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Clinical aspects of Diabetes Mellitus and Complications Flashcards

1
Q

How is DM diagnosed ?

A

 Glycated Haemoglobin≥48mmol/mol

 Fasting blood glucose≥7.0mmol/L (on two occasions)

 2hr blood glucose≥11.1mmol/L following OGTT

 Random blood glucose≥11.1mmol/L in presence of symptoms

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2
Q

Identify other types of diabetes besides type I and II.

A
  • Genetic (Maturity onset diabetes of the young)
  • Pancreatic disease
  • Endocrine disease
  • Drugs

 Gestational diabetes (occurs in pregnancy)

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3
Q

Identify the main autoantibodies present in type I DM.

A
  • antibodies against islet cell
  • antibodies against Insulin
  • GAD (GAD65) autoantibody
  • antibodies against tyrosine phosphatases
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4
Q

Describe the genetics of type I DM.

A

Strong HLA associations
• linkage to the DQA and DQB genes
• influenced by the DRB genes.

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5
Q

Describe the ideal diet for a diabetic patient.

A
  • Protein 15%
  • Carbohydrate 50%
    (mainly starches, less simple carbs)
  • Fat 35%
  • Fibre (to slow down gut transit, so glucose peak slower)
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6
Q

Identify the main components of education for type I DM patients.

A
  • Diet
  • Hypoglycaemia (what will happen if sugars drops too much when start on insulin)
  • Sick day rules (how to respond to intercurrent illness)
  • Monitoring (blood and urine)
  • Driving
  • Alcohol
  • Smoking
  • Insulin card
  • Pregnancy/ Contraception (may change this if DM)
  • Complications (acute and chronic)
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7
Q

How is DM type 1 monitored ?

A
  • Glucose meter

- FreeStyle Libre (reads interstitial glucose)

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8
Q

What is Diasent (in the context of DM type I) ?

A

Software which allows practitioner to see patterns of blood glucose over time (e.g. last two weeks, last two months etc.)

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9
Q

What is the significance of Glycated Hb ?

A

Glycated Haemoglobin (HbA1c) is a marker for average blood sugar over past two to three months

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10
Q

How many time is insulin given per day ?

A

Usually, once or twice daily intermediate acting insulin (e.g. Isophane or mixture using short acting and long acting)

Multiple injections/basal bolus (background basal insulin once a day, and everytime patient eats, depending on amount of carbs in the meal, give amount of insulin to match that)

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11
Q

Describe clinical features and their timeline in type 2 diabetes.

A 
 Thirst, polyuria
 Malaise, fatigue
 Infections e.g. Candidiasis
 Blurred vision
 Complications

MORE CHRONIC, INSIDIOUS PRESENTATION

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12
Q

Describe CT findings of type II DM.

A

More visceral fat present (metabolically active)

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13
Q

Identify complications of DM.

A

ACUTE

  • DKA (type 1)
  • Hypoglycaemia
  • Other emergencies (HyperOsmolar Non-Ketotic coma, Metformin associated Lactic Acidosis)

CHRONIC

  • Glycation
  • Microvascular (eyes, kidneys, nerves, small vessels)
  • Macrovascular (heart, brain, feet)
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14
Q

What are the main biochemistry changes occurring in DKA ?

A

Bicarbonate is low

Glucose is high

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15
Q

How does DKA result in impaired excretion of H+ and jketone bodies ?

A

Insulin deficiency results in:

1) HyperG
Glycosuria
Osmotic diuresis

2) Ketosis
Acidosis
Gastroparesis

1) and 2) lead to:
- V depletion
- Renal hypoperfusion

Which leads to:
-Impaired excretion of H+ and ketone bodies

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16
Q

How much water is lost in DKA ?

17
Q

Identify symptoms of Hypoglycaemia.

A

ADRENERGIC

  • tachycardia
  • palpitations
  • sweating
  • tremor
  • hunger

NEUROGLYCOPAENIC (due to lack of glucose to brain)

  • dizziness
  • confusion
  • sleepiness
  • coma
  • seizure
18
Q

What is the formal definition of hypoglycaemia ?

A

Blood glucose <=2.2mmoll-1

19
Q

What are the main causes of hypoglycaemia ?

A
  • Too much insulin
  • Too little good
  • Unusual exercise
20
Q

What are the mains stages of hypoglycaemia ? Describe the signs and symptoms which occur at each.

A

1) Below Blood Glucose 4 mmoll-1:
- Autonomic Reaction

2) Below Blood Glucose 3 mmoll-1: Neuroglycopaenia
- Impaired cognitive function
- EEG changes
- Visual dysfunction

3) Below Blood Glucose 2: Biochemical Hypoglycaemia (Behavioral changes)
- Reduced conscious level
- Coma
- Death
- EEG generalised slowing

21
Q

Describe the mechanisms in palace to counter falls in blood glucose.

A

Falls in blood Glucose
⬇
Vagal stimulation ➔ PSNS ➔ Glucagon Release
⬇
Adrenal Medulla Stimulation ➔ SNS ➔ Adrenaline Release
⬆
Neuroglycopaenia

Both Glucagon release and Adrenaline release result in Glycogen release by liver

22
Q

Describe treatment for hypoglycaemia.

A

IV 50% Dextrose

23
Q

What are the main features of Hyperosmolar Non-Ketotic coma (HONK) (AKA Hyperosmolar hyperglcemic state) ?

A
  • Elderly patients
  • Often undiagnosed
  • Associated with intercurrent stress (e.g. may be caused by MI, chest infection)
24
Q

Why does Metformin Associated Lactic Acidosis (MALA) occur ?

A

“Often associated with pre-existing renal impairment”

25
Q

Describe the chronic complication of glycation.

A

Increased cross linking and browning of protein, can lead to CT abnormalities (e.g. cannot do prayer sign)

26
Q

Identify the main stages of nephropathy as a chronic complication of DM.

A
  • Hyperfiltration
  • Normal
  • Microalbuminuria
  • Overt Nephropathy
  • Chronic Renal Failure
27
Q

How is nephropathy (as a chronic complication of DM) managed ?

A

BP

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

Hyperlipidaemia
- Statin

Good glycaemic control

Diet

28
Q

Describe screening for nephropathies.

A
  • Albustix (test for protein)
  • Microalbuminuria
  • Creatinine (annual creatinine blood check)
29
Q

What are the main features of microangiopathy as a chronic complication of diabetes ?

A
  • Lumen decreases in size

- Can get ischemic neuropathy, and diabetic foot

30
Q

What are the main steps in foot examination (in the context of diabetes) ?

A

General appearance
“Architecture”
Pulses
Sensation
- Neurosthesiometer (vibration measuring tool)
- Monofilament
Education (tell patient to look after their feet)

31
Q

Identify the main stages of diabetic retinopathy.

A

Pre-proliferative to proliferative to advanced eye disease

Maculopathy can result from Diabetic Retinopathy (

32
Q

Describe screening for diabetic retinopathy.

A

Annual if no previous DR
More frequent as necessary

Using ophthalmoscope, or retinal camera

33
Q

Describe the main features of macrovascular disease as a chronic complication of diabetes.

A

Atherosclerosis affects heart, brain, large vessels to feet causing foot disease

MD4001 (74 decks)

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