Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
114 Cards in this Set
- Front
- Back
What is the NHMRC definition of diabetes mellitus?
|
A heterogenous condition characterised by hyperglycaemia, disturbances of CHO, fat and protein metabolism associated with relative deficiencies in insulin action or secretion.
|
|
What are the 3 main types of diabetes?
|
- Type 1 diabetes (Insulin dependent, juvenile-onset).
- Type 2 diabetes (non-insulin dependent, traditionally adult onset). - Gestational diabetes. |
|
Diabetes is the __ leading cause of death.
|
7th
|
|
What percentage of health cost does diabetes have on the Australian healthcare system?
|
3%
|
|
Epideimologically, diabetes increases in prevalence with age. True or false?
|
True.
|
|
What are the risk factors for diabetes?
|
- Obesity and/or inactivity.
- High saturated fat diet. - Age. - Ethnicity. - Waist > 100cm in men, 90cm in women. - Low birth weight or diabetes in pregnancy. - Stress. - Lack of exercise. - Excess alcohol, smoking, and some drugs. - Sleep deprivation. - High fat, sugar diet. |
|
What are the dietary recommendations to prevent diabetes?
|
- Low fat.
- Low GI. - ?Dairy foods. - Green leafy vegetables, fruit and berries, olive oils, ?margarine, poultry. |
|
List substances that could possibly influence diabetes.
|
- Cinnamon.
- Alcohol. - Coffee. - Metformin. |
|
List complications (macrovascular and microvascular) that can occur with diabetes.
|
Macrovascular:
- Heart, brain and peripheral vascular disease. Microvascular: - Peripheral neuropathy. - Retinopathy. - Nephropathy. |
|
At the time of diagnosis of diabetes, 1 in 3 to 1 in 20 of patients have what complication?
|
Microvascular disease.
|
|
What is the annual incidence of dialysis/transplants needed for diabetic patients?
|
1.2%.
|
|
What is the annual incidence of heart attacks, stroke or amputation in diabetic patients?
|
2-5%.
|
|
What are the common co-morbidities of diabetes?
|
- Hypertension (55%).
- Hypercholesterolaemia (53%). - Coronary heart disease (30%). - Obesity (44%). |
|
What self-help device is used to help influence the behaviour of a diabetic?
|
Pedometer.
|
|
How frequently should high risk populations be screened for diabetes?
|
Every 3 years.
|
|
At what age should ATSI, PI, Indian and Chinese populations start being screened for diabetes?
|
Age 35 and above.
|
|
Which CVD patients should be screened for diabetes?
|
AAAAALL OF THEM
|
|
If a patient has a BMI > 29, hypertension or a family history of diabetes, at what age should they be screened for diabetes?
|
Age 45 and above.
|
|
At what age should an overweight patient with PCOS be screened for diabetes?
|
AAAAANY AGE
|
|
Everybody, regardless of physical health, should be screened for diabetes after age 55. True or false?
|
True!
|
|
At what age should a patient with a past medical history of gestational diabetes be screened?
|
Any age.
|
|
How frequently should a patient be screened for diabetes if they have an impaired glucose tolerance or impaired fasting glucose result?
|
Every year.
|
|
At what blood sugar level is considered normal in both fasting and random blood glucose tests?
|
5.5mmol/L.
|
|
At what range of a fasting blood glucose result should an OGTT be ordered?
|
5.5-6.9mmol/L.
|
|
At what range of a random blood glucose result should an OGTT be ordered?
|
5.5-11mmol/L.
|
|
At what fasting blood glucose level can a diagnosis of diabetes be likely?
|
> 7.0mmol/L.
|
|
At what random blood glucose level can a diagnosis of diabetes be likely?
|
> 11mmol/L.
|
|
On an OGTT, what result is needed for a diagnosis of diabetes?
|
11mmol/L.
|
|
On an OGTT, what result range would indicate impaired glucose tolerance?
|
7-11mmol/L.
|
|
List the GP's role in managing diabetes.
|
- Diagnosis/Screening.
- Optimising care and coordinating chronic disease management. - Regular review. - Detection and minimisation of complications. - Education, lifestyle and behaviour modification. |
|
In a diabetic patient, how frequently should the HbA1c be checked?
|
1-4 times a year (depending on compliance and current stage of disease).
|
|
What needs to be checked twice a year in a diabetic patient?
|
BP, BMI and feet.
|
|
What needs to be checked annually for a diabetes patient?
|
BSL, urine, lipids, medications, SNAP review.
|
|
What needs to be checked biannually for a diabetes patient?
|
Eye check.
|
|
What do you check for at the legs for a diabetic patient?
|
- Foot check for neuropathy.
- Ankle/brachial BP and pedal pulses for vasculopathy. |
|
What does an aspirin every day do for a diabetic patient?
|
- Reduced major cardiovascular events by 28%.
- The benefits > harms if more than CVD 3% risk in 5 years (but take care in patients > 70). |
|
List medications used to control diabetes and CVD risk.
|
- Aspirin.
- ACE-I. - Statin. - Biguanides (metformin). - Sulphonylureas (e.g. glibenglamide). - Insulin. - Glitazones (e.g. rosiglitazones). - Alpha glucosidase inhibitor (acarbose). |
|
Differentiate the features of Type 1 and Type 2 diabetes.
|
Type 1:
- Young (generally). - Rapid onset. - Ketosis prone. - Insulin deficient. - Recent weight loss. Type 2 diabetes: - Middle aged (generally). - Slow onset. - Not prone to ketosis. - Insulin resistant. - Overweight. - Strong family history. |
|
How does one confirm diagnosis of Late onset Autoimmune Diabetes in Adults (LADA)?
|
Testing for glutamic acid decarboxylase (GAD) antibodies can confirm the diagnosis.
|
|
What are the characteristics of a typical patient with Late onset Autoimmune Diabetes in Adults (LADA)?
|
- Young (30-40 years).
- Lean. - Personal and/or family history of other autoimmune disease. |
|
How does one confirm diagnosis of Late onset Autoimmune Diabetes in Adults (LADA)?
|
Testing for glutamic acid decarboxylase (GAD) antibodies can confirm the diagnosis.
|
|
What are the characteristics of a typical patient with Late onset Autoimmune Diabetes in Adults (LADA)?
|
- Young (30-40 years).
- Lean. - Personal and/or family history of other autoimmune disease. |
|
What symptoms do you ask about in the history for suspected diabetes?
|
- Polyuria.
- Polydipsia. - Polyphagia. - Weight loss. - Nocturia. - Malaise/fatigue. - Altered vision. |
|
What factors predisposes an individual to diabetes?
|
- Age over 40 (type II).
- Family history. - Cultural group. - Overweight. - Physical inactivity. - Hypertension. - Obstetric history of large babies or gestational diabetes. - Medication causing hyperglycaemia. - Family or personal history of autoimmune disease (for Type 1). |
|
What general symptoms reviews do you need to do for suspected diabetes?
|
- Cardiovascular symptoms.
- Neurological. - Ophthalmic. - Bladder and sexual function. - Foot and toe problems. - Recurrent infections (especially urinary and skin). |
|
What are the risk factors for diabetic complications?
|
- Personal or family history of CVD.
- Smoking. - Hypertension. - Dyslipidaemia. |
|
What examinations do you need to elicit for suspected diabetes?
|
- Weight/waist.
- CVS: BP (lying and standing), peripheral neck and abdominal vessels. - Eyes: Retinopathy, cataracts, visual acuity. - Feet. - Peripheral nerves. - Urinalysis. |
|
What aspects of the feet do you need to examine?
|
- Sensation and circulation.
- Skin condition. - Pressure areas. - Interdigital problems. - Abnormal boney architecture. |
|
What aspects of the peripheral nerves is it important to examine?
|
- Tendon reflexes.
- Sensation (touch and vibration). |
|
What do you need to look at on urinalysis?
|
- Albumin.
- Ketones. - Nitrites and/or leukocytes. |
|
What do you need to look for in terms of renal function?
|
- Plasma urea and creatinine.
- Microalbuminuria. |
|
How frequently are you recommended to do an ECG for a diabetic over the age of 50 with at least one other vascular risk factor?
|
Every 2 years.
|
|
When should you do TFTs for a diabetic?
|
- Family history.
- Clinical suspicion. |
|
What are the short and long-term aims of diabetes management?
|
Short term:
- Relief of symptoms and acute complications. Long term: - Achievement of appropriate glycaemia. - Reduction of risk factors. - Identification and treatment of chronic complications. |
|
How frequently should a diabetic see an ophthalmologist?
|
Every 2 years.
|
|
What would an ophthalmologist look for in a diabetic consultation?
|
- Fundal examination (dilated pupils).
- Presence of cataracts needs to be checked. |
|
Who should be referred to an endocrinologist?
|
- Anybody with Type I diabetes.
- Pregnant women with established diabetes or gestational diabetes. - People with Type II diabetes and uncontrolled hyperglycaemia or with significant complications. |
|
Foot complications account for what percentage of hospital bed days occupied by diabetic patients?
|
50%.
|
|
What is the typical waist circumference for an overweight male and an obese male?
|
Overweight male: 94-102cm.
Obese male: >102cm. |
|
What is the typical waist circumference for an overweight female and an obese female?
|
Overweight female: 80-88cm.
Obese female: >88cm. |
|
What percentage of the total energy intake should comprise of carbohydrates with a low GI index and high in fibre?
|
50%.
|
|
What percentage of the total energy intake should comprise of fat with a low GI index and high in fibre?
|
Less than 30%.
|
|
What percentage of the energy should protein contribute to?
|
10-20% of total energy.
|
|
Low level aerobic exercise in diabetics has what benefits?
|
- Improved glucose tolerance as insulin sensitivity increases.
- Increased energy expenditure resulting in weight loss. - Increased feeling of well being. - Increased work capacity. - Improved blood pressure and lipid profiles. |
|
All people requiring insulin need to ________ their carbohydrate intake and/or
_________ their insulin before exercise. |
All people requiring insulin need to increase their carbohydrate intake and/or
decrease their insulin before exercise. |
|
Diabetes exercising need to take what with them?
|
Refined carbohydrates.
|
|
What might occur 6-12 hours after exercise if diabetics aren't careful?
|
Delayed hypoglycaemia.
|
|
What is the suggested initial schedule for blood glucose testing in a patient newly diagnosed Type II diabetic?
How frequently can it be reduced down to once control is established? |
3-4 blood glucose tests daily.
Once control is established, it can be just 1-2 times daily, 2-3 days a week. In the elderly, 1-2 days a week may be sufficient. |
|
What needs to be done at the 3-4 monthly routine review?
|
- Review SNAP profile.
- Review self-monitoring. - Foot symptoms and signs. - Other symptoms. - BP. - Weight, height. - Urinalysis. - HbA1c (every 6 months). |
|
What needs to be done every 6 months at least?
|
- BP.
- Height/weight/waist measurements. - Foot exam. |
|
What needs to be done at least once a year?
|
- HbA1c.
- Blood lipids. - Microalbuminuria. - SNAP. - Medication review. - Self care education. - Podiatrist referral. |
|
What needs to be done every two years?
|
Ophthalmologist referral.
|
|
When should you vaccinate a diabetic patient for pneumococcus (describe for non-ATSI and ATSI populations)?
|
Non-Aboriginal and Torres Strait Islanders:
- < 65 – single dose and revaccinate age 65 or after 10 years whichever later. - > 65 – single dose and revaccinate 5 years later Aboriginal and Torres Strait Islanders: - < 50 – single dose and revaccinate age 50 or after 10 years whichever later. - > 50 – single dose and revaccinate 5 years later. |
|
When should the tetanus booster be given?
|
Booster at age 50 (unless booster has been given within
10 years). |
|
What referrals may be done for a diabetic patient?
|
- Opthalmologist: Every 2 years.
- Dietician, podiatrist: If problem occurs that requires review. - Pharmacist (Home Medications Review). |
|
When can anti-diabetic medication be used early in diagnosis (i.e. without a 6 week trial of healthy living)?
|
- Symptomatic at initial diagnosis.
- Blood glucose level is very high (>20mmol/L). |
|
How does metformin work?
|
- Reduces hepatic glucose output.
- Reduces insulin resistance. - Promotes weight loss. |
|
What is the only absolute contraindication in metformin use?
In what people should it be used with caution? |
Absolute contraindication:
- Renal impairment. Relative contraindications: - Hepatic disease. - Cardiac disease. - Heavy alcohol intake. |
|
How do sulphonylureas work?
|
Stimulates insulin secretion.
|
|
How does acarbose work?
|
Inhibits the digestion of carbohydrates and thus slows the rate of delivery of glucose into the circulation.
|
|
In what patient would acarbose useful?
|
Useful when blood glucose values remain high after meals despite dietary modifications.
|
|
When is acarbose to be taken?
|
At the time of starting a meal and introduced gradually to minimise side effects.
|
|
What are the main side effects of acarbose?
|
- Flatulence.
- Abdominal discomfort. |
|
Care is necessary in prescribing acarbose to what patients?
|
Those with:
- Renal impairment. - Gastrointestinal disease. |
|
How does repaglinide work?
|
Causes a rapid, transient increase in pancreatic insulin secretion.
|
|
What should repaglinide never be used in conjunction with?
|
Sulphonylureas.
|
|
Glitazones work by what mechanism?
|
An oral hypoglycaemic agent that reduces insulin resistance.
|
|
What drug class is thiazolidinediones from?
|
Glitazones.
|
|
True or false: Pioglitazone and rosiglitazone can be used with insulin or other oral anti-diabetic agents.
|
True.
|
|
Care is required when prescribing glitazones to what patients?
|
Those with:
- Cardiac failure. - Liver dysfunction (liver enzymes should be monitored). |
|
What could sulphonylureas do if given in excessive amounts?
|
Cause hypoglycaemia.
|
|
Why shouldn't repaglinide be used with sulphonylureas?
|
Because they both can cause hypoglycaemia.
|
|
What are the main side effects of metformin?
|
- Anorexia, nausea, vomiting.
- Diarrhoea, abdominal cramps, flatulence. - Lactic acidosis (if renal, liver or cardiovascular disease exist). |
|
What are the main side effects of metformin?
|
- Weight gain.
- Symptomatic hypoglycaemia. - Anorexia, nausea, diarrhoea, skin rashes. - Occasionally blood dyscrasias. |
|
What are the main side effects of repaglinide?
|
- Symptomatic hypoglycaemia.
- Nausea, diarrhoea, constipation. - Skin rashes, abnormal LFT (Rare) hepatitis and/or jaundice. |
|
What are the main side effects of glitazones?
|
- Increased subcutaneous fat and/or fluid.
- Decreased haemoglobin levels. - Increased LDL cholesterol (rosiglitazone). - Abnormal liver function tests. |
|
What are the main side effects of acarbose?
|
- Flatulence and abdominal bloating.
- Non response to carbohydrates if hypoglycaemic (need glucose). - (Rare) liver abnormalities. |
|
What non-diabetes medications might reduce blood glucose?
|
- Alcohol.
- Beta blockers. - Sulphonamides. - MAO inhibitors. - Salicylates (in high doses). - Gemfibrozil. |
|
What non-diabetes medications might increase blood glucose?
|
- Adrenergic compounds.
- Oestrogens. - Glucocorticoids. - Thiazide diuretics (high dose). - Phenytoin. |
|
What are the optimal lipid profile goals for diabetes?
|
LDL < 2.5mmol/L.
Total cholesterol < 4.0mmol/L. HDL > 1mmol/L. Triglycerides < 2mmol/L. |
|
What are the target BPs for diabetic patients with and without significant proteinuria?
|
< 130/85 for people with proteinuria < 1g/day.
< 125/75 for people with proteinuria > 1g/day. |
|
In Type II diabetes, insulin therapy may help:
|
- Preserve pancreatic beta cell function.
- Improve insulin sensitivity and secretion. - Reduces microvascular complications. |
|
Metformin must never be initiated or must be ceased in patients with:
|
- Keto-acidosis or history of lactic acidosis.
- Severe renal impairment (creatinine clearance < 30 mL/min). - Severe hepatic disease or alcohol abuse. - Conditions associated with tissue hypoxia (e.g. respiratory or cardiac failure, severe infection, trauma or myocardial infarction). - Dehydration or undergoing surgery or contrast radiography (cease for 48 hours before and after procedures). |
|
Destroy the following myth about insulin treatment for Type II diabetes with the facts!
Myth: Insulin increases insulin resistance. |
Reality: Insulin reverses glucose toxicity and can reduce insulin resistance
|
|
Destroy the following myth about insulin treatment for Type II diabetes with the facts!
Myth: Insulin increases cardiovascular risk. |
Reality: Insulin did not increase cardiovascular risk in the UKPDS and it reduced
mortality risk following acute myocardial infarction in the DIGAMI study. |
|
Destroy the following myth about insulin treatment for Type II diabetes with the facts!
Myth: Weight gain with insulin is a risk. |
Reality: The long-term benefits of insulin therapy outweigh the risks of modest
weight gain. |
|
Destroy the following myth about insulin treatment for Type II diabetes with the facts!
Myth: Insulin frequently causes severe hypoglycaemia. |
Reality: The incidence of severe hypoglycaemia is low and occurs less frequently
in type 2 compared to type 1 diabetes. |
|
Destroy the following myth about insulin treatment for Type II diabetes with the facts!
Myth: Insulin therapy involves too many injections. |
Reality: Insulin may be as simple as one injection at bedtime with concurrent
oral agents. |
|
What is the recommended initial dosage of insulin prescribed for a patient with Type II diabetes where oral hypoglycaemics are not working well enough?
|
Start on 10 Units of intermediate-acting isophate insulin at bedtime. If patient is very thin, they often have greater insulin deficiency and may require a morning injection as well.
|
|
In patients with Type II diabetes, what fasting blood glucose level would you be aiming for?
|
4-6mmol/L.
|
|
Do not delay insulin therapy by more than _______ in patients for whom double or triple oral therapy no longer provides adequate glycaemic control.
|
2 months.
|
|
Glitazones are absolutely contraindicated in what?
|
Moderate to severe heart failure.
|
|
When added to therapy with metformin, a sulfonylurea or insulin, a glitazone reduces HbA1C by about ________.
|
0.5–1.5%.
|
|
If fasting blood glucose remains high after initiating 10 units of insulin in Type II diabetes, how would you titrate it up?
|
Increase it by 2 units every 1-2 weeks up to about 20 units.
|