Flashcards in Endocrinology Deck (122)
What is type 1 diabetes?
Autoimmune destruction of pancreatic beta-cells causes reduced insulin production, resulting in hyperglycaemia
List aetiology/risk factors for type 1 diabetes
Genetics (HLA DR3/4)
Latent autoimmune diabetes of adulthood
List clinical features of type 1 diabetes
Blurred vision (retinopathy)
What investigations would you do for type 1 diabetes?
Bloods: FBC, U+E, LFT's, eGFR
Antibodies: anti- islet cell, GAD
Screening for retinopathy/nephropathy/neuropathy
What are the parameters for impaired glucose tolerance testing in diabetes?
Fasting: less than 7 mmol/l
2h oral glucose level: greater than 7.8, less than 11.1 mmol/l
What are the parameters for impaired fasting glucose testing in diabetes?
Fasting: greater than 6.1, less than 7 mmol/l
What are the WHO diagnostic criteria for diabetes?
Fasting glucose greater than 7 mmol/l
Random glucose greater than 11.1 mmol/l
HbA1C greater than 48
Either symptomatic + 1 positive lab test or asymptomatic + 2 positive lab tests
List two rapid-acting insulins
List two short-acting insulins
List two intermediate-acting insulins
List two long-acting insulins
Novomix 30 insulin has how much short and how much long -acting insulin?
List the main insulin regimens that patients may be on
Once-daily: long-acting before bed
Twice-daily: short-acting pre-breakfast and pre-dinner
Basal-bolus: long-acting before bed, short-acting before meal
What is type 2 diabetes?
Relative insulin deficiency caused by insulin resistance/reduced sensitivity, resulting in hyperglycaemia
List aetiology/risk factors for type 2 diabetes
Low level of exercise
List clinical features of type 2 diabetes
List the main drug classes (and examples) used in type 2 diabetes
Sulfonylureas (gliclazide, glibenclamide)
DPP-IV inhibitors (sitagliptin)
GLP-1 analogue (exenatide)
Alpha-glucosidase inhibitors (acarbose)
What does metformin do? List side effects
Reduces hepatic gluconeogenesis, increases insulin sensitivity
No weight gain or hypo risk
SE: lactic acidosis, GI upset, avoid if eGFR less than 35
What does gliclazide do? List side effects
Increases insulin secretion from pancreatic B-cell
SE: weight gain, hypoglycaemia
What does pioglitazone do? List side effects
Enhances PPAR-alpha to increase insulin gene transcription, also reduces hepatic gluconeogenesis
SE: fluid overload, weight gain, osteoporosis
What does sitagliptin do?
Increases incretin effect of GLP-1 and GDP (delays gastric emptying, reduces appetite)
What are the components of metabolic syndrome?
Outline management of metabolic syndrome
Exercise (Tai Chi)
Weight reduction, orlistat
Statin, anti-hypertensive, metformin +/- pioglitazone
What is the pathophysiology of diabetic ketoacidosis?
Reduced insulin results in reduced cellular uptake of glucose, causing less pyruvate and more acetyl-coA
Acetyl-coA is converted to ketone bodies and acetate
List aetiology/risk factors for diabetic ketoacidosis
Missed dose, missed meal
Infection (esp UTI)
List clinical features of diabetic ketoacidosis
Ketotic "pear-drop" breath
Kussmaul (deep) breathing
What investigations would you do for diabetic ketoacidosis?
Glucose usually greater than 11
Bloods: FBC, U+E, osmolarity, ABG
Urinary ketones, culture
Outline management of diabetic ketoacidosis
NG tube if vomiting/unconscious
IV insulin 6u per hour, increase if poor response
IM insulin 20u if no infusion pump
Monitor U+E ever hour, aim for glucose to drop by 5mmol/l
What is hyperosmolar hyperglycaemic state (HHS)?
Hyperosmolar state caused by uncontrolled hyperglycaemia, usually in type 2 diabetics