Case 5 - Diabetes Flashcards
What are the different types of diabetes?
- Type 2
- Type 1
- MODY
- LADA
- Gestational
- Drug induced (steroids, anti-psychotics)
What is MODY?
Maturity onset diabetes of the young – Genetic defects of beta cell function or insulin action.
- Like T2DM but young
- Strong FH
What is LADA?
Some insults causes pancreas to stop producing adequate insulin by damaging beta cells.
- Think of this in older patient with T1DM presentation or not responding to anti-hyperglycaemic agents.
What is pre-diabetes?
Blood glucose levels are higher than normal but not high enough to be called diabetes.
What is type 1 diabetes?
Result of an autoimmune response that triggers the destruction of β cells in the pancreas and results in an absolute insulin deficiency.
What are the causes of type 1 diabetes?
- Genetic
- Autoimmune response with production of antibodies
- Viral: enterovirus
What anti bodies are associated with T1DM?
- ICA: Islet cell antibodies
- GAD: Glutamic acid decarboxylase
When is T1DM presented?
Childhood onset <20 years
What are the risk factors of diabetes?
- Black/Hispanic/Native -
- America/ South Asian origin are 6x more likely to develop diabetes – non-modifiable
- Family history of diabetes – non-modifiable
- High waist to hip ratio – modifiable
- Older age – non-modifiable
- Hypertension
- Dyslipidaemia
- Physical inactivity – modifiable
- Dyslipidaemia
What are the symptoms of T1DM and T2DM?
- Polyuria - Glucosuria leads to polyuria in diabetic patients;
- Polydipsia – due to excessive thirst
- Polyphagia – increase in appetite
- Fatigue
- Visual disturbances – blurred vision
- Calf cramps
- Poor wound healing
- Pruritus – due to poor circulation, dry skin or yeast infection
- Candida infections
- Weight loss: T1DM
- Weight gain: T2DM
What is type 2 diabetes?
- Insulin resistance and pancreatic β cell dysfunction resulting in relative insulin deficiency.
- Over time insulin sensitivity goes down leading to increased blood glucose.
How to diagnose diabetes?
- HBA1c
- OGTT
- C peptides
- Fasting plasma glucose
What is fasting glucose test?
- Test after min 8 hours fast
- DM: ≥ 126 mg/dL (≥ 7.0)
C-peptide test results
- Increased: T2DM
- Decreased: T1DM
What is oral glucose tolerance test?
- Give 75g oral glucose, wait 2 hours.
- Given to fasting patient.
- DM: ≥ 200 mg/dL (≥ 11.1)
What are the normal levels for the different diabetes test?
- HBA1c: <42mmol/mol
- Fasting glucose: < 100 mg/dL (< 5.6)
- OGTT: < 140 mg/dL (< 7.8)
What specific tests are done for T1DM?
- Anti-GAD
- ICS antibody
What is the treatment for T1DM?
Life long insulin
What is the conservative management for diabetes?
- Weight loss (T2)
- Increased physical activity
- Balanced diet (reduced carbohydrate intake)
- Smoking cessation
- Reduced hypertension
- High fibre diet
How are complications monitored?
- Yearly retinal screening
- Foot exam for ulcers + neuropathy
- Annual urine testing for kidney function
- Weight/BP/lipids
- Education on complications
What are the different types of insulin?
- Rapid-acting (10min-4h) - Novorapid
- Short-acting (30min-8h) - Actrapid
- Intermediate-acting (1h-16h) - Insulatard
- Long-acting (1h-24h) - Lantus
- Combination (intermediate: rapid-acting) - Humalog 25 (25:75), Humalog 50 (50:50), Novomix 30 (30:70)
What is T2DM anti-hyperglycaemic therapy algorithm?
1st - General measures
2nd - Metformin
3rd - Metformin + another drug
4th - Metformin + 2 other drugs OR metformin + insulin
Which DM meds work by increasing insulin sensitivity?
- Metformin
- Pioglitazone
Which DM meds work by increasing insulin secretion?
- DPP4 inhibitors (gliptin)
- GLP1 agonists (glutide)
- Meglitinides (glinide)
- Sulfonylurea (zide)
Which DM med works by increasing renal excretion of glucose?
SGLT2 inhibitors (flozin)
