Clinical Presentations and Management of Diabetes Flashcards
What is diabetes mellitus?
Diabetes melliitus is a group of metabolic disorders characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both.
Chronic hyperglycaemia is associated wth long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels.
What are the diagnostic tools used for diabetes?
- Glycated haemoglobin ≥48mmol / mol
- Fasting blood glucose ≥7.0mmol / L
- 2 hour blood glucose ≥11.1mmol / L following OGTT
- Random blood glucose ≥11.1mmol / L in the presence of symptoms
What percentage of diabetics are type 1, type 2 and other?
- Type 1 - 10%
- Type 2 - 80%
- Other types - 5%
- Genetic (MODY etc.)
- Pancreatic disease
- Endocrine disease
- Drugs
- Gestational diabetes
Describe the pathophysiology of type 1 diabetes.
- Autoimmune disease
- β-cell destruction
- Symptoms when 80% β-cell mass lost
- Environmental factors e.g. viral infection
- Autoantibodies
- Islet celll
- Insulin
- GAD (GAD65)
- Tyrosine phosphates
- 85-90% of individuals
- Strong HLA associations
- Linkage to the DQA and DQB genes
- Influenced by the DRB genes
Compare and contrast the British diet and the diabetic diet.
British Diet
Diabetic Diet
Protein – 12%
Protein – 15%
Carbohydrate – 46%
Carbohydrate – 50%
Starch
Fat – 42%
Fat – 35%
Fibre
List the factors which diabetes patients need to be educated about.
- Diet
- Hypoglycaemia
- Sick day rules
- Monitoring
- Blood
- Urine
- Driving - must tell the DVLA if you have type 1
- Alcohol
- Smoking
- Insulin card
- Pregnancy / contraception
- Complications (mention these early to make them aware of why we make a big fuss about diabetes control)
- Acute
- Chronic
What does the freestyle libra do?
- Measures interstitial glucose.
- Education required because it does not measure blood glucose (which can change more slowly).
Explain why glycated haemoglobin is used in diagnosis of diabetes.
Glycated haemoglobin (HbA1c) is a form of hemoglobin that is measured primarily to identify the three-month average plasma glucose concentration. The test is limited to a three-month average because the lifespan of a red blood cell is four months.
Describe the pathophysiology of type 2 diabetes melltus.
- Genetic factors:
- Defect of β-cell
- Insulin resistance
- Environmental factors
- Obesity
- Stress
- Reduced physical activity
Describe the clinical presentation of type 2 diabetes mellitus.
- Thirst, polyuria
- Malaise, fatigue
- Infections e.g. candidasis (yeast infections and itching can be a presentation of diabetes).
- Blurred vision
- Complications
- Incidental finding (highly appropriate to screen for diabetes in an obesity clinic).
List drugs used in the management of diabetes.
- Sulphonylureas
- Chlorpropamide
- Glipizide
- Gliclazide
- Biguanides
- Metformin
- α-glucosidase inhibitors
- Thiazolidinediones
- Pioglitazone
- GLPI agonists
- Exanitide
- DPP IV inhibitors
- SGLT2 inhibitors
- Insulin
What are the different types of complications associated with diabetes mellitus?
-
Acute
- Diabetic ketoacidosis
- Hypoglycaemia
- Other emergencies
-
Chronic
-
Microvascular
- Eyes
- Kidneys
- Nerves
- Feet
- Macrovascular
- Heart
- Brain
- Feet
-
Microvascular
What are the clinical features of diabetic ketoacidosis?
-
Hyperglycaemia
- Dehydration
- Tachycardia
- Hypotension
- Clouding of consciousness
-
Acidosis
- Air hunger (Kussmaul’s respiration)
- Acetone on breath
- Abdominal pain
- Vomiting
- Plus features related to precipitating factors (e.g. sepsis)
Describe the cascade of events in diabetic ketoacidosis.
Describe the fluid and electrolyte losses associated with diabetic ketoacidosis.
- Water - 5-10 litres
- Sodium - 400-700 mmol
- Chloride - 300-600 mmol
- Potassium - 300-700 mmol
- Magnesium - 30-60 mmol
- Phosphate - 50-100 mmol
- Calcium - 50-100 mmol
- Bicarbonate - 300-500 mmol
Describe the stages of hypoglycaemia.
Describe the human counter-regulatory mechanisms associated with hypoglycaemia.
