What is diabetes? (3)
Endocrine disorder characterised by elevtaed blood glucose. 2 Types. Chronic condition.
1 of 50
What are the aims of diabetic treatment? (2)
Alleviate symptoms and manage risk/occurrence of macro vascular and micro vascular complications.
2 of 50
Normal range of endogenous insulin? (1)
3-5.7 mmol/L
3 of 50
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.
4 of 50
What is the purpose of diagnosis? (2)
To identify patients at risk of complications of arterial (macrovascular) and microvascular complications and treat diabetic symptoms.
5 of 50
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.
6 of 50
What is the aim range for HbA1c? (2)
6.5-7.5%. Individualize for patient situation.
7 of 50
How is it diagnosed? (5)
WHO criteria: either HbA1c, random plasma glucose 11mmol/L. fasting glucose >7mmol/L or OGTT >11.1mmol/L
8 of 50
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
9 of 50
Risk factors of type 2 diabetes? (7)
Obesity. Family Hx. Age. Asian origin Smoking. Exercise. Gender.
10 of 50
List the diabetic complications that can occur? (9)
Short Term: Hypoglycaemia, Hyperglycaemina; DKA, HHS. Long Term: Microvascular; Retinopathy, Neuropathy, Nephropathy Macrovascular: CVD, CBVD
11 of 50
Symptoms of diabetes? (10)
Polyuria. Polydipsia. Thirst. Dehydration. Weight Loss. Blurred Vision. Tiredness. Confusion. N&V. Ab Pain and superficial infections.
12 of 50
Outline DKA. (4)
Fast onset (1-3 days). Life threatening 5-10%. >12mmol (usually 22-28). Metabolic acidosis HCO3
13 of 50
Outline HHS. (4)
Slow onset. Life threatening 5%. >50mmol/L. No metabolic acidosis. No ketones. Severe dehydration
14 of 50
When does diabetic emergency arise? (3)
New onset of diabetes. Poor compliance. Acute Illness
15 of 50
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.
16 of 50
How is DKA diagnosed? (4)
BGL >13.9mmol/L. pH> 7.5 bicarb
17 of 50
Aims of DKA treatment? (4)
Resolve fluid and electrolyte imbalance. Risk of hypokalaemia. Optimise insulin therapy.
18 of 50
How is DKA treated? (3)
Insulin on sliding scale. Replacement potassium. IV NaCl 0.9%
19 of 50
How is HHS diagnosed?
BGL >33mmol/L. pH 18mmol/L. Osmolarity >320mmol/kg. Are they awake?
20 of 50
Causes of hypoglycemia. (3)
Dramatic exercise. Reduced carb intake. Inc in insulin or sulphonylureas.
21 of 50
Adrenergic signs of hypo. (8)
Sweating. Trembling. Tachycardia. Palitation. Pallor. Hunger. Headache. Weakness.
22 of 50
Neuro-glycemia signs of hypo (6)
Headache. Lack of co-ordination. Double vision. Inapp behaviour. Confusion. Drowsiness.
23 of 50
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
24 of 50
4 methods of lipid managments? (4)
Lifestyle. Statins. FIbrates. Ezetibime.
25 of 50
Lipid target? (2)
26 of 50
How can diabetic neuropathy be treated? (6)
Low dose TCA. Duloxetine. Pregabalin. Gabapentin. Opiates or Capsaiscin
27 of 50
How is kidney damage managed? (1)
ACEI and annual monitoring
28 of 50
Advantages of Metformin. (6)
Weight neutral. No hypo. Preserves beta cell func. Strong evidence. Legacy FX. Reduces MI/death.
29 of 50
Side effects of metformin. (7)
Often Transient: N&V Anorexia. Diarrhoea. Taste disturbamce. Impaired Vit B abs. Lactic acideosis.
30 of 50
Contraindications of metformin? (3)
Renal impairment. Severe dehydration and alcohol dependance.
31 of 50
Advantages of sulphonylurea. (4)
Well tolerated. Provides choice in excretion impairment. Quick response. Early option in lean patients.
32 of 50
Side effects of sulphonylurea. (3)
Weight gain. Hypoglycemia. B cell exhaustion.
33 of 50
Advantages of glimerpride (5)
Mimic endogenous release. Good post postprandial control. Reduce PR hypoglycemia. Flexible administration/Use in erratic life. Rapid action
34 of 50
Side effects of glimerpride (3)
Hypoglycemia. URTI. Rhinitis.
35 of 50
Two programs for DM (2)
36 of 50
What is important when treating a patient with thizolidinediones?
37 of 50
Advantages and Disadvantages of Acarbose? (6)
Adv: Weight Neutral. Weak Potency. Easy hypo treatment. Disadv:Flatulence, Ab pain and diarrhoea
38 of 50
What do GLP-1 and GIP do? (4)
Stiumlate glucose-dependant insulin. Supress glucagon. Delay gastric emptying. Inc insulin sensitivity.
39 of 50
inactivates GLP-1
40 of 50
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
41 of 50
Contraindications of incretin mimetics. (2)
Renal impairment and severe GI disease.
42 of 50
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.
43 of 50
Contraindications of DPP4-Inhibitors (2)
Renal and hepatic impairment.
44 of 50
SGLT2 inhibtors? (2)
lowers renal threshold for glucose secretion. Inhibiting SGLT2 which accounts for 90% glucose reabsorption.
45 of 50
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.
46 of 50
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.
47 of 50
T1DM insulin regimens. (3)
Basal Bolus. BD Injections. Dose adjustment for normal eating.
48 of 50
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
49 of 50
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)


Preview of the front of card 4

Card 5


What is the purpose of diagnosis? (2)


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