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Flashcards in Endocrinology Deck (11):
1

What is the Omnious Octet?

The 8 pathophysiological pathways in DM targeted by oral hypoglycaemics

Pancreas

  1. Decreased insulin secretion [Beta-cell dysfunction]
  2. Increased glucagon secretion

GI

  1. Decreased incretin effect
  2. Neurotransmitter dysfunction [appetite]

Liver

  1. Increased lipolysis -> insulin resistance
  2. Increased gluconeogenesis

Muscles

  1. Decreased glucose uptake

Urinary

  1. Increased glucose reabsorption

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2

Purpose of checking visual field in patients with DM retinopathy

  • Laser photocoagulation therapy for DM retinopathy may → visual field defect
  • Laser scars may be found in the periphery of fundus, appears like exudate + pigment deposition

3

What are the Management Options for DM

[General Framework]

  1. Lifestyle Measures - Diet, Exercise, Body Weight
  2. Oral Hypoglycaemics
  3. Insulin
  4. Treatment of Complications

4

Name the Classes of Oral Hypoglycaemic Agents and their Mechanism of Action (6)

 

  1. Biguanides - AMPK activation decrease gluconeogenesis and insulin resistance
  2. Sulphonylureas - X K+ channels in beta-cells -> increase insulin secretion
  3. TZD - Targets PPARy -> decrease insulin resistance
  4. Incretin-Based Therapy - GLP1 analogue/ inhibit breakdown by DPP4 -> Increase insulin; Decrease glucagon
  5. SGLT2 Inhibitor - Increase urine glucose loss
  6. Acarbose - Inhibit glucose absorption

5

What are the Benefits of Incretin based Anti-diabetic therapy?

  • Glucose-dependent stimulation of post-prandial insulin release + glucagon suppression
  • X cause hypoglycaemia

6

GLP1 Analogues and DPP-4 inhibitors

[Considerations, Examples, Side Effects]

GLP-1 Analogue [Liraglutide, Exenatide]

  • Decreases appetite -> WL [for obese pt]
  • Resistant to DPP-4 degradation
  • S/E - N&V due to Delayed Gastric Emptying

DPP-4 Inhibitors [Sitagliptin]

  • Dose adjustment required for renal failure
  • S/E (rare) - Pancreatitis, Joint Pain

7

SGLT2 Inhibitors

[Benefits, Considerations, Examples, Side Effects]

  • Examples - Dapaglifozin, Canaglifozin
  • Mechanism - Increases urine glucose loss
  • Additional Benefits
    • Weight loss
    • Decreased fat mass
    • Lowered BP
    • X Hypoglycaemia if monotherapy
  • Considerations - X effective if eGFR <45
  • S/E
    • UG - UTI and Fungal infection
    • Systemic - Osmotic diuresis and Postural hypotension
    • Others - DKA [rare; in insulin requiring patients]
    • Drug Specific - D -> avoid in bladder Ca; C -> increased fractured risk

8

Cushing’s Syndrome vs Cushing’s Disease

  • Cushing’s Syndrome = Hyper-cortisol of any cause
  • Cushing’s Disease = Cushing’s Syndrome 2o to pituitary ACTH hypersecretion

9

Cushingoid Mnemonic

  • C – Cataracts
  • U – Ulcers
  • S – Striae
  • H – Hypertension & Hirsutism [not in exogenous causes]
  • I – Infections
  • N – Necrosis (Avascular) of Femoral Head [Osteoporosis]
  • G – Glucose (Hyperglycaemia/DM)
  • O – Obesity
  • I – Impaired Wound Healing
  • D – Depression

10

Signs of Cushing’s Syndrome

  • Face – Moon face, Acne & Hirsutism [∵androgen excess; only in endogenous causes]
  • Trunk – Central obesity, Buffalo hump, Purple striae, Thinning of Skin
  • Limbs – Muscle wasting, Bruising, Proximal muscle weakness
  • Hyperpigmentation [∵ACTH excess; only in ACTH-dependent Cushing’s]

11

Classical Signs of Thyrotoxicosis

[Apart from Hand & Eye Signs]

  • Diffuse goitre that moves on swallowing; Thyroid bruit
  • Pre-tibial myxoedema
  • Proximal muscle weakness
  • CVS – Tachycardia, AF, ↑Output HF