Diabetes Flashcards
diabetes is…
elevation of blood-glucose above diagnostic threshold
c-ppetide is a good measure of ____
endogenous insulin secretion- pro-insulin cleaved into insulin and c-peptide so c-peptide used
2 pathophysiology mechanisms for diabetes are
disorder of b-cells, impaired insulin secretion
s/s of diabetes
polydipsia, polyuria, fatigue, wt loss
ix for diabetes
random blood glucose: >11mmol/l
fasting blood glucose: >7mmol/L
2hr post glucose: >11mmol/L
HbA1c: >48mmol/L
Auto antibodies for T1: GAD
what is a ketosis reading for blood-ketones
> 5mmol/L
which 2 tests form the glucose tolerance test
fasting plasma glucose, 2hr plasma glucose post 75g solution
tx for diabetes
MONITOR: HbA1c, capillary blood-glucose, continuous blood glucose monitoring
Rx: insulin, metaphotmin, sulphonylureas, TDZ. SGLT2i (mono, combo, combo + insulin)
what are 2 surgical options for diabetes
pancreatic-kidney transplant, islet transplant
what actually is HbA1c?
how much glucose is attached to haemoglobin molecule
main complications of T1 diabetes
microvascular: retinopathy, nephropathy, neuropathy
hypoglycaemia, DKA
Type 1 diabetes mellitus is…
T cell mediated AI destruction of pancreatic b-cells (can’t produce insulin)
aetiology of T1
genetic (HLA gene), idiopathic
classic triad of T1 in kids
polyuria. polydipsia, wt loss/ not gaining wt
if pt is symptomatic…
tes random glucose. Dx = >11mmol/L
asymptomatic- do glucose tolerance test
c-peptide +ve test
<0.2mmol/L
classic insulin regimen for T1
Background + long acting + short acting (30mins pre-meal)
why must you inject insulin in different locations
to avoid lipodystrophy
how does microvascular injury occur
chronic hyperglycaemia causes inc vessel wall thickness but it hence becomes weaker and most susceptible to leakage and bursting
50% of T1 diabetics will develop ______
nephropahty
T2 diabetes is…
mix of insulin resistance and insulin deficiency
pathophysiology of T2
obesity > exceeding fat storage threshold > deposited in other sites > lipotoxicity > insulin resistance
s/s of T2
fits risks (overweight, older etc), dx of exclusion- polydipsia, polyuria
mx for T2
lifestyle
Rx- metformin, MF + another drug, MF + another drug + insulin
what are tx aims for new T2 diabetic
HbA1c 48mmol/L
others 53mmol/L
comps for T2
HT, HL, hyperglycaemia, microvascular disease
what is hypoglycaemia and causes
low blood-sugar levels, T1 diabetes, t2 diabetes with insulin therapy, missed meal/lots of exercise
s/s of hypo
ANS- trembling, anxious, palpitations, tingling fingertips, irritable, hungry
neuroglycopenic: weakness, concentration, coordination, slurred speech, seizures
dx reading of a hypo
glucose <4mmol/L
tx for hypo
if swallowing- rapid sugar (lucozade) + slow acting (biscuit)
drowsy- glucose gel
severe- IV dextrose (glucose), IM glucagon
hyperglycaemia is…
too much glucose, tx is to alter urine which may result in hypo
what is DKA
production of ketones due to insufficient levels of insulin
how does DKA happen
no insulin to use up glucose > ketones produced > ketones use up HCO3-= acidosis so ketoacidosis
aetiology of DKA
insulin deficiency- new dx of diabetes, malcompliance
inc insulin demand: infection. inflammation, intoxication, infarcion
s/s of DKA
hyperglycaemia, polydipsia/ polyuria
ketone body related: vomiting, flushed, abd pain, kussmaul’s resp, acetonic breath, hypotension
dx of DKA
hyperglycaemia >11mmol/L
ketosis >3mmol/L
acidosis <7.35pH and HCO3- low
potassium >5.5mmol/L
tx for DKA acronym
FIG PICK
Fluids
Insulin
Glucose
Potassium
Infection (check)
Chart fluid balance
Ketones
what is hyperglycaemia hyperosmolar syndrome
hyperglycaemia + hyperosmolarity
why does HHS occur
in T2 diabetics usually due to new dx of DM or infection
ix for diagnosis of HSS
hyperglycaemia (usually >30mmol/L), osmolarity >320mosmol/kg
how to measure osmolarity
2x Na + urea + glucose
mx of HSS
monitor and chart plasma osmolarity, blood-glucose and Na
fluids*
why else can ketoacidosis occur (other than insulin lack)
alcohol or starvation
lactic acidosis is…
lactate is end-product of anaerobic respiration
causes of lactic acidosis
fasting
what are 2 types of lactic acidosis
typeA: tissue hypoxaemia, sepsis, haemorrhage
type B: liver disease, leukaemic states, diabetes
s/s of lactic acidosis
hypervent, confusion, stupor, coma
ix for lactic acidosis
hypolactataemia (<0.6mmol/L)
reduced bicarbonate, raised anion gap, raised phosphate, no ketonaemia
what is monogenic diabetes
diabetes caused by mutation in a single gene usually affecting b-cell function
types of monogenic diabetes
subcategories are- defects in insulin secretion and defects in insulin action
secretion: MODY (GCK MODY and TNF a MODY), neonatal diabetes
epi of MODY
occurs before 25yo
MODY run down
onset <25yo, non-insulin dependent diabetes
- GCK mutation: b-cel glucose sensor muttaion
- TF mutation: HNF-1a most common
what are the most common mutations that cause neonatal diabetes
KCNJ11, ABCC8 genes
block Katp channel so membrane doesn’t polarise
s/s of MODY
acanthosis nigricans, lipodystrophy
GCK: stable hyperglycaemia
TF: progressive
how to differentiate between the 2 MODYs
oral glucose test, c-peptide
tx for MODY
GCK: mainly diet
HNF-1a TF MOFY: 1/3rd diet, 1/3rd sulphonylureas, 1/3rd insulin
tx for neonatal diabetes
insulin then sulphonylureas
