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C21 Phase 1 > Case 11 - Diabetes > Flashcards

Case 11 - Diabetes Flashcards

1
Q

Symptoms of diabetes

A 
increased urine output
increased thirst
blurred vision
thrush
weight loss
tiredness
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2
Q

Blood tests for diabetes

A

Random plasma glucose
Fasting plasma glucose
HbA1C

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3
Q

Criteria for pre-diabetes

A

impaired glucose tolerance + impaired fasting glucose

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4
Q

What is the pathophysiology of T1 diabetes

A

Beta cell destruction of an autoimmune cause leading to insulin deficiency

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5
Q

Stages of T1 diabetes

A

Stage 1 - presymptomatic
Stage 2 - Presymptomatic with cell destruction
Stage 3 - symptomatic presentation

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6
Q

Clinical features of T1 diabetes

A 
Young
Thin
Rapid onset
Insulin dependent 
85% no family history
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7
Q

What is DKA and how is it treated

A

Diabetic ketoacidosis

Hyperglycaemia
Ketonaemia
Acidosis

Fluids and inslulin

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8
Q

What is hypoglycaemia

A

Severe hypoglycaemia presenting as fits, confusions and unconsciousness

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9
Q

What is a HbA1C blood test showing you

A

How much of your haemoglobin is glycated. It is a good indicator of your blood sugar levels over the last 8-12 weeks

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10
Q

Risk factors for long term complications of diabetes

A 
Age of onset
Duration of diabetes
High HbA1C
Hypertension
Obesity
Microalbuminuria
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11
Q

Macrovascular complications of diabetes

A

CVD

Cerebrovascular disease

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12
Q

Microvascular complications

A

Retinopathy
Neuropathy
Nephropathy

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13
Q

Microvascular diabetic complications pathophysiology

A

Hyperpermeable vessels allow fluid and protein to leave the vessel and causes thickening of the basement membrane reducing contractility of the capillary

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14
Q

Diabetic retinopathy pathophysiology

A

the retina cells proliferate and reduces blood supply. To compensate tries to create a new blood supply but the vessels are much too delicate and can easily haemorrhage. This can cause infarction of retinal tissue and detachment

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15
Q

Management of diabetic patients

A 
Glycaemic control
Annual albumin screening
Control of risk factors
Reduce hypertension and cholesterol
Smoking cessation
Retinopathy/kidney function/neuropathy screening
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16
Q

Genetic implication of type 2 diabetes

A

Obesity genes
insulin resistance
islet cell function

17
Q

Genetic implication of type 1 diabetes

A

Less genetic than T2 but immune genes are commonly affected

18
Q

Causes of obesity

A 
Increased caloric intake
Reduced physical activity
Antipsychotics
Reduced sleep
Refined sugar effect
Intrauterine environment
19
Q

Causes of weight loss in T1 patients

A

When you lose glucose through frequent urination, you also lose calories. At the same time, diabetes may keep the glucose from your food from reaching your cells — leading to constant hunger. The combined effect can potentially cause rapid weight loss, especially with type 1 diabetes.

20
Q

Causes of thrush in diabetic patients

A

More glucose in damp warm regions of the body provide a better environment for bacteria

21
Q

Random blood sugar test indicative of T1

A

A blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher suggests diabetes

22
Q

HbA1C indicative of T2

A

> 6%

23
Q

Methods of glucose monitoring for diabetics

A

Blood glucose monitoring.
Urine glucose testing.
Urine ketone testing.
Continuous glucose monitoring (CGM) Subcutaneous CGM machines show real-time glucose on the monitor every five minutes and have alarms to indicate hypoglycaemia and hyperglycaemia.

24
Q

Risk factors for gestational diabetes

A

Any woman can develop gestational diabetes during pregnancy, but you’re at an increased risk if:
• your body mass index (BMI) is above 30 – use the healthy weight calculator to work out your BMI
• you previously had a baby who weighed 4.5kg (10lb) or more at birth
• you had gestational diabetes in a previous pregnancy
• 1 of your parents or siblings has diabetes
• you are of south Asian, Black, African-Caribbean or Middle Eastern origin (even if you were born in the UK)

25
Q

Complications of gestational diabetes

A
  • your baby growing larger than usual – this may lead to difficulties during the delivery and increases the likelihood of needing induced labour or a caesarean section
  • polyhydramnios – too much amniotic fluid (the fluid that surrounds the baby) in the womb, which can cause premature labour or problems at delivery
  • premature birth – giving birth before the 37th week of pregnancy
  • pre-eclampsia – a condition that causes high blood pressure during pregnancy and can lead to pregnancy complications if not treated
  • your baby developing low blood sugar or yellowing of the skin and eyes (jaundice) after he or she is born, which may require treatment in hospital
  • the loss of your baby (stillbirth) – though this is rare
26
Q

How does metformin work and what are the side effects

A

It works by lowering glucose production in the liver and improving your body’s sensitivity to insulin so that your body uses insulin more effectively. Nausea and diarrhoea are possible side effects of metformin

27
Q

How do sulfonylureas work and what are the side effects

A

These medications help your body secrete more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain

28
Q

How do Meglitinides work and what are the side effects

A

by stimulating the pancreas to secrete more insulin, but they’re faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar and weight gain.

29
Q

How do Thiazolidinediones work and what are the side effects

A

make the body’s tissues more sensitive to insulin. These drugs have been linked to weight gain and other more-serious side effects, such as an increased risk of heart failure and anaemia. Because of these risks, these medications generally aren’t first-choice treatments.

30
Q

How do DPP-4 inhibitors work and what are the side effects

A

help reduce blood sugar levels, but tend to have a very modest effect. They don’t cause weight gain, but may cause joint pain and increase your risk of pancreatitis.

31
Q

How do GLP-1 receptor agonists work and what are the side effects

A

These injectable medications slow digestion and help lower blood sugar levels. Their use is often associated with weight loss. Possible side effects include nausea and an increased risk of pancreatitis.

32
Q

How do SGLT2 inhibitors work and what are the side effects

A

These drugs prevent the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine. Medications in this drug class may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Side effects may include vaginal yeast infections, urinary tract infections, low blood pressure, and a higher risk of diabetic ketoacidosis.

33
Q

Mechanism of insulin resistance

A

Cellular stressors activate serine kinases, phosphorylating proteins which will halt the insulin signalling pathway

C21 Phase 1 (45 decks)

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