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Endocrinology 2 Flashcards

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1
Q

C-peptide levels are typically low or high in T1DM?

A

typically low

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2
Q

Name four antibodies associated with T1DM

Which one correlates strongly with age?

A
  1. anti-GAD (glutamic acid decaroxylase)
  2. ICA (islet cell antibodies)
  3. IAA (insulin autoantibodies)
  4. Insulinoma associated 2 autoantibodies

3 - found in 90% of young children, but only 60% in older patients

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3
Q

What is the diagnostic criteria for T1DM and symptomatic T2DM?
Fasting glucose
Random glucose

A

fasting glucose >=7.0 mmol/l
random glucose >=11.1 mmol/l (or after 75g oral glucose tolerance test)

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4
Q

Ix for T1DM (2)

A

measurement of C-peptide or autoantibodies

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5
Q

Diagnostic criteria for an asymptomatic (T2DM) but has raised glucose as per diagnostic criteria

A

fasting glucose 7 or more
random 11 or more
on two separate occasions

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6
Q

HbA1c diagnostic criteria

A

=>48 (6.5%) (at least two readings)

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7
Q

When can you not use a HbA1c?
(5)

A

haemoglobinopathies
haemolytic anaemia
untreated iron deficiency anaemia
(the above essentially means anything haematology related)

suspected GDM
HIV
CKD
If taking medication that may cause hyperglycaemia (for example corticosteroids)

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8
Q

Impaired fasting glucose measurements:

If within that range then offer which test?

A

6.1-7.0 fasting

OGTT

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9
Q

Impaired glucose tolerance measurements for OGTT

A

Fasting glucose <7 and OGTT 2 hour 7.8>= - <11.1

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10
Q

T1DM
How often should HbA1c be monitored?
What is the target?

A

every 3-6 months
48 (6.5%) or lower

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11
Q

How often should T1DM self monitor their glucose?

Targets on waking and before meals?

A

QDS, before each meal and before bed

5-7 on waking
4-7 before meals

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12
Q

T1DM mx

A

basal-bolus regimens
BD insulin detemir regime of choice
OR
OD glargine or detemir

rapid acting insulin analogues with meals

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13
Q

When would you add in metformin for a T1DM?

A

BMI >=25

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14
Q

T2DM targets
Lifestyle, metformin, drugs that can cause hypoglycaemia
How often to be checked?

A

Every 3-6 months until stable, then 6 monthly
Target 48 if on lifestyle or metformin
If on a drug that can cause hypoglycaemia target 53

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15
Q

T2DM targets
Lifestyle
Metformin
Drugs that can cause hypoglycaemia

A

48/6.5
48/6.5%

53/7%

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16
Q

When do you add a second drug for rx of T2DM?

What is the target for a pt like this?

A

Once HbA1c is 58

53/ 7%

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17
Q

T2DM Mx Step 1

A

QRISK 10%>/ CVD/ chronic heart failure = metformin, once established then SGLT2 inhib

If not then just metformin

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18
Q

What to do if metformin is not tolerated?

A

Switch to MR metformin

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19
Q

If metformin is CI then what do you give?

A

QRISK>10%/ CVD/ heart failure = monotherapy SGLT2

If not then DPP4, pioglitazone or sulfonylurea

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20
Q

Step 2 T2DM mx

A

If HbA1c has risen to 58 add any of the following:

DPP4/ pioglit/sulfonylurea
SGLT2 if NICE criteria met

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21
Q

3rd line T2DM

A

If HbA1c has risen to 58 add any of the following:

DPP4/ pioglit/sulfonylurea
SGLT2 if NICE criteria met

OR can start insulin

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22
Q

What would you do next if triple therapy for diabetes is ineffective

A

Swap a drug for a GLP1 mimetic if BMI >35 of if insulin would have occupational implications

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23
Q

When would you continue a GLP1 mimetic?

Study These Flashcards
A

If there is a reduction of at least 11 or 1% of HbA1c and a weight loss of at least 3% of initial body weight in 6 months.

24
Q

Which insulin is recommended to be started on with T2DM?

Study These Flashcards
A

Isophane intermediate acting ON or BD

25
Examples of GLP1 mimetic Administration (for both) It should not be given when?
Exanatide + liraglutide Exanatide SC within 60 minutes before the morning and evening meals After meals Liraglutide OD
26
Exanatide and liraglutide can be given with which two drugs?
Metformin + sulfonylurea
27
Standard release exanatide can be given with
basal insulin or just metformin
28
Examples of DPP4 inhibitors
sitagliptin, vildagliptin
29
Thiazolidindiones example
pioglitazone
30
Pioglitazone SE (4) CI
weight gain liver impairment fluid retention bladder cancer CI heart failure
31
SGLT 2 examples
canagliflozin, dapagliflozin
32
Examples SGLT2 DPP4 Thiazolidinidiones Sulfonylurea GLP1 mimetics
SGLT2 - canagliflozin DPP4 - sitagliptin Thiazolidinidiones - pioglitazone Sulfonylurea - gliclazide GLP1 mimetics - exanatide
33
SE SGLT2 DPP4 Thiazolidinidiones Sulfonylurea GLP1 mimetics
SGLT2 - weight loss, risk of amputation, UTI, gangrene DPP4 Thiazolidinidiones - weight gain, fluid retention, bladder ca, liver impairment Sulfonylurea -hypoglycaemia GLP1 mimetics
34
SGLT2 SE (4) Canagliflozin
weight loss increased risk of amputation urinary and genital infection fournier's gangrene
35
Sulfonylureas SE (6)
hypoglycaemia weight gain SIADH liver impairment Peripheral neuropathy Bone marrow suppression
36
What can cause a lower than expected HbA1c (3)
Sickle-cell anaemia GP6D deficiency Hereditary spherocytosis
37
What can cause a higher than expected HbA1c (3)
Vitamin B12/folic acid deficiency Iron-deficiency anaemia Splenectomy
38
Sick rules If patient is sick and insulin dependent and sugars and ketones are raised what is rule of thumb for corrective doses that should be given?
Daily insulin dose divided by 6 with a max dose of 15 units
39
When might a pt need admitting with ketones and raised sugars? (4)
underlying illness unable to keep fluids down persistent diarrhoea BM >20 persistently despite additional insulin
40
Rules for T2DM during Ramadan Food in the morning recommendation: Metformin dosing
eat a meal containing long-acting carbohydrates prior to sunrise the dose should be split one-third before sunrise (Suhoor) and two-thirds after sunset (Iftar)
41
Rules for T2DM during Ramadan Sulfonylureas Pioglitazone
OD should be switched to the evening If BD, take a larger proportion after sunset No changes
42
Diabetic neuropathy mx 1st line (3) Rescue
amitryptilline/ duloxetine/ gabapentin Rescue tramadol
43
What can be used for localised neuropathic pain such as post herpetic neuralgia?
Topical capsaicin
44
Mx of gastroparesis (GI autonomic neuropathy in DM) (3)
Metoclopramide/ domperidone or erythromycin
45
How often should diabetic patients have an annual foot screen? How is it done?
Annually - palpate both pulses in the foot - 10g monofilament to be used
46
Diabetic foot disease Low risk Moderate High If high risk?
Low - only callus RF Moderate - deformity or neuropathy or non critical limb ischaemia High - previous ulcer/ amputation/ RRT/ neuropathy + critical limb ischaemia together FU with local diabetic foot centre regularly
47
Most common causes of DKA (3)
Infection Missed insulin MI
48
Diagnostic criteria DKA (4) Glucose pH bicarb ketones
glucose > 11 pH <7.3 bicarb <15 ketones >3/ +++
49
Mx of DKA Insulin management
Fluid replacement NaCl over 1 hour NaKCL over 2, 2, 4,4, 6 hrs Insulin 0.1unit/kg/hour
50
DKA resolution is defined as? (3)
DKA resolution is defined as: pH >7.3 and blood ketones < 0.6 mmol/L and bicarbonate > 15.0mmol/L
51
When do you give dextrose in DKA? What do you give?
gluc<15 5% dex
52
Rapid acting human insulin analogues examples (2)
Novorapid (insulin aspart) Humalog S (insulin lispro)
53
Soluble insulin short acting examples (2)
Short acting Actrapid Humulin S
54
Intermediate acting insulin example
Isophane
55
Long-acting insulin example
Insulin determir (levemir) OD or BD Insulin glargine (lantus) OD
56
What drug can cause a reduction in hypoglycaemic awareness
BB

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