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What is diabetes? (3)
Endocrine disorder characterised by elevtaed blood glucose. 2 Types. Chronic condition.
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What are the aims of diabetic treatment? (2)
Alleviate symptoms and manage risk/occurrence of macro vascular and micro vascular complications.
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Normal range of endogenous insulin? (1)
3-5.7 mmol/L
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What are OGTT and HbA1c (4)
OGTT - oral glucose tolerence test. Measures BGL before and 2 hours post 75mg oral glucose. HbA1c is a measure of glycated heamoglobin. Provides average of BGL over recent weeks/months.
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What is the purpose of diagnosis? (2)
To identify patients at risk of complications of arterial (macrovascular) and microvascular complications and treat diabetic symptoms.
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Who is HbA1c not suitable for? (8)
Children. Pregnancy. Patients with symptoms for less than 2 months. Acutely ill. Acute pancreas injury. Pts on interacting meds. Patients with genetic or haemologic illness.
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What is the aim range for HbA1c? (2)
6.5-7.5%. Individualize for patient situation.
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How is it diagnosed? (5)
WHO criteria: either HbA1c, random plasma glucose 11mmol/L. fasting glucose >7mmol/L or OGTT >11.1mmol/L
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Difference between T1DM and T2DM? (10)
T1 - autoimmune. fast onset. lean body. under 40. strong genetic link. T2- insulin insuff/insensitive. onset >40. strong obesity link. slow onset. v strong genetic link
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Risk factors of type 2 diabetes? (7)
Obesity. Family Hx. Age. Asian origin Smoking. Exercise. Gender.
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List the diabetic complications that can occur? (9)
Short Term: Hypoglycaemia, Hyperglycaemina; DKA, HHS. Long Term: Microvascular; Retinopathy, Neuropathy, Nephropathy Macrovascular: CVD, CBVD
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Symptoms of diabetes? (10)
Polyuria. Polydipsia. Thirst. Dehydration. Weight Loss. Blurred Vision. Tiredness. Confusion. N&V. Ab Pain and superficial infections.
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Outline DKA. (4)
Fast onset (1-3 days). Life threatening 5-10%. >12mmol (usually 22-28). Metabolic acidosis HCO3
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Outline HHS. (4)
Slow onset. Life threatening 5%. >50mmol/L. No metabolic acidosis. No ketones. Severe dehydration
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When does diabetic emergency arise? (3)
New onset of diabetes. Poor compliance. Acute Illness
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How is DKA caused?
hyperglycemia results in unabsorbed water sodium potassium and glucose being excreted in patients urine. Due to lack of insulin non-esterified fatty acids are taken up by the liver and convered through beta oxidation to produce ketone bodies.
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How is DKA diagnosed? (4)
BGL >13.9mmol/L. pH> 7.5 bicarb
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Aims of DKA treatment? (4)
Resolve fluid and electrolyte imbalance. Risk of hypokalaemia. Optimise insulin therapy.
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How is DKA treated? (3)
Insulin on sliding scale. Replacement potassium. IV NaCl 0.9%
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How is HHS diagnosed?
BGL >33mmol/L. pH 18mmol/L. Osmolarity >320mmol/kg. Are they awake?
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Causes of hypoglycemia. (3)
Dramatic exercise. Reduced carb intake. Inc in insulin or sulphonylureas.
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Adrenergic signs of hypo. (8)
Sweating. Trembling. Tachycardia. Palitation. Pallor. Hunger. Headache. Weakness.
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Neuro-glycemia signs of hypo (6)
Headache. Lack of co-ordination. Double vision. Inapp behaviour. Confusion. Drowsiness.
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How is hypo treated? (4)
If conscious - fast acting oral carb. If semi - glucogel or hypostop. if unconscious -iv glucose/glucagon. once >4mmol/L give long acting carb: sandwhich/meal
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4 methods of lipid managments? (4)
Lifestyle. Statins. FIbrates. Ezetibime.
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Lipid target? (2)
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How can diabetic neuropathy be treated? (6)
Low dose TCA. Duloxetine. Pregabalin. Gabapentin. Opiates or Capsaiscin
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How is kidney damage managed? (1)
ACEI and annual monitoring
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Advantages of Metformin. (6)
Weight neutral. No hypo. Preserves beta cell func. Strong evidence. Legacy FX. Reduces MI/death.
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Side effects of metformin. (7)
Often Transient: N&V Anorexia. Diarrhoea. Taste disturbamce. Impaired Vit B abs. Lactic acideosis.
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Contraindications of metformin? (3)
Renal impairment. Severe dehydration and alcohol dependance.
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Advantages of sulphonylurea. (4)
Well tolerated. Provides choice in excretion impairment. Quick response. Early option in lean patients.
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Side effects of sulphonylurea. (3)
Weight gain. Hypoglycemia. B cell exhaustion.
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Advantages of glimerpride (5)
Mimic endogenous release. Good post postprandial control. Reduce PR hypoglycemia. Flexible administration/Use in erratic life. Rapid action
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Side effects of glimerpride (3)
Hypoglycemia. URTI. Rhinitis.
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Two programs for DM (2)
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What is important when treating a patient with thizolidinediones?
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Advantages and Disadvantages of Acarbose? (6)
Adv: Weight Neutral. Weak Potency. Easy hypo treatment. Disadv:Flatulence, Ab pain and diarrhoea
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What do GLP-1 and GIP do? (4)
Stiumlate glucose-dependant insulin. Supress glucagon. Delay gastric emptying. Inc insulin sensitivity.
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inactivates GLP-1
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Advantages and disadvantages of incretin mimetics. (8)
Adv: Avoids insulin -> DVLA LVG drivers. Weight loss. Not degraded by DPP4. Side effects: Hypo. Diarrhoea. Dec appetite. N&V. Expensive
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Contraindications of incretin mimetics. (2)
Renal impairment and severe GI disease.
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Advantages and side effects of DPP4-Inhibitors. (9)
Weight neutral. Well tolerated. Cheaper v mimetics. Oral. Avoids insulin. Side FX: Hypo. Nausea. Ab pain. Oedema.
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Contraindications of DPP4-Inhibitors (2)
Renal and hepatic impairment.
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SGLT2 inhibtors? (2)
lowers renal threshold for glucose secretion. Inhibiting SGLT2 which accounts for 90% glucose reabsorption.
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Advantages and Disadvantages of SGLT2 Inhibitors? (15)
Adv: Oral. OD dose. Similar HbA1c reduction. Weight Loss. Low hypo risk. No CVD associates. Reduces mortality. Disadv: No long term safety data. No pt data. Cost. Renal monitoring. Side FX: UTI thrush. pt education imp. Poss vol depletion.
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Insulin Plans for T2DM. (4)
Intermediate Insulin ON or BD. Isophane Mix OD or BD. Analogue mix. LA if injections difficult/carers or hypos affecting life.
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T1DM insulin regimens. (3)
Basal Bolus. BD Injections. Dose adjustment for normal eating.
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Advantages and disadvantages of basal bolus.
Avd:Flexible regimen. Tight glycaemic control. 3 SA + LA. Dis: Multiple Inj. Weight gain. Hypo risk. Compliance is KEY
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Advantages and disadvantage of BD injections.
Adv: Simple. Convenient. Fits well into regular work. Dis: Limited flexibility. Intermeal snacks. Less tight glycaemic controll and risk of overnight hypos
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Card 2


What are the aims of diabetic treatment? (2)


Alleviate symptoms and manage risk/occurrence of macro vascular and micro vascular complications.

Card 3


Normal range of endogenous insulin? (1)


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Card 4


What are OGTT and HbA1c (4)


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Card 5


What is the purpose of diagnosis? (2)


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