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RW Endocrinology > General Diabetes > Flashcards

General Diabetes Flashcards

1
Q

What is the definition of diabetes mellitus?

A

A group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.

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2
Q

What are the main classification of types of diabetes?

A
  • Type 1
  • Type 2
  • Type 3 (other including MODY)
  • Type 4: Gestational
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3
Q

What rough percentage of the population has diabetes, and what Type does the majority (88%) have?

A

~5%, Type 2

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4
Q

What is the time course/presentation ages of different types of diabetes?

A
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5
Q

What is the classification of different types of diabetes based on clinical features?

A
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6
Q

Which is more genetic, Type 1 or Type 2 diabetes?

A

Type 2

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7
Q

What tests can help distinguish Type 1 and Type 2 diabetes?

A

GAD/IA2 antibodies, C-peptide and ketosis (as well as symptoms)

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8
Q

How do various factors differentiate Type 1 and Type 2 Diabetes?

A
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9
Q

What are the main tests for diagnosing diabetes and the cut-offs?

A
  • Random lab blood glucose (11.1)
  • Fasting glucose (7mmol/L)
  • OGTT (11.1)
  • HbA1C (6.5%/48mmol/mol)
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10
Q

What is HbA1c?

A

Glycated hemoglobin - a form of hemoglobin that shows the three-month average plasma glucose concentration.

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11
Q

What is the criteria of diabetes, pre diabetes and normal using HbA1c?

A

Normal: below 42 mmol/mol (<6%) Pre diabetes: 42-47 mol/mol (6-6.4%) Diabetes: 48 mol/mol (>6.5%)

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12
Q

What is the diagnostic criteria for diabetes for HbA1c?

A

HbA1c - 48mmol/m and above (6.5%)

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13
Q

What is the diagnostic criteria of diabetes using Oral Glucose Tolerance Test?

A

> 11.1 mmol/l

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14
Q

What is the diagnostic criteria of diabetes using random glucose ?

A

>11.1 mmol/l

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15
Q

What is the diagnostic criteria of diabetes using fasting glucose ?

A

> 7mmol/l

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16
Q

What is the main measure of glycemic control?

A

HbA1c

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17
Q

What is the HbA1c goal for controlling diabetes?

A

<7% (53 mmol/m)

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18
Q

What is the BG targets for before and after meals, for T1, T2, children and pregnant women?

A

4-7 mmol/l before meal, and 5-9mmol/l after meal in T1DM and children, and <8.5 mmol/l later meal in T2DM (NICE 2015) (pregnant women is same but more specific, children

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19
Q

What screening tests are there for diabetics?

A

Eye clinics, foot clinics, BMI, blood pressure and bloods: HbA1c, renal function and lipids

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20
Q

When is hospitalisation required in diabetes?

A

DKA, significant ketonaemia and/or vomiting

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21
Q

What are the main complications of diabetes?

A

Macrovascular: heart disease and stroke Microvascular: Retinopathy, nephropathy and neuropathy

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22
Q

Generally, how does diabetes cause micro/macrovascular complications?

A

Multiple contributing factors that occur with hyperglycaemia (i.e. direct damage of glucose, inflammation, oxidative stress, mitochondrial dysfunction, AGE_RAGE) contribute to hypoxia and accelerate vascular disease, resulting in reduced blood flow and damaged nerves

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23
Q

Autonomic neuropathy

A

Alterations in functioning of organs e.g. changes in bowel, bladder function, sexual response, sweating, heart rate, blood pressure, hypoglycaemic unawareness

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24
Q

Proximal neuropathy

A

Affects the lumbosacral plexus e.g.pain in the thighs, hips or buttocks leading to weakness in the legs (Amyotrophy)

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25
Q

Focal Neuropathy

A

Sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel

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26
Q

Peripheral Neuropathy

A

Distal symmetric or sensorimotor neuropathy - Pain/ loss of feeling in feet and hands (commonest)

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27
Q

What is Charcot foot?

A

Destruction of metatarsal bones

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28
Q

What are the treatment options for painful neuropathy?

A

Amitriptyline, duloxetine, gabapentin, or pregabalin. Alternatively as a topical treatment: Capsaicin Cream

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29
Q

What are the digestive complications of autonomic neuropathy?

A
  • Gastroparesis (slow emptying) and oesophagus nerve damage (difficulty swallowing)
30
Q

What are the treatment options of gastroparesis?

A
  • Dietary - smaller, more frequent food portions. Low fat. Low in fiber (Bezoars). If severe may need liquid meals - Promotility drugs eg. metoclopramide, domperidone, and erythromycin - Anti-nausea medications eg. prochlorperazine and serotonin antagonists - Abdominal pain - NSAIDs, low dose tricyclic antidepressants, gabapentin, tramadol and fentanyl. - Botulinum Toxin - Gastric Pacemaker
31
Q

True/False: Gustatory sweating (sweating at night or when eating) is a complication of diabetes

A

True, due to autonomic neuropathy of sweat glands. Treated with topical glycopyrrolate, clonidine, botulinum toxin

32
Q

What diagnostic tools are there for neuropathy?

A

Nerve conduction studies or EMG, HR studies, US and gastric emptying studies

33
Q

What is nephropathy?

A

A progressive kidney disease caused by damage to the capillaries in the kidneys’ glomeruli. It is characterized by nephrotic syndrome and diffuse scarring of the glomeruli

34
Q

What test is used to screen for nephropathy and what levels are diagnostic?

A

Urinary albumin creatinine ratio (ACR) - Microalbuminuria is a bad sign, indicated by 30-300mg/ml or ACR ≥3.5 mg/mmol (female) or ≥2.5 mg/mmol (male) with ACR

35
Q

What treatment should be given to patients with microalbuminuria?

A

ACE inhibitor or ARB

36
Q

What are the different structures of the back of the eye?

A
37
Q

What eye pathologies do people with diabetes get?

A
  • Diabetic Retinopathy - microvascular disease - Cataract- clouding of the lens (develops earlier in people with diabetes) - Glaucoma- increase in fluid pressure in the eye leading to optic nerve damage (2 x more common in diabetes) - Acute hyperglycaemia- visual blurring (reversible)
38
Q

What are the stages of retinopathy?

A
  • Mild non-proliferative (Background) - Moderate non-proliferative - Severe non-proliferative - Proliferative
39
Q

What is the biochemical triad that characterises diabetic ketoacidosis?

A

Hyperglycaemia, ketosis and acidosis

40
Q

Ketosis

A

Occurs when the body can’t use glucose for energy (due to not enough insulin for example) so breaks down fat instead, producing ketones

41
Q

Acidosis

A

When ketones build up in the body, it becomes acidic

42
Q

Diabetic Ketoacidosis (DKA)

A

Acute metabolic complication of diabetes that is potentially fatal, resulting from a severe lack of insulin means the body cannot use glucose for energy so ketosis occurs, then causing acidosis

43
Q

What are the biochemical criteria for ketosis, hyperglycaemia and acidosis for DKA?

A

Ketosis: Ketonaemia > 3mmol/L Hyperglycaemia: Blood glucose >11.0 mmol/l Acidosis: Bicarbonate < 15 mol/L or venous pH < 7.3

44
Q

What are the signs and symptoms of DKA?

A

Osmotic related: Thirst, polyuria and dehydration Ketone body related: Flushed, vomiting, abdominal pain and tenderness, Breathless – Kussmaul’s respiration (may smell ketones on breath)

45
Q

What is the management of DKA?

A

IV fluids, insulin and potassium therapy

46
Q

Hyperglycaemic Hyperosmolar Syndrome (HHS)

A

Serious complication of diabetes, characterised by profound hyperglycaemia (>33mmol/l), hyperosmolality (>320), and volume depletion in the absence of significant ketoacidosis

47
Q

What are the main differences between DKA and HHS?

A
48
Q

Lactic acidosis

A

A form of metabolic acidosis due to the inadequate clearance of lactic acid from the blood, as a byproduct of anaerobic respiration

49
Q

What are the 2 types of lactic acidosis?

A

Type A (Associated with tissue hypoxia - either from lack of perfusion or hyperaemia) and Type B (no tissue hypoxia, - associated with underlying conditions eg. Diabetes and drugs)

50
Q

What are the clinical signs of lactic acidosis?

A

Hyperventilation, mental confusion or stupor/coma if severe

51
Q

What are the lab findings of lactic acidosis?

A

Reduced bicarb, raised anion gap, possibly raised glucose, no ketonaemia

52
Q

What are the main nutritional considerations for Type 1 Diabetes?

A

Consistency and timing of meals and CHO, timing on insulin and regular monitoring of blood glucose

53
Q

What is the general rule on when to increase insulin to carb ration?

A

If BG level more than 2 mmol/l above pre meal level on 3 consecutive days

54
Q

What 2 components are involved in Advanced Carb Counting?

A

Insulin to carbohydrate ratio (ICR) - how many insulin units to give per grams of carbohydrate and Insulin sensitivity factor (ISF)/Correction factor (CF) - number of units of insulin to give to correct a certain amount of blood glucose (eg. 1 unit to reduce by 3 mmol)

55
Q

What are the main nutritional considerations for Type 2 Diabetes?

A

Weight loss, smaller meals and snacks, physical activity and monitoring blood glucose and medication

56
Q

What is DAFNE and in which insulin regimes is it suitable?

A

Dose Adjustment for Normal Eating (advanced carb counting) - used with basal bolus insulin

57
Q

Glycaemic index

A

Rank of rate at which food makes BG rise

58
Q

What are the 2 main options for blood glucose monitoring?

A

Urine or blood testing for ketone (Self monitoring blood glucose - SMBG e.g. fingersticking) or Continuous glucose monitoring system (CGMS)

59
Q

How does hypoglycaemia present?

A

Hunger, autonomic activation (pale, anxious, sweating, palpitations), tired/weak, nauseous and dizzy

60
Q

What is the treatment for hypoglycaemia?

A
  • 15-20 grams of glucose or simple carbohydrates (or 1mg Glucagon) - Recheck your blood glucose after 15 minutes, repeat if still hypo - small complex carb snack afterwards
61
Q

What is Impaired Hypoglycaemia Awareness, and in who does it often occur?

A

When hypoglycaemia occurs (<4.0 mmol/l) and individuals feel no or a change symptoms. Often occurs in those who: frequently have low blood glucose episodes, Long duration type 1 or 2 diabetes or Intensively-treated type 1 diabetes (low HbA1c

62
Q

What is the UK criterion of hypoglycaemia?

A

4mmol/l (4 is the floor)

63
Q

What are 2 conditions can be main contributors to hypoglycaemia risk? (basically for exams-box-ticking, rare in actual life)

A

Addison’s (pigment in mouth) and Cushing’s

64
Q

Why is it retinal, nerve and vascular tissue that are primarily affected by hyperglycaemia?

A

Insulin normally regualtes the movement of glucose into cells, however these tissues are insulin-independent meaning they cant regulate the movement of glucose into them. Leading to retinopathy, neuropathy and nephropathy

65
Q

What is the Poyol pathway and how does it cause damage in hyoerglycaemia?

A
  • It is a pathway which is normally inactive and the glycolysis pathway is carried out instead, however it activates when there is excess glucose
  • Its enzyme aldose reductase converts glucose into sorbital (its alcohol sugar)
  • Sorbital exerts osmotic pressure on the cells as it is so large and this causes the cells to die
66
Q

What tests are done at a diabetic review and what are they checking?

A
  • HbA1c - glucose control
  • Blood pressure - hypertension and vascular problems
  • BMI
  • Creatinine in bloods - check for renal failure
  • Proteinuria - check for nephropathy or hypertension
  • Foot examination
  • Retinal screening
67
Q

Why are diabetics more likely to have a higher blood pressure?

A
  • Vasodilator effects of insulin are limited
  • Increased reabsorption at the kidneys caused by insulin may occur of there’s is hyperinsulinaemia
68
Q

What is the fundamental vascular complication that causes nephropathy, neuropathy and retinopathy?

A

Capillary microangiography - results in thickened, permeable and dilated blood vessels. Leads to microaneurysms and protein leakage

69
Q

What tool is used for recording results of a diabetic foot examination?

A

SCI- DC

70
Q
A

RW Endocrinology (9 decks)

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