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Flashcards in Endocrinology Deck (122)
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1

What is type 1 diabetes?

Autoimmune destruction of pancreatic beta-cells causes reduced insulin production, resulting in hyperglycaemia

2

List aetiology/risk factors for type 1 diabetes

Autoimmunity
Genetics (HLA DR3/4)
Latent autoimmune diabetes of adulthood

3

List clinical features of type 1 diabetes

Polyuria
Polydipsia
Weight loss
Fatigue
Malaise
Blurred vision (retinopathy)

4

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

5

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

6

What are the parameters for impaired fasting glucose testing in diabetes?

Fasting: greater than 6.1, less than 7 mmol/l

7

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

8

List two rapid-acting insulins

Humalog
Novorapid

9

List two short-acting insulins

Actrapid
Humulin S

10

List two intermediate-acting insulins

Insulatard
Humulin I

11

List two long-acting insulins

Lantus
Levemir

12

Novomix 30 insulin has how much short and how much long -acting insulin?

30% short-acting
70% long-acting

13

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

14

What is type 2 diabetes?

Relative insulin deficiency caused by insulin resistance/reduced sensitivity, resulting in hyperglycaemia

15

List aetiology/risk factors for type 2 diabetes

Asians
Obesity
Low level of exercise
Cardiovascular disease
Monogenic twins

16

List clinical features of type 2 diabetes

Polyuria
Polydipsia
Obesity
Fatigue
Malaise
Blurred vision
Recurrent infections

17

List the main drug classes (and examples) used in type 2 diabetes

Biguanides (metformin)
Sulfonylureas (gliclazide, glibenclamide)
TZD's (pioglitazone)
DPP-IV inhibitors (sitagliptin)
GLP-1 analogue (exenatide)
Alpha-glucosidase inhibitors (acarbose)

18

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

19

What does gliclazide do? List side effects

Increases insulin secretion from pancreatic B-cell
SE: weight gain, hypoglycaemia

20

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

21

What does sitagliptin do?

Increases incretin effect of GLP-1 and GDP (delays gastric emptying, reduces appetite)

22

What are the components of metabolic syndrome?

Central obesity
Hypertension
Hyperglycaemia
Dyslipidaemia

23

Outline management of metabolic syndrome

Exercise (Tai Chi)
Weight reduction, orlistat
Statin, anti-hypertensive, metformin +/- pioglitazone

24

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

25

List aetiology/risk factors for diabetic ketoacidosis

Non-compliance
Missed dose, missed meal
Infection (esp UTI)
MI
Steroid use
Pancreatitis
Surgery
Alcohol-induced

26

List clinical features of diabetic ketoacidosis

Drowsiness
Vomiting
Dehydration
Polyuria, polydipsia
Ketotic "pear-drop" breath
Kussmaul (deep) breathing

27

What investigations would you do for diabetic ketoacidosis?

Glucose usually greater than 11
Bloods: FBC, U+E, osmolarity, ABG
CXR
Urinary ketones, culture

28

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
IV fluids

29

What is hyperosmolar hyperglycaemic state (HHS)?

Hyperosmolar state caused by uncontrolled hyperglycaemia, usually in type 2 diabetics

30

List clinical features of HHS

Dehydration
Stupor, coma
Impaired consciousness