cotransporter 2 (SGLT2)
inhibitors taken orally

glucagon-like peptide-1 receptor (GLP-1) agonist
(e.g. exanatide

73
Q

Approximately ___________- of type 2 patients
eventually require insulin even after years of successful
oral therapy.

A

30%

74
Q 
Short-term intensive treatment
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
can induce long-term
improvement in glycaemic control to the extent of
being off insulin for months to years.
A

(approximately 2 weeks)

75
Q

Stepwise approach for insulin

Step 1:

A

Step 1
• Continue oral agents: metformin + sulfonylurea
± glitazone or acarbose or DPP-4 inhibitor
(limited to 3).
• Add 10 units isophane insulin at bedtime

76
Q

Stepwise approach for insulin:

Step 2
Titrate insulin therapy according to fasting blood
glucose (6 mmol/L).

Increase insulin in about _________ increments every
3–4 days (or more gradually).

Cease _______

A

4–5 U

glitazone, acarbose, gliptin or SGLT2
inhibitor (if used).

77
Q

If larger doses of insulin are required (NPH or mixed
regimen), gradually withdraw _________continue
metformin and review

A

sulfonylurea,

78
Q

The combination of a _____________
has been shown to improve control of diabetes
sometimes to the extent of being able to reduce
insulin dosage.

A

glitazone and insulin

79
Q

Food breakdown in patients with DM

A 
• protein 10–20%, 
fat 20–40%, carbohydrate
35–60%
• reduce fat, especially saturated fats, sugar and
alcohol
80
Q

__________-are one of the commonest complications
that need special attention; prevention is the
appropriate approach

A

Foot problems

81
Q

Studies have highlighted the importance of blood

pressure control to reduce _____________ and ___________complications in diabetes patients

A

macrovascular and

microvascular

82
Q

Preferred pharmacological agents for BP control are ____, _____, ________-

A

ACE

inhibitors or ARBs and calcium-channel blockers

83
Q

__________is a common finding in

patients with diabetes

A

Mixed hyperlipidaemia

84
Q

_________is an independent risk factor
for the macrovascular complications of diabetes and
proper control is important.

A

Dyslipidaemia (especially

hypercholesterolaemia)

85
Q

Preferred agents for dyslipidemia

A

HMG-CoA reductase inhibitors and resins for
hypercholesterolaemia and fibrates and resins for
mixed hyperlipidaemia

86
Q

Target for chol control

A
  • total cholesterol—<4 mmol/L
  • triglycerides—<1.5 mmol/L
  • HDL cholesterol— ≥ 1 mmol/L
  • LDL cholesterol—<2.0 mmol/L
87
Q

Hypoglycaemia 5 , 8 occurs when blood glucose levels

fall to less than_____

A

3.0 mmol/L.

88
Q

It is more common
with treated type 1 diabetes but can occur in type
2 diabetes patients on oral hypoglycaemic drugs,
notably__________).

A

sulphonylureas (biguanides hardly ever

cause hypoglycaemia

89
Q

Treatment of hypoglycaemia requires ______

A

one dose of

carbohydrate.

90
Q

Treatment (severe cases or patient

unconscious)

A

20–30 mL 50% glucose IV until fully conscious
(instil rectally using the nozzle of the syringe if
IV access difficult)
or
(alternative) 1 mL glucagon IM or SC

91
Q

This life-threatening emergency requires intensive

management. It usually occurs during an illness (e.g.
gastroenteritis) when insulin is omitted

A

Diabetic ketoacidosis 5

92
Q

Management of DKA

A

• Arrange urgent hospital admission.
• Give 10 units rapid-acting insulin IM
(not SC).
• Commence IV infusion of normal saline.

93
Q

Patients with this problem may present with an
altered conscious state varying from stupor to
coma and with marked dehydration

A

HHS

94
Q

Key features of HHS

The key features are
marked ________ and ___________without
ketoacidosis

A

hyperglycaemia and dehydration

95
Q

HHS

The essential
findings are extreme __________ and ________.

A

hyperglycaemia and high plasma osmolarity

96
Q

HHS

The condition has a high mortality—even
higher than ketoacidosis

A

T

97
Q

Tx of HHS

A

• IV fluids, e.g. normal to ½ normal saline, given
slowly
• Insulin—relatively lower doses than acidosis

98
Q

Patients with lactic acidosis present with marked

hyperventilation ‘air hunger’ and confusion

A

Lactic acidosis

99
Q

Lactic acidosis

It has
a high mortality rate and must be considered in the
very ill ___________taking metformin, especially
if kidney function is impaired.

A

diabetic patient

100
Q

labs of Lactic acidosis

A

The investigations reveal blood
acidosis (low pH), low bicarbonate, high serum
lactate, absent serum ketones and a large anion
gap.

101
Q

Tx of lactic acidosis

A

Treatment is based on removal of the cause,
rehydration and alkalinisation with IV sodium
bicarbonate

102
Q

The prevalence of _____________in men over
40 years may be as high as 50%. It may be caused by
macrovascular disease, pelvic autonomic neuropathy
or psychological causes

A

erectile dysfunction

103
Q

Those with organic-based
ED may benefit from appropriate counselling and
(if not taking nitrates) one of the ________- starting with a low dose

A

phosphodiesterase

inhibitors,

104
Q

___________may result in reduced vaginal
lubrication with arousal in women, but not the degree
of sexual dysfunction that affects men.

A

Autonomic dysfunction

105
Q

Autonomic neuropathy-related postural hypotension
may be compounded by medication, including
_____ and ______-

A

antihypertensives and anti-angina agents.

106
Q

Symptoms of gastroparesis (due to autonomic
neuropathy) with decreased gastric emptying include
a sensation of_____, ______, _____ especially after meals

A

fullness, dysphagia, reflux or recurrent

nausea and vomiting,

107
Q

Tx of gastroparesis

A

medication with domperidone,

cisapride or erythromycin

108
Q

Recent development in the tx of gastroparesis

A recent development is
injections of ______ into the pylorus
via gastroscopy to facilitate gastric emptying

A

botulinum toxin type A

109
Q

In general terms people controlled by diet alone have
no restrictions for driving whereas those on insulin
may obtain a conditional licence subject to ____

A

annual

or 2-yearly review

110
Q

The _____is generally
regarded as the most appropriate option for birth
control in women not interested in permanent
sterilisation

A

combined oral contraceptive pill

111
Q

Future of DM Tx

_______ for type 1 diabetes
• Increased availability _____ and ____ for type 2 diabetes
• Continuous ______
monitoring

A

immunomodulators

glucagon-like peptide and amylin-like peptides

implantable venous glucose

112
Q

Future of DM Tx

• Combination \_\_\_\_
• Inhaled insulin
• Transplantation:
\_\_\_\_\_\_
\_\_\_\_\_\_
A

‘type 2 tablet’

— combined kidney/pancreas
— islet cells

113
Q

Hyperglycaemia is a common cause of tiredness. If
elderly type 2 diabetic patients are very tired, think
of hyperglycaemia and consider giving______ to
improve their symptoms

A

insulin

114
Q

If a diabetic patient (particularly type 1) is very
drowsy and looks sick, consider first the diagnosis
of ____

A

ketoacidosis

115
Q

Treat associated hypertension with _____ and _____(also good in combination

A

ACE inhibitors or a

calcium-channel blocker

116
Q 
8 things you have to review in 3 month control of DM
1
2
3
4
5
6
7
8
A 
Discourage smoking and alcohol.
Review symptoms.
Review nutrition.
Check weight (BMI), BP, urine.
Review self-monitoring.
Review exercise and physical activity.
Review HbA1c (test at least every 6 months).
Review lipid levels (test at least every 12 months).

MC (90 decks)

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