Case 11 - Diabetes Flashcards
Symptoms of diabetes
increased urine output increased thirst blurred vision thrush weight loss tiredness
Blood tests for diabetes
Random plasma glucose
Fasting plasma glucose
HbA1C
Criteria for pre-diabetes
impaired glucose tolerance + impaired fasting glucose
What is the pathophysiology of T1 diabetes
Beta cell destruction of an autoimmune cause leading to insulin deficiency
Stages of T1 diabetes
Stage 1 - presymptomatic
Stage 2 - Presymptomatic with cell destruction
Stage 3 - symptomatic presentation
Clinical features of T1 diabetes
Young Thin Rapid onset Insulin dependent 85% no family history
What is DKA and how is it treated
Diabetic ketoacidosis
Hyperglycaemia
Ketonaemia
Acidosis
Fluids and inslulin
What is hypoglycaemia
Severe hypoglycaemia presenting as fits, confusions and unconsciousness
What is a HbA1C blood test showing you
How much of your haemoglobin is glycated. It is a good indicator of your blood sugar levels over the last 8-12 weeks
Risk factors for long term complications of diabetes
Age of onset Duration of diabetes High HbA1C Hypertension Obesity Microalbuminuria
Macrovascular complications of diabetes
CVD
Cerebrovascular disease
Microvascular complications
Retinopathy
Neuropathy
Nephropathy
Microvascular diabetic complications pathophysiology
Hyperpermeable vessels allow fluid and protein to leave the vessel and causes thickening of the basement membrane reducing contractility of the capillary
Diabetic retinopathy pathophysiology
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
Management of diabetic patients
Glycaemic control Annual albumin screening Control of risk factors Reduce hypertension and cholesterol Smoking cessation Retinopathy/kidney function/neuropathy screening
Genetic implication of type 2 diabetes
Obesity genes
insulin resistance
islet cell function
Genetic implication of type 1 diabetes
Less genetic than T2 but immune genes are commonly affected
Causes of obesity
Increased caloric intake Reduced physical activity Antipsychotics Reduced sleep Refined sugar effect Intrauterine environment
Causes of weight loss in T1 patients
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.
Causes of thrush in diabetic patients
More glucose in damp warm regions of the body provide a better environment for bacteria
Random blood sugar test indicative of T1
A blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher suggests diabetes
HbA1C indicative of T2
> 6%
Methods of glucose monitoring for diabetics
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.
Risk factors for gestational diabetes
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)
