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Flashcards in Endocrinology Deck (145)
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1

Antibodies associated with T1DM?

Anti-islet and anti-GAD

2

Diagnosis for diabetes on blood sugars?

Fasting > 7 / HbA1c >48mmol/L (6.5%)

2-hours post OGTT / Random glucose > 11.1mmol/L

3

What is the definition of impaired fasting glucose?

6.1 - 7.0

Offer these OGTT, If this is 7.8 - 11.1 = IMPAIRED GLUCOSE TOLERANCE

4

Conservative management of diabetes?

MDT

The 4 C's? = Control, compilations, competency and coping

5

Diabetes conservative management - Control?

Record of complications e.g. DKA, HONK and hypo's

CBG - target of 5-7 on waking and 4-7 pre-meal

HbA1c <6.5% or 48mmol/L
Check every 3-6 months then 6-monthly when stable

Control HTN - <140/80 if no end organ damage
<130/80 if end organ damage

6

What are BP targets for diabetics?

Control HTN - <140/80 if no end organ damage
<130/80 if end organ damage

7

Conservative management of diabetes - Complications?

Macro = Pulses, BP, cardiac

Micro = Fundoscopy, U&E's and sensory testing

8

Conservative management of diabetes - Competency?

With insulin injections, checking injection sites and BM monitoring

9

Conservative management of diabetes - coping?

Psychological, occupational and domestic

10

Sick day rules for diabetes?

Increase frequency of blood sugars

Aim for at least 3 litres of fluid a day

Access to mobile and emergency food supplies

Continue all medication

11

Medical management of T1DM?

Always need insulin

Biphasic = first line = Twice daily insulin detemir

12

Management of type 2 diabetes - metformin tolerated?

If metformin tolerated it is 1st line

2nd line once HbA1c > 58mmol/L (7.5%) =
Add in gliptin / sulfonylurea / pioglitazone / SGLT-2 inhibitor

3rd line once HbA1c > 58mmol/L (7.5%) = metformin plus:

Sulfonylurea + gliptin
Sulfonylurea + pioglitazone
Sulfonylurea + SGLT-2 inhibitor
Pioglitazone + SGLT-2 inhibitor

3rd line = insulin
OR
Metformin + sulfonylurea + GLP-1 mimetic

13

When should you not use metformin?

End stage renal disease

14

Management of type 2 diabetes - metformin not tolerated?

1st line = gliptin or sulfonylurea or pioglitazone

2nd line once HbA1c >58mmol/L (7.5%):

Gliptin + pioglitazone
Gliptin + sulfonylurea
Pioglitazone + sulfonylurea

3rd line = insulin

15

When HbA1c hits what level do you move onto the next treatment in T2DM?

58 mmol/L or 7.5%

16

When can you use metformin + sulfonylurea + GLP-1 mimetic?

When normal triple therapy not effective (3rd line), then use this if BMI >35, or BMI<35 but weight loss or using insulin would have a big impact

17

Metformin - MOA, SE's and CI's?

Increases insulin sensitivity + decreases hepatic neogenesis

Nausea, diarrhoea, abdominal pain, lactic acidosis

Cannot use if eGFR <30ml/minute

18

Sulfonylureas - Examples, MOA, SE's?

Gliclazide or Glimepiride

Stimulate pancreatic beta cells to stimulate insulin

SE's = hypoglycaemia, WEIGHT GAIN, hyponatraemia

19

Thiazolidinediones - Example, MOA, SE's?

Pioglitazone (contraindicated in blander cancer and heart failure)

Activate PPAR-gamma receptor in adipocytes to promote adipogenesis and fatty acid reuptake, reducing peripheral insulin resistance

SE's = Weight gain and fluid retention

20

DPP-4 inhibitors / Gliptins - examples, MOA and SE's?

Vildagliptin and sitagliptin

Increases incretin levels which inhibit glucagon secretion

SE = increased risk of pancreatitis

21

SGLT-2 inhibitors - MOA, SE's?

-Gliflozins

Inhibit resorption of glucose in the kidneys - typically results in WEIGHT LOSS

SE's = UTI as more glucose in the urine

22

GLP-1 agonists - How do you take it, MOA and SE's?

Exanitide

Subcut

Incretin mimetic which inhibits glucagon secretion - typically results in WEIGHT LOSS

SE's = N&V, pancreatitis

23

Macrovascular complications of diabetes?

MI/CVA

24

Microvascular complications of diabetes?

Diabetic foot
Nephropathy
Retinopathy
Neuropathy

25

Microvascular complications of diabetes - diabetic foot?

ISCHAEMIA = hyperglycaemia damages blood vessels = critical toes, absent pulses and painful punched out ulcers

NEUROPATHY = hyperglycaemia can cause damage to nerves = loss of protective sensation = CHARCOTS FOOT = painless ulcers

26

Management of diabetic foot?

Conservative = regular inspection, comfortable therapeutic footwear. Regular chiropody

Medical = treat any infections and pain management e.g. amitriptyline

Surgical = abscesses, cellulitis or gangrene

27

Microvascular complications - nephropathy?

Hyperglycaemia = nephron loss and glomerulosclerosis

Clinical features = Microalbuminaemia - urine albumin:creatinine ratio > 30

Management = ACEI's and ARBS

28

Microvascular complications - Retinopathy?

Leading cause of blindness <60

Due to small vessel damage = ischaemia = VEGF = neovascularisation

29

Classification of diabetic retinopathy

Mild NPDR = 1 or more microaneurysm

Moderate NPDR:
Microaneurysms
Blot haemorrhages
Hard exudate
Cotton wool spots, venous bleeding

Severe NPDR:
Blot haemorrhages and micro aneurysms in all quadrants
Venous bleeding in two quadrants

PROLIFERATIVE = neovascularisation

30

Microvascular complications of diabetes - neuropathy

Nerve damage due to hyperglycaemia

Symmetrical sensory loss = polyneuropathy
Mononeuropathy = CN3 and 6 palsies
Autonomic neuropathy = postural hypotension, diarrhoea, urinary retention