Clinical aspects of Diabetes Flashcards
In type 1 diabetes, what can there be autoantibodies to?
- Islet cell
- Insulin
- GAD
- tyrosine phosphate
How can a patient monitor their blood glucose?
- Capillary blood glucose
* Free style libre: measures the interstitial glucose
Describe the multiple injections or basal bolus injection regime
- Long acting ionsulin once a day, usually at night
- Adjust based on the morning value
- Vary insulin taken before meals based on the pre test values
Describe CSII
- Pump
- Cannula under the skin
- Closed looping - measures and gives insulin
What are the genetic factors of type 2 diabetes?
- Defect of the beta cell
* Insulin resistance
What are the environmental factors of type 2 diabetes?
- obesity
- Stress
- Reduced physical activity
What are the acute complications of diabetes mellitus?
- Diabetic ketoacidosis
* Hypoglycemia
What are the chronic complications of diabetes mellitus?
• Microvascular
- diabetic retinopathy
- diabetic nephropathy
- diabetic neuropathy
• Macrovascular
- atherosclerosis
- cardiovascular disease
- stroke, cerebrovascular disease
What are the clinical features of diabetic ketoacidosis?
hyperglycemia: • dehydration • tachycardia • hypotension • clouding of consciousness
Acidosis • Air hunger • Acetone on breath • Abdominal pain • vomiting
What are the symptoms of hypoglycemia?
Adrenergic: • Tachycardia • Palpitations • Sweating • Tremor • hunger
Neuroglycopaenic - lack of glucose to the brain • dizziness • Confusion • Sleepiness • Coma • Seizure
Describe the human counter regulatory mechanism ion response to a fall in blood glucose
- Fall in blood glucose causes vagal stimulation (parasympathetic)
- Vagal stimulation and neuroglycopaenia stimulates the adrenal medulla (sympathetic)
- This results in adrenaline and glucagon release
Alcohol and the response to a fall in blood glucose
Adrenaline release doesnt happen so less glycogen release
What are the treatments of hypoglycaemia?
- IV 50% Dextrose
* Glucogel
HONK
- Hyper osmolar non ketotic coma
- Elderly patients
- Intercurrent stress - MI or chest infection
MALA
Metaformin associated lactic acidosis
• Renal impairment
