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MD4001 Week 10 > 9. Clinical aspects of Diabetes Mellitus and Complications > Flashcards

9. Clinical aspects of Diabetes Mellitus and Complications Flashcards

1
Q

Diagnosis of Diabetes mellitus

A

Diabetes mellitus is a group of metabolic disorders characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both.
The chronic hyperglycaemia is associated with long- term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels.

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2
Q 
Diagnosis of DM?
 Glycated Haemoglobin 
 Fasting blood glucose
 2hr blood glucose
 Random blood glucose
A

 Glycated Haemoglobin ≥48mmol/mol
 Fasting blood glucose≥ 7.0mmol/L
 2hr blood glucose≥ 11.1mmol/L following OGTT
 Random blood glucose≥ 11.1mmol/L in presence of symptoms

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3
Q

Different classifications of DM? (4)

A

Type 1 diabetes ( ß cell destruction) (10%)

Type 2 diabetes (85%)
 Insulin resistance with relative insulin deficiency
 Secretory defect with insulin resistance

Other types (5%)
 Genetic (MODY etc) 
 Pancreatic disease
 Endocrine disease
 Drugs

Gestational diabetes

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4
Q

Pathophysiology of T1DM?

A

 Autoimmune disease

 B cell destruction

  • Symptoms when 80%  cell mass lost
  • Environmental factors e.g viral infection
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5
Q

Autoantibodies present in T1DM?

A

 islet cell
 Insulin
 GAD (GAD65)
 tyrosine phosphatases

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6
Q

Typical T1DM history?

A 
Hyperglycaemia...
 Thirst
 Polyuria
 Nocturia
 Weight loss 2stone 
 Osmotic lens change

 Clinically dry
 Blood sugar 44mol/L
 Urine ketones ++

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7
Q

How does a diabetic diet compare to a typical british diet?

A

Higher protein
Higher complex carbs
Lowers fat
Higher fibre

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8
Q

Options of glucose monitoring?

A

Blood glucose monitoring

Libra device (patch on arm which detects interstitial glucose). Requires education

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9
Q

Use of diasend in diabetic control?

A

Information from monitoring device sent to pc to monitor blood sugar fluctuations.
Aids assessment of problems with control

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10
Q

What is HbA1c?

A

Glycated haemoglobin

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11
Q

Who is insulin dependent?

A

Type 1 DMs

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12
Q

MDI vs CSII for insulin management?

A

Both example of “intensive” regimes for insulin management.
In which the basal [background] and bolus [meal] insulin doses are given separately. Intensive insulin therapy has been shown to reduce risk of complications.
It can be delivered as:
1. Multiple daily dose insulin injections (MDI) including long acting basal insulin with boluses of rapid acting insulin given pre-meal,
2. Continuous subcutaneous insulin infusion [CSII] via an insulin pump. CSII delivers the “basal” component of the insulin regime via a slow infusion, and the patient can deliver “boluses” as and when required in addition to this.

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13
Q

MDI?

A

multiple daily dose insulin injections (MDI)

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14
Q

CSII?

A

Continuous subcutaneous insulin infusion [CSII]

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15
Q

Genetic and environmental factors of T2DM?

A

Genetic factors:
 defect of  cell
 insulin resistance

Environmental factors:
 Obesity
 Stress
 Reduced physical activity

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16
Q

Who is insulin dependent?

A

Type 1 DMs

17
Q

MDI vs CSII for insulin management?

A

Multiple daily dose insulin injections (MDI)

18
Q

MDI?

A

multiple daily dose insulin injections (MDI)

19
Q

CSII?

A

Continuous subcutaneous insulin infusion [CSII]

20
Q

Genetic and environmental factors of T2DM?

A

Genetic factors:
 defect of  cell
 insulin resistance

Environmental factors:
 Obesity
 Stress
 Reduced physical activity

21
Q

In diabetic ketoacidosis, signs?

A 
Hyperglycaemia
 Dehydration
 Tachycardia
 Hypotension
 Clouding of conciousness

Acidosis
 Air hunger (Kussmaul’s respiration)
 Acetone on breath  Abdominal pain
 Vomiting

PLUS
Features related to precipitating factors (e.g. sepsis)

22
Q

Ketone body metabolism

A

Muscle breakdown to give: Amino acids, leucine, lysine

Adipose tissue breakdown to give: FFAs

Breakdown products sent to the liver which generates…
KETONE BODIES
H+
Acetone

Products all then sent to end organ

23
Q

Mechanism of diabetic ketoacidosis?

A 
Insulin deficiency --->
-Hyperglycaemia
-Glycosuria
-Osmotic diuresis
\+
-Ketosis 
-Acidosis
-Gastroparesis

Leading to..
Volume depletion + renal hypoperfusion

–> Impaired excretion of H+ and ketone bodies

24
Q

Chronic complications of DM?

A

 Microvascular
- Eyes, Kidneys, Nerves (Feet)

 Macrovascular
- Heart, Brain, (Feet)

25
Q

Kussmauls respiration

A

Hyperventilation to try blow of CO2, to create resp alkalosis to balance ketoacidosis

26
Q

DKA treatment?

A
  1. Hyperglycaemia treatment
     Insulin intravenously 6U/hr then by Sliding scale
  2. Dehydration treatment
     N/Saline initially
     May require 4-6litres
     Dextrose 5% subsequently to replace water losses
  3. Potassium losses
     Careful monitoring of K+
     Replace as required
27
Q

In DKA, what kills patients?

A

K+ loss of 300-700mmol

28
Q

Ketone testing by…

A

dipstick

29
Q

DKA treatment?

A
  1. Hyperglycaemia treatment
     Insulin intravenously 6U/hr then by Sliding scale
  2. Dehydration treatment
     N/Saline initially
     May require 4-6litres
     Dextrose 5% subsequently to replace water losses
  3. Potassium losses
     Careful monitoring of K+
     Replace as required
30
Q

Symptoms of hypoglycaemia?

A 
ADRENERGIC
 tachycardia 
 palpitations 
 sweating
 tremor
 hunger
NEUROGLYCOPAENIC
 dizziness
 confusion
 sleepiness 
 coma
 seizure

FIGHT OR FRIGHT SYMPTOMS

LACK OF GLUCOSE TO BRAIN

31
Q

2 examples of hypoglycaemic acute complications/ emergencies?

A 
HyperOsmolar Non-Ketotic coma (HONK)
 Elderly patients
 Often undiagnosed
 Intercurrent stress
-MI
-Chest Infection etc

Metformin Associated Lactic Acidosis (MALA)
 Renal impairment

32
Q

Stages of nephropathy in DM?

A 
 Hyperfiltration
 Normal
 Microalbuminuria
 Overt Nephropathy 
 Chronic Renal Failure
33
Q

Management of nephropathy associated with DM?

A

 Screening

  • Albustix
  • Microalbuminuria
  • Creatinine

 Blood pressure

  • Aggressive treatment ACEI/AIIRA
  • 130/80 or lower

 Hyperlipidaemia
- Statin

 Good glycaemic control
 Diet

34
Q

2 examples of hypoglycaemic emergencies?

A 
HyperOsmolar Non-Ketotic coma (HONK)
 Elderly patients
 Often undiagnosed
 Intercurrent stress
-MI
-Chest Infection etc

Metformin Associated Lactic Acidosis (MALA)
 Renal impairment

35
Q

Stages of nephropathy in DM?

A

 Hyperfiltration
 Normal
 Microalbuminuria
 Overt Nephropathy  Chronic Renal Failure

36
Q

Management of nephropathy associated with DM?

A

 Screening

  • Albustix
  • Microalbuminuria
  • Creatinine
 Blood pressure
- Aggressive treatment ACEI/AIIRA 
- 130/80 or lower
 Hyperlipidaemia 
- Statin
 Good glycaemic control
 Diet
37
Q

Stages of diabetic retinopathy

A

Maculopathy:
Fat deposition in back of eye
–> Exudative/ oedematous/ ischaemic

Proliferation of vessels: Due to ischaemia so GFs released to form new/fragile vessels

  1. Background change
  2. Pre-proliferative
  3. Proliferative
  4. Advanced eye disease

BOTH CAN LEAD TO BLINDNESS

38
Q

Problems with n

A

Can encroach onto iris or macula

Are fragile, so slight knock can lead to bleed/haemorrhage (vitreous haemorrhage)
–> Fibrosis –> Retinal detachement –> Blindness

39
Q

Clinical presentation of macrovascular disease in diabetics?

A

Thrombosis in arteries leading to MI, stroke

MD4001 Week 10 (11 decks)

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