Endocrine part 1 November 23

Question 1

Q1: What is diabetes and what are the main causes of diabetes?

Answer 1

• Diabetes is a general term for metabolic disorders affecting blood sugars.
• Subtypes include Type 1 (lack of insulin),
• Type 2 (insulin resistance),
• Gestational (during pregnancy),
• Diabetes insipidus (water balance), Secondary diabetes (due to other conditions).
• Causes vary: Type 1 (autoimmune),
• Type 2 (lifestyle, genetics),
• Gestational (pregnancy),
• Diabetes insipidus (genetics, damage),
• Secondary diabetes (organ damage).

Question 3

Q3: What is diabetes insipidus and what are the different types?

Answer 3

• Diabetes insipidus involves water regulation due to decreased ADH.
• Types include Cranial (brain produces less ADH)
• Nephrogenic (kidneys resist ADH).

Question 4

Q4: What are the main complications of diabetes insipidus?

Answer 4

Complications include
* hyponatremia,
* hyponatremic
* convulsions,
* dehydration.

Question 5

Q5: What is used to treat diabetes insipidus?

Answer 5

Treatment depends on type.

For Cranial:
* Vasopressin,
* Desmopressin.

For Nephrogenic:
* Oxytocin,
* Thiazide diuretics,
* Carbamazepine.

Question 6

Q6: What is the main side effect of desmopressin and what are the symptoms of this electrolyte imbalance?

Answer 6

The main side effect is

extreme water dilution,

leading to hyponatremic convulsions.

Question 7

Q7: What’s the DVLA advice for diabetics?

Answer 7

• Diabetic drivers on insulin or hypoglycemic drugs must inform DVLA.
• Monitoring, safe blood glucose levels,
• actions during hypo,
• not driving with low BG are advised.

Question 8

Q8: How often should diabetics check their glucose levels while driving and what should their blood glucose levels be?

Answer 8

Check every 2 hours while driving, with BG above 5 mmol/L.

Question 9

Q9: What should diabetics do if their blood sugars get too low while driving?

Answer 9

• If BG falls
• <4mmol/L
• hypo signs develop,
• stop driving,
• eat,
• wait 45 mins after BG normal before continuing journey.

Question 10

Q10: What blood glucose level should diabetics never drive?

Answer 10

BG should never be below 4 mmol/L.

Question 11

Q11: What advice would you give to a diabetic regarding alcohol consumption?

Answer 11

Alcohol can mask hypo signs,

drink in moderation and with food.

Question 12

Q12: What is an oral glucose tolerance test and what is it used for?

Answer 12

It’s a test to diagnose Impaired Glucose Tolerance and gestational diabetes.

Question 13

Q13: What is HbA1c and what is it used for?

Answer 13

1. HbA1c shows blood sugar control over 2 months,
2. predicts complications,
3. Is used to monitor both Type 1 and Type 2 diabetes.

Question 14

Q14: When do you avoid using the HbA1c test?

Answer 14

Avoid for diagnosing diabetes
1. In children,
2. pregnant women, 2 months postpartum,
3. type 1,
4. Monitoring in Type 2 with symptoms <2 months, high diabetes risk, certain treatments,
5. CKD,
6. HIV.

Question 15

Q15: How often should HbA1c be used in terms of monitoring Type 1 and Type 2 diabetes?

Answer 15

Type 1: every 3-6 months,

Type 2: every 3-6 months until stable,

then every 6 months.

Question 16

Q16: What is Type 1 diabetes?

Answer 16

Type 1 diabetes is the complete deficiency of endogenous insulin secretion in the pancreas,

requiring insulin replacement.

Question 17

Q17: What are the main diabetic complications?

Answer 17

Major acute complications include
1. foot infections,
2. neuropathy,
3. nephropathy,
4. retinopathy,
5. CVD, cancers,
6. sexual dysfunction,
7. hyperglycemia, hypoglycemia, DKA, and Hyperosmolar Hyperglycemic States.

Question 18

Q18: What are the signs and symptoms of Type 1 diabetes?

Answer 18

1. increased thirst,
2. frequent urination at night
3. hyperglycemia,
4. extreme hunger,
5. unintended weight loss,
6. irritable mood,
7. fatigue, blurred vision.

Question 19

Q19: For Type 1 diabetes, what are the main aims of treatment?

Answer 19

1. achieving optimal BG levels,
2. avoiding hypoglycemic episodes,
3. minimizing complications,
4. preventing disability from complications,
5. individualizing glycaemic control targets.

Question 20

Q20: How many times a day should a Type 1 diabetic measure their blood sugars?

Answer 20

At least 4 times a day,
including before each meal
and before bed.

Question 21

Q21: What are the common target ranges for blood glucose levels in Type 1 and Type 2 diabetes?

Answer 21

Ranges vary before and after meals,
waking, and during driving,

with targets typically between 4-9 mmol/L.

Question 22

Q22: Give a simple overview of the drug and non-drug treatments for Type 1 diabetes.

Answer 22

1. Type 1 diabetes requires insulin replacement.
2. Lifestyle,
3. exercise,
4. planned meals,
5. medication management are crucial.

Question 23

Q23: What is insulin, and what are the 2 types of insulin secreted naturally by the body?

Answer 23

• **Insulin is a hormone that regulates blood sugar.
• The 2 types are

1. Basal insulin (steady background)
2. Bolus insulin (in response to meals).

Question 24

Q24: What are the 3 types of insulin available in the UK?

Answer 24

Human insulin,
Human insulin analogue,
Animal insulin.

Question 25

Q25: How is insulin administered to patients?

Answer 25

Insulin is given subcutaneously (S/C) and should not be taken orally due to enzymatic destruction.

Question 26

Q26: What is the main advice you'd give to a patient on how to inject their insulin?

Answer 26

Administer insulin S/C in fatty areas like abdomen or outer thigh. Rotate injection sites to avoid lipoatrophy or lipohypertrophy.

Question 27

Q27: What are the 3 groups of insulin used in treating diabetes?

Answer 27

Short-acting insulin (soluble + rapid-acting), Intermediate-acting insulin, Long-acting insulin.

Question 28

Q28: Give examples of short-acting insulins.

Answer 28

Examples include soluble insulin like Actrapid.

Question 29

Q28: Give examples of rapid-acting insulins.

Answer 29

Examples include Aspart (Fiasp, NovoRapid), Glusine (Apidra), Lispro (Humalog).

Question 30

Q28: Give examples of intermediate-acting insulins.

Answer 30

Examples include Insulin isophane (NPH, Humulin I).

Question 31

Q28: Give examples of long-acting insulins.

Answer 31

Examples include 1. Detemir (Levemir), 2. Glargine (Lantus, Tou

Question 32

Q29: What are the 3 main types of insulin regimes diabetics use?

Answer 32

The main types are 1. Basal Bolus (multiple injections throughout the day), 2. Once Daily (single dose each day), 3. and Mixed (combination of short- and intermediate-acting insulins).

Question 33

Q30: What is the basal bolus regime, and who is it suitable for?

Answer 33

Basal Bolus involves multiple injections throughout the day, with basal (background) and bolus (mealtime) insulin. It's suitable for both Type 1 and Type 2 diabetics who want flexible mealtime control.

Question 34

Q31: What is the once daily regime, and who is it suitable for?

Answer 34

The once daily regime involves a single daily dose of insulin, typically for Type 2 diabetics with oral tablets. It helps maintain stable BG levels but can risk hypo with long-acting insulin.

Question 35

Q32: What is the mixed regime, and who is it suitable for?

Answer 35

The mixed regime combines short-acting and intermediate-acting insulins, often taken before meals. It's suitable for those with set routines and can be used by both Type 1 and Type 2 diabetics.

Question 36

Q33: What type of insulin regime is used in patients with severe debilitating hypoglycemia?

Answer 36

Continuous subcutaneous insulin infusions are used in such cases.

Question 37

Q34: What can cause poor blood glucose control?

Answer 37

Medication issues, lifestyle factors, psychological stress, and comorbidities like renal disease and thyroid disorders can cause poor control.

Question 38

Q35: What activity increases and decreases the body's insulin demands?

Answer 38

Increased demands are caused by infection, stress, trauma, pregnancy, physical activity, and vomiting. Decreased demands result from reduced food intake, impaired renal function, and certain endocrine disorders like Addison's disease.

Question 39

Q36: What should patients do with the used needles they have?

Answer 39

Patients should be advised on the safe disposal of needles, lancets, and syringes, using suitable disposal containers and arrangements for collection.

Question 40

Q37: What are the sick day rules for diabetic patients?

Answer 40

During illness, patients should monitor blood sugars more frequently, potentially increase insulin doses, never stop insulin, maintain fluid and food intake, Be prepared to deal with hypo episodes.

Question 41

Q38: What drugs can be stopped during the sick day rules?

Answer 41

Some medications like SGLT2 inhibitors, ACE inhibitors, diuretics, metformin, ARBs, and NSAIDs can be temporarily stopped during illness due to dehydration and other risks.

Question 42

Q39: What are the most common insulin errors reported?

Answer 42

Common errors include failure to manage insulin, dosing errors, wrong frequency, and delayed or missed doses.

Question 43

Q40: What guidance has been issued by the EMA on reducing errors with regards to insulins?

Answer 43

The EMA advises prescribing insulin by brand name, avoiding unit abbreviations, and providing adequate patient information.

Question 44

Q41: What mistakes have caused DKA when it comes to prescribing and administering insulins?

Answer 44

DKA can result from using GLP1 agonists and insulin together and then quickly reducing insulin doses instead of tapering them gradually.

Question 45

Q42: What mistakes have patients made when it comes to self-administering insulins that have caused severe harm and death?

Answer 45

Patients should not use insulin syringes to withdraw insulin from pens or cartridges, as syringes calculate doses differently, risking overdose.

Question 46

Q43: What mistakes have prescribers made when it comes to dispensing insulins and caused confusion?

Answer 46

Prescribers should ensure correct strength, avoid abbreviating 'units,' and prescribe and dispense insulin by brand name to prevent confusion.

Question 47

Q44: What is the MHRA warning regarding the risks of all insulin devices, and what should patients be advised to do as a result of this?

Answer 47

MHRA warns of the risk of amyloid deposits with constant site use. Patients should rotate injection sites and consult their GP for dose adjustments if they repeatedly use the same site.

Question 48

Q45: In terms of blood sugar monitoring, what efforts should be made to never go below what blood glucose concentration?

Answer 48

Patients should never let their blood glucose levels go below 4 mmol/L.

Question 49

Q46: What are the 3 main patient and carer advice measures given to patients when giving them insulin?

Answer 49

Patients should be advised to avoid hypoglycemia, understand insulin types and doses, and be aware of driving and skilled task regulations.

Question 50

Q47: When converting animal insulin to human insulin, what are the dose adjustments, if any?

Answer 50

When converting from bovine (cow) to human insulin, reduce the dose by 10% to avoid hypoglycemia. There's usually no dose change when converting from porcine (pig) to human insulin.

Question 51

Q48: What are the 8 main classes of drugs used to treat Type 2 diabetes?

Answer 51

The main drug classes include 1. Biguanides (e.g., Metformin), 2. Sulfonylureas, 3. Meglitinides (e.g., Repaglinide), 4. Acarbose, 5. Dipeptidylpeptidase-4 (DPP-4) inhibitors (e.g., Sitagliptin), 6. Sodium glucose co-transporter 2 (SGLT2) inhibitors (e.g., Canagliflozin), 7. Thiazolidinediones (e.g., Pioglitazone), 8. Glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., Liraglutide).

Question 52

What is Hba1c used to diagnose

Answer 52

Hba1c used to diagnose type 2 diabetes only