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DM Flashcards

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1
Q

what antibodies are present in T1DM?

A

anti islet

ant GAD

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2
Q

what is the pathophysiology of T2DM?

A

insulin resistance and beta cell dysfunction

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3
Q

what are the fasting and random venous glucose levels ?

A

fasting >7

random >11.1

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4
Q

how is asymptomatic DM diagnosed?

A

increased venous glucose on 2 occasions
or
2hr OGTT (oral glucose tolerance test) >11.1

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5
Q

what does IFG and IGF mean in relation to DM?

A

IFG (impaired fasting glucose)

IGF (impaired glucose tolerance)

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6
Q

what test is used to diagnose IFG?

A

fasting glucose (6.1-6.9)

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7
Q

what is the test used to diagnose IGT?

A

OGTT (7.8-11)

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8
Q

what is metabolic syndrome?

A

central obesity and two of:

  • increased triglycerides
  • decreased HDL
  • HTN
  • hyperglycaemia (DM, IGT, IFG)
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9
Q

state some secondary causes of DM?

A

steroids, anti-HIV drugs, thiazides, atypical neuroletics

CF, chronic pancreatitis, HH, pancreatic cancer

phaemochromocytoma, cushings, acromegaly, hyperthryoidism

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10
Q

what are the 4Cs of DM management?

A

control glycaemia
complications (macro, micro)
competency (insulin injections, injection sites, BM monitoring)
coping (psychological)

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11
Q

what three things are monitored in order to control glycaemia?

A

capillary blood glucose
HbA1c
BP, lipids

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12
Q

what should fasting glucose be?

A

4.5-6.5mM

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13
Q

what should the HbA1c aim be?

A

<45-50mM (7.5-8%)

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14
Q

what lifestyle modifications can be done for DM? DELAYS

A 
diet 
exercise
lipids 
ABP
aspirin 
yearly checkups 
smoking cessation
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15
Q

what is 1st line for DM?

A

metformin

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16
Q

what are SEs of metformin?

A

Nausea/diarrhoea, abdo pain, lactic acidosis

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17
Q

when is metformin taken?

A

500mg after evening meal

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18
Q

what are CIs for metformin?

A

GFR<30
sepsis, MI
iodinated contrast media

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19
Q

what is 2nd line for Dm and give an example?

A

sulfonylurea

- gliclazide

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20
Q

when is sulfonylurea taken?

A

with breakfast

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21
Q

what are SEs of sulfonylureas?

A

weight gain, hypoglycaemia

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22
Q

does sulfonylureas need to be stopped before surgery?

A

stop on morning of surgery

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23
Q

what are three SEs of insulin treatment?

A

hypoglycaemia risk
lipohypertrophy
weight gain in T2DM

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24
Q

what BM informs you on the long acting insulin dose?

A

fasting BM before meals

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25
what BM informs you on the short acting insulin dose?
finger prick BM after meals
26
state 3 common insulin regimes?
BD biphasic regime basal bolus regime OD long acting before bed
27
what is the BM biphasic regime?
BD insulin mixture 30min before breakfast and dinner  Rapid-acting: e.g. actrapid  Intermediate- / long-acting: e.g. insulatard
28
what is the basal bolus regime?
Bedtime long-acting (e.g. glargine) + short acting before each meal (e.g. lispro)  Adjust dose according to meal size  ~50% of insulin given as long-acting
29
what is the OD long acting regime?
 Initial regime when switching from tablets in T2DM
30
what insulin regime is best for T1DM?
basal bolus regime
31
what are the 4 sick rules for insulin use?
``` Insulin requirements usually ↑ (even if food intake ↓) Maintain calories (e.g. milk) Check BMs ≥4hrly and test for ketonuria ↑ insulin dose if glucose rising ```
32
what screening should be done in DM?
fundoscopy, albumin/creatinine ratio, foot checks
33
what are two type of ulcers DM pts can get on their feet?
ischaemic | neuropathic
34
what deformities can occur with DM neuropathy?
``` charcots joints pes cavus (high arch) claw toes ```
35
are iscahemic ulcers sore?
yes
36
are neuropathic ulcers sore?
no
37
what are indictions for surgery for DM complications?
abscesses, spreading celllulitis, gangrene, suppurative arthritis (septic arthritis)
38
what changes can occur in the kidney to hyperglycaemia?
nephron less and glomerulosclerosis
39
what is the treatment for microalbuminuria in DM?
ACEi/ARB
40
over what level is ACR for microalbuminuria a problem?
>30mg/mM
41
what does ACR stand for?
urine albumin:creatinine ratio
42
what is rubeosis iris ?
new vessels on the iris due to increase VEGF due to retinal ischaemia
43
what is a complication of rubeosis iris?
glaucoma
44
what investigation should be done for diabetic retinopathy ?
fluorescein angiography
45
what is the treatment for diabetic retinopathy ?
laser photocoagulation
46
what structure does DM affect to cause ischaemic neuropathy ?
loss of vasa nervorum | - small arteries that provide blood supply to peripheral nerves
47
accumulation of what 3 metabolic features increases the risk of DM neuropathy complications?
increased glycosylation ROS (role of reactive oxygen species) sorbitol accummulation
48
what 4 neuropathy conditions can occur in DM?
symmetric sensory polyneuropathy mononeuropathy (CN3/6 palsy) femoral nueropathy autonomic neuropathy
49
what are some featurs of autonomic neuropathy?
``` postural hypotension gastroparaesis diarrhoea urinary retention ED (erectile dysfunction) ```
50
what is the presentation of symmetric sensory polyneuropathy?
glove and stocking absent of ankle jerks numbness, tingling, pain (worse at night)
51
what medication can be given for symmetric sensory polyneuropathy ?
``` paracetamol amitriptyline gabapentin SSRI baclofen capsaicin cream ```
52
what is femoral neuropathy ?
 Painful asymmetric weakness and wasting of quads c¯ | loss of knee jerks
53
how is a diagnosis of femoral neuropathy made?
nerve conduction and electromyography
54
what is postural hypotension treated with?
fludrocortisone
55
what is autonomic diarrhoea treated with?
codeine phosphate
56
state the presentation of DKA?
``` Abdo pain + vomiting  Gradual drowsiness  Sighing “Kussmaul” hyperventilation  Dehydration  Ketotic breath ```
57
what is myasthenia gravis associated with?
thymus problems (hyperplasia, adenocarcinoma)
58
what are the levels of ketones in serum and urine for DKA?
>3mM in serum | >2+ on dipstik
59
will HCO3 be high or low for DKA?
low
60
what investigations should be done for DKA?
``` Urine: ketones and glucose, MCS  Cap glucose and ketones  VBG: acidosis + ↑K  Bloods: U+E, FBC, glucose, cultures  CXR: evidence of infection ```
61
are people with DM usually hypo/hypernatreamic?
hypo | - since Osmolar compensation for hyperglycaemia
62
what is a complication after treatment of DKA?
hyperchloraemic metabolic acidosis | - since loss of bicarbonate with the excretion of ketones
63
state some complications of DKA?
Cerebral oedema: excess fluid administration  Commonest cause of mortality  Aspiration pneumonia  Hypokalaemia  Hypophosphataemia → resp and skeletal muscle weakness  Thromboembolism
64
what are the 4 managements for DKA in HDU? GRIP
Gastric aspiration  Rehydrate  Insulin infusion  Potassium replacement
65
what is hyperosmolar non ketotic coma?
marked dehydration and glucose >35mM but with no acidosis
66
state the presentation of someone with hyperosmolar non ketotic coma?
Usually T2DM, often new presentation  Usually older  Long hx (1 week)
67
what medication should be given to a hyperosmolar non ketotic coma pt to prevent occlusion events?
LMWH
68
what is the osmolality of someone with hyperosmolar non ketotic coma?
>340mosmol/kg
69
what is the management of hyperosmolar non ketotic coma?
rehydrate with 0.9% over 48hrs | wait 1 hr before starting insulin to avoid rapid changes in osmolality
70
what is the triad called for hypoglycaemia presentation?
Whipples triad
71
what is whipples triad?
low plasma glucose <3 hypoglycaemia symptoms relief of symptoms by glucose administration
72
what two classifications of hypoglycaemia symptoms are there?
autonomic neuroglycopenic
73
state some autonomic hypoglyaemia symptoms?
``` Sweating  Anxiety  Hunger  Tremor  Palpitations ```
74
state some neurglycopenic hypoglyaemia symptoms?
``` Confusion  Drowsiness  Seizures  Personality change  Focal neurology (e.g. CN3)  Coma (<2.2) ```
75
what 4 things in the blood should be measured during a hypoglycaemic attack?
Glucose, insulin, C-peptide, ketones
76
what is the management of hypoglycaemia in an alert pt?
oral carbs
77
what is the management of hypoglycaemia in a drowsy pt?
buccal carb | - glucogel
78
what is the management of hypoglycaemia in an unconscious pt?
100ml 20% glucose
79
what is the management of hypoglycaemia in a deteriorating pt?
1mg glucagon IM/SC
80
what are some causes of Hyperinsulinaemic hypoglycaemia
drugs | insulinoma
81
what medication could cause increased C peptide with Hyperinsulinaemic hypoglycaemia?
sulfonylurea
82
what medication could cause normal C peptide with Hyperinsulinaemic hypoglycaemia?
insulin
83
what could cause ↓ insulin, no ketones ?
Non-pancreatic neoplasms | Insulin receptor Abs
84
what could cause ↓ insulin, ↑ ketones ?
 Alcohol binge c¯ no food  Pituitary insufficiency  Addison’s
85
is an insulinoma benign or malignant?
benign
86
what condition is insulinoma associated with?
MEN1
87
what can trigger hypoglycaemia with insulinoma?
fasting | exercise
88
what is the management of insulinoma?
excision
89
what is post prandial hypoglycaemia ?
Dumping post-gastric bypass

Y4 Endo (5 decks)

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