Term
| SE include vomiting, nausea and increased risk of pancreatitis |
|
Definition
|
|
Term
| MOA of thiazolidinediones |
|
Definition
| they activate PPAR- gamma receptor in adipocytes. this promotes adipogenesis and fatty acid uptake |
|
|
Term
| SE include hypoglyceamia, weight gain and lipodystrophy |
|
Definition
|
|
Term
| which diabetes drugs typically cause weightloss? |
|
Definition
metformin
GLP-1 agonist (-tides)
SGLT-2 inhibitors (-gliflozins) |
|
|
Term
| diabetes drugs that are taken orally |
|
Definition
metformin
sulfonylureas
thiazolidinediones
DPP inhibitors (-gliptins)
SGLT-2 inhibitors (-gliflozins) |
|
|
Term
|
Definition
| chronic condition characterised by abnormally raised blood glucose |
|
|
Term
| pathophysiology of type one DM |
|
Definition
AI condition
insulin producing cells in islets of langerhan are completely destroyed by the immune system
there is an absolute deficiency of insulin resulting in raised glucose level
pt develop Type 1 DM in childhood/early adult life usually presenting with DKA |
|
|
Term
| pathophysiology of type II DM |
|
Definition
commonest cause of diabetes in developed world
relative insulin deficiency due to to xs adipose tissue
there isn't enough glucose to go around all the xs fatty tissue leading to blood glucose creeping up |
|
|
Term
diagnostic criteria for diabetes mellitis in a symptomatic pt?
what if the patient is asymptomatic? |
|
Definition
in symptomatic pt diagnose diabetes if:-
fasting glucose >7
random glucose or after 75mg OGTT is >11.1
if pt is asymptomatic, the above criteria should be demonstrated on 2 separate occasions |
|
|
Term
| what are the normal, pre diabetes and diabetic levels for fasting glucose? |
|
Definition
< 6 is normal
6.1 -6.9 is pre diabetes
> 7 is diabetes |
|
|
Term
| what are the normal, pre diabetes and diabetic levels when using HB1AC |
|
Definition
< 41 (5.9%) is normal
42- 47 is pre diabetes
>48 (6.5%) is diabetes |
|
|
Term
| in asymptomatic pts can you diagnose diabetes from one test? |
|
Definition
| nope. in asymptomatic pts, the results must be demonstrated on 2 separate occasions. |
|
|
Term
features of thiazolidinediones including SE
why is this class CI in heart failure?
examples include: pioglitazone |
|
Definition
PPAR-gamma receptor agonist. this is an intracellular nuclear receptor. natural ligand safe free fatty acids
they reduce peripheral insulin resistance
SE: weight gain, liver impairment so monitors LFTs, fluid retention thus CI in heart failure, increased risk of fractures,
risk of bladder cancer in those taking pioglitazone. |
|
|
Term
| what is the MOA of GLP-1 agonist (-tides) |
|
Definition
| it is an incretin mimetic. this inhibits glucagon secretion. |
|
|
Term
| commonest adverse effect associated with pioglitazone? |
|
Definition
| fluid retention. this is why it is ci in heart failure |
|
|
Term
|
Definition
| it inhibits glucagon secretion. DDP4 inhibitors block the inactivation of incretin and this increases their levels in the blood. |
|
|
Term
| diabetes medicines that cause weightloss? remember the acronym MSG |
|
Definition
metformin
SGLT-2 inhibitors -glifliozins
GLP-1 agonists -tides |
|
|
Term
| MOA of sulfonylureas and meglitinides? |
|
Definition
| increase pancreatic insulin secretion |
|
|
Term
what is the 1st line treatment for diabetic neuropathy?
what can you use as rescue therapy? |
|
Definition
amitriptyline, duloxetine, gabapentine or pregabalin
tramadol can be used as rescue therapy |
|
|
Term
| a diabetic has gastroparesis. what are the signs and symptoms and what can be given as a treatment? |
|
Definition
symptoms: erratic BP control, bloating and vomiting
mx: pro kinetic agents such as metoclopromide, domperidone or erythromycin |
|
|
Term
| what is the target BP in diabetes if there is no end organ damage? |
|
Definition
no end organ damage target BP: < 140/80
if there is end organ damage: < 130/80 |
|
|
Term
| if a patient is on lifestyle modification alone or with metformin, what is their target HBA1C? |
|
Definition
|
|
Term
| if a pt is on lifestyle plus medication that causes hypoglycaemia what is their target HBA1C? |
|
Definition
|
|
Term
| if the pt is on one diabetes drug plus lifestyle changes, what must the HBA1C exceed before you add another diabetes drug? |
|
Definition
it needs to be higher than 7.5% this is 58mmol/mol
also if the pt is on one drug and their HBA1C has risen to 7.5% , you start them on another drug and their target HBA1C should be lowered to 7% 53mmol/mol |
|
|
Term
|
Definition
GLP-1 agonist
you would give these in situations where pt is on max triple therapy for diabetes and their BMI is >35. for these people give GLP-1 agonist with metformin and sufolnylurea because weightless is desired here and insulin causes weight gain. |
|
|
Term
| which enzyme does Metformin activate that helps peripheral cells increase their sensitivity to insulin? |
|
Definition
|
|
Term
Arcabose is an example of alpha glucosidase inhibitor. how do these work?
how do you take arcabose? |
|
Definition
they slow down the digestion of carbohydrates found in starchy foods.
arcabose can be chewed with the first bite of a meal or swallowed whole with some water immediately before a meal/ |
|
|
Term
| what does GLP-1 do? it is a hormone but what is its function? |
|
Definition
| GLP-1 helps to delay digestion and decreases appetite |
|
|
Term
| mode of action of gliptins? |
|
Definition
|
|
Term
| Repaglinide and Nateglinide are examples of? |
|
Definition
prandial glucose regulators
MOA: ATP dependent K+ channel on pancreatic cells.
you take up to RDS 30 mins before meal. they work to reduce post meal spikes in glucose
they are basically a fast acting sulfonylurea |
|
|
Term
| which diabetes drug reduces the body's resistance to insulin? |
|
Definition
biguanides
thiazolidinediones |
|
|
Term
what does Wolfram's syndrome consist of? clue it is AKA
DIDMOAD |
|
Definition
diabete insipudus
diabete melitus
optic atrophy
deafness |
|
|
Term
| which HLA is type 1 diabetes associated with? |
|
Definition
|
|
Term
| what do you use to check sensation in the feet of a diabetic? |
|
Definition
|
|
Term
| what is the name of the diabetes education program for type 1 and type 2 diabetics? |
|
Definition
type 1 is DAFNE
type 2 is DESMOND |
|
|
Term
| which measurement is strongly associated with cardiovascular disease? |
|
Definition
|
|
Term
| how would you measure HBA1C? |
|
Definition
| initially you do it 3-6 monthly intervals then once stable you would do it 6 monthly. |
|
|
Term
| for adults with type 2 diabetes on lifestyle and/or metformin we advise them to keep their HBA1C less than 6.5% (48mmol/mol) what do we advise if the pt is on a drug that is known to cause hypoglycaemia? |
|
Definition
|
|
Term
you should measure BP annually in adults with type 2 DM. you need to repeat measurements in certain conditions for example
if bP is higher than 150/90mmHg when should you repeat
if bp is higher than 140/80 mmHg when should you repeat?
if BP is higher than 130/80mmHg and there is kidney, eye or cerebrovascular damage when should you repeat |
|
Definition
repeat BP in 1 month if higher than 150/90
repeat in 2 months if higher than 140/90
also repeat in 2 months is higher than 130/90 and their is end organ damage |
|
|
Term
| if a pt with diabetes presents to the doctors with unexplained diarrhoea particularly at night what would you think? |
|
Definition
|
|
Term
| which vaccines should people with diabetes be offered? |
|
Definition
| influenza and pneumococcal vaccinations |
|
|
Term
| for people with type 1 diabetes who cannot commit to the DAPHNE program what else can they do? |
|
Definition
| the X-PERT diabetes program |
|
|
Term
| list some perioperative risks associated with diabetes? |
|
Definition
you can't silent MI
those undergoing PCI are at increase risk for adverse outcomes
Stroke
Problems with lower limb ischemia
Heel pressure sores
Postop wound infection
Chest and UTIs. TB can occur in elderly with diabetes
disruption and worsening control of diabetes
having diabetes is a risk factor for prolonged care in ITU post op
poor period control of diabetes associated with unfavourable outcomes in certain surgeries such as cardiac surgery |
|
|
Term
| how to convert from mmol/mol to % |
|
Definition
|
|
Term
| how to convert from % tom mol/mol |
|
Definition
|
|
Term
| if a woman has htn but is going to get pregnant what is the 1st line anti hypertensive drug? |
|
Definition
|
|
Term
| combined use of which anti hypertensives can precipitate onset of diabetes? |
|
Definition
| thiazides diuretics and beta blockers |
|
|
Term
| when is exercise contra indicated in a diabetic pt? |
|
Definition
| when they have active retinal haemorrhage or recent retinal photocoagulation |
|
|
Term
| if a medication ends with -gliflozin what type of medication is it? |
|
Definition
a SGLT2 inhibitor - SE increased risk of UTI.
it is advised to stop taking this medication if the pt is unwell and unable to eat or drink |
|
|
Term
| how to manage diabetes when ill? |
|
Definition
continue taking medicines and insulin but stop SGLT2 inhibitors if you are unable to eat or drink.
monitor glucose more frequently and ketones if type 1 diabetic |
|
|
Term
| benefits of using local anaesthesia versus GA in a diabetic pt |
|
Definition
reduces local stress response
easier to monitor hypoglycaemia if pt awake
post op nausea is reduced
easier for post op diabetic control |
|
|
Term
| which sulfonylurea should be avoided in the elderly as it has a long half life? |
|
Definition
|
|
Term
| a type 2 diabetic has to go on insulin what is the most acceptable insulin regimen? |
|
Definition
| long acting or intermediate insulin given at bedtime |
|
|
Term
| describe a twice daily insulin regime |
|
Definition
given pre breakfast and pre evening meal
assumes pt will have 3 meals a day |
|
|
Term
| what are the different types of insulin regimes? |
|
Definition
once daily
twice daily
basal bolus |
|
|
Term
| insulin determir and insulin glargine can be administered in which insulin regime? |
|
Definition
| OD as they are long acting |
|
|
Term
| lithium can cause which type of diabetes? |
|
Definition
| nephrogenic diabetes insipidus |
|
|
Term
| features of diabetic foot ulcer |
|
Definition
| painless punched out ulcers in areas of thick callus |
|
|
Term
| what type of ulcers tend to occur at the plantar surface of the foot? |
|
Definition
|
|
Term
| features of neuropathic ulcers |
|
Definition
warm, dry skin
bounding pulse
dilated veins
reduced sensation and callus around ulcer |
|
|
Term
| features of neuro ischemic foot |
|
Definition
cool and pink
atrophic skin and absent pulses
the foot may be painful and there is little callus |
|
|
Term
| in diabetes pts who are having a pre op assessment what does postural hypotension give a late indication of? |
|
Definition
|
|
Term
| what specific lesions are found in diabetic nephropathy? |
|
Definition
| Kimmelstiel-Wilson lesions |
|
|
Term
| in diabetic nephropathy when the eGFR falls less than what should you refer to specialist? |
|
Definition
|
|
Term
|
Definition
ACR > or equal to 2.5 mg/mmol in men or 3.5 mg/mmol in women OR
albumin concentration > 20mg/L |
|
|
Term
|
Definition
ACR > or equal to 30mg/mmol OR
albumin concentration > or equal to 200mg/L |
|
|
Term
| what skin condition characterised by collagen degeneration followed by a granulomatous response is found in diabetics? |
|
Definition
necrobiosis lipoidica
these can ulcerate and heal poorly.
mx: avoid trauma, use potent steroids and immunomodulator drugs |
|
|
Term
| drivers who are on insulin need to tell dvl a but if you are on short term insulin for how long do you not have to tell DVLA |
|
Definition
| if you are on short term for <3 months, for gestational diabetes or 3 months post birth you do not have to notify dvl a |
|
|
Term
| if you are group 1 car and motorcycle and have declare insulin use to dvla how often will your license be renewed? |
|
Definition
|
|
Term
| if you are a group 1 driver not on insulin when should you notify DVLA ? |
|
Definition
if you have had 2 hypos in the last 12 months where you were dependent on someone else to look after you
if you have had a hypo whilst driving
you develop impaired awareness of hypoglycaemia
if you have other problems that could impact your driving e.g peripheral neuropathy, impaired vision needing laser surgery |
|
|
Term
group 2 drivers are bus or lorry drivers. unlike group 1 they must notify DVLA if they take any medication for diabetes.
what happens if they are on insulin rx? |
|
Definition
| they undergo medical assessment every year where you will need to provide 3 months of continuous blood readings |
|
|
Term
| if you are on insulin when should you check your blood sugars in relation to driving? |
|
Definition
| 2 hours before starting to drive and every 2 hours that you drive. DVLA also recommend this for people on sulfonylureas or glinides (metglinides: nateglinide and repaglinide) |
|
|
Term
| what do DVLA advise in terms of BG and driving? |
|
Definition
if <5mmol then take carbohydrates before driving
if <4 mmil then do not drive |
|
|
Term
| tell the dvl a if you take insulin and what other problems? |
|
Definition
2 episodes of hypoglycaemia
impaired awareness
visual problems |
|
|
Term
| group 2 bus and lorry drivers are advised to test BG no more than 2 hours before they start driving and every 2 hours they drive. what else must they do? |
|
Definition
| they need to test their BG twice a day even on the days they are not driving |
|
|
Term
| give hypo advice to a pt with diabetes |
|
Definition
stop vehicle, switch of engine, remove keys and move from drivers seat
take some fast acting carbs e.g glucose tablets or jelly babies and some longer acting carbs
do not start driving until 45 minutes after blood glucose has return to normal. |
|
|
Term
| where do neuropathic ulcers tend to occur? |
|
Definition
| plantar surface of the foot |
|
|
Term
| where do neuro ischemic ulcers tend to occur? |
|
Definition
| on the margins of the foot |
|
|
Term
| what are the differences between neuropathic and neuroischemic foot? |
|
Definition
neuropathic: occurs on plantar surface of foot. Warm, dry skin, bounding pulses, distended veins, reduced sensation and callus around the ulcer
neuro ischemia: located on the margins of the foot. the foot is cool, pink with atrophic skin and absent pulses. The foot may be painful and there is little callous. |
|
|
Term
| how to document severity of a foot ulcer. in other words what does the mnemonic SINBAD stand for? |
|
Definition
SITE
ISCHEMIA
NEUROPATHY
BACTERIAL INFECTION
AREA
DEPTH |
|
|
Term
|
Definition
infection
missed insulin
MI |
|
|
Term
|
Definition
abdo pain
polyuria, dyspia and dehydration
Kussmaul respiration
acetone smelling breath
nausea and vomiting |
|
|
Term
what is diagnostic criteria for DKA?
Karen grant (two up)
Bums Phil (two down) |
|
Definition
glucose > 11 or known DM
PH , <7.3
bicarb < 15
ketones >3 or ++ on urinalysis |
|
|
Term
|
Definition
ABC
fluids
insulin 0.1/kg/hr. once glucose <15 then 5% dextrose can be added
correct hypokalemia |
|
|
Term
|
Definition
THROMBOEMBOLISM
GASTRIC STASIS
arrhythmia's
cerebral oedema
ARDS
AKI |
|
|
Term
| what are the main causes of hypoglycemia |
|
Definition
diabetes
insulinoma
self administration of insulin or sulphonyureas
liver failure
addisons
alcohol |
|
|
Term
| cause of hypoglycaemia in children characterised by beta cell hyperplasia? |
|
Definition
|
|
Term
| what is the incretin effect? |
|
Definition
| in normal physiology an oral glucose load results in increased insulin release than if the same load were given IV. this effect is largely mediated by GLP-1 |
|
|
Term
| how to define hyperosmolar hyperglycaemic state? |
|
Definition
dehydration
osmolality >320
hyperglycemia >30
PH >7.3
bicarb >15
no significan ketones <3 |
|
|
Term
| a pt has hyperglycemia >40mmol and marked serum hyperosmolality >320 what are you thinking? |
|
Definition
HONK
this is define by hyperglycaemia and marked increase in serum osmolality
THERE IS NO EVIDENCE OF KETONUIRIA |
|
|
Term
| in HONK serum osmolilty exceed 320. what is the normal range? |
|
Definition
|
|
Term
|
Definition
ABCD
oxygen, fluid replacement
reduce glucose no more than 5mmol per hour
give anticoagulation
check heels for ulcers
encourage oral fluids as soon as they can tolerate them |
|
|
Term
| out of HONK and DKA which has a higher mortality? |
|
Definition
|
|
Term
|
Definition
ischemia infarction
thromboembolism
ARDS
DIC
multi organ failure
rhabdomyolysis
cerebral oedema
central pontine myelinosis |
|
|
