Diabetes Flashcards
Diabetes Mellitus def
Group of metabolic diseases characterized by inappropriate hyperglycemia resulting from defects in insulin secretion, insulin action or both
Symptoms of diabetes
Polyuria Polydipsia Polyphagia Weight loss Blurred vision Fatigue Headache Poor wound healing
Chronic hyperglycemia can lead to organ damage Kidney Eyes Heart Nerves Blood vessels
Classification of Diabetes
T1DM
T2DM
Gestational DM
Other ( monogenic DM, LADA)
T1DM
Age below 30
Absolute Insulin deficiency
Autoimmune destruction of B cells of islets of langerhans
Antibodies to Glutamic Acid Decarboxylase, pancreatic B cells and/or insulin
T2DM
Age over 30 Overweight Positive family history Signs of insulin resistance High triglycerides & LDLs
Gestational DM
Elevated plasma glucose level during pregnancy
Monogenic DM
Formerly known as Maturity onset diabetes of the young
In children with atypical presentation or response to therapy
LADA
Latent autoimmune Diabetes of Adult
Slow destruction of B cells as in T2DM but antibodies are present as in T1DM
Secondary diabetes
Cushing Syndrome Acromegaly Cystic fibrosis Down syndrome Pancreatic disorder Glucocorticoids Antipsychotics
Prediabetes
Individual with high plasma glucose level. But not high enough for DM
Hormones involved in normal glucose regulation
Insulin
Glucagon
Growth hormone
Catecholamines
Cortisol
Incretin
Amylin
Insulin function
Regulates metabolism of carbs protein fats
Promotes cellular uptake of plasma glucose
Stimulates conversion of glucose into energy storing molecules (glucagon, fat)
Facilitate cell uptake of amino acid and their incorporation in protein
Inhibits production of glucose from liver, muscle glycogen, amino acids
Decrease breakdown of fatty acids to ketone bodies.
Counter regulatory hormones
Work against insulin
Increase blood glucose
Glucagon
Growth Hormone
Catecholamines
Cortisol
Incretin hormones
Released by intestine in response to glucose ingestion
Amylin
Cosecreted with insulin from B cells
Lowers postparendial glucose
Causes of T1DM
Genetics
Environment (infection, chemical, diet)
Autoimmune (Anti insulin, Anti B cell, Anti glutamic Acid Decarboxylase GAD found in blood in 70% )
T2DM reasons
Genetics
B cell dysfunction
Peripheral site defect (defect in post receptor binding and decreased insulin rec)
Secondary diabetes
Diagnostic test for Diabetics
Blood glucose monitoring
A1c
Glucose tolerance test
Diabetes values in normal adults
Fasting >126 mg/dL Random >200 mg/dL Oral Glucose tolerance test (OGGT) 75g anhydrous glycerin in water > 200mg/dL A1c >6.5%
GDM values
Fasting >92 ng/dL
1 hr OGTT 180mg /dL
2hr >153 mg/dL
Postpartum testing gor 6 to 12 weeks.
If -ve then every 3 yr
Prediabetes
Fasting 100 - 125mg/dL
GTolerance 140 - 199 mg/dL
A1c 5.7 - 6.4%
Glycemic control goals
ADA :
A1c < 7%
FPG 70 to 130mg/dL
1 2 hr PPG< 140 mg/dL
AACE:
A1c < 6.5%
FPG< 110 mg/dL
2hr PPG <140 mg/dL
Insulin types
Rapid acting
Short acting
Intermediate acting
Long acting
Rapid acting Insulin
Lispro (Humalog)
Aspart (NovoLog)
Glulisine (Apidra)
Short acting
Regular insulin
Humulin regular, Novolin Regular
Intermediate acting insulin
Isophane insulin suspension (neutral protamine Hagedron, NPH)
Long acting insulin
Glargine (Lantus)
Detemir (Levemir)
Premixed insulin
50/50 insulin
50% protamine lispro insulin + 50% lispro insulin
70/30
70% aspart protamine + 30% aspart insulin or
70% NPH + 30% regular
75/25
75% protamine lispro insulin with 25% lispro insulin
Extemporaneous Mixture insulin
Glargine should never be mixed with Detemir
When rapid acting is mixed with another insulin it should be used immediately
Stable for 14 days in fridge 7 days in room temp
Mechanism of insulin
Stimulates hepatic glycogen synthesis
Increased protein synthesis
Facilitate triglycerides synthesis and storage by adipocytes, inhibits liploysis
Stimulates peripheral glucose uptake
Dosage for T1DM
0.6 units /kg/ day
50/50 rule: 50% of TDD given as basal dose ( glargine Detemir NPH)
Remaining given as bolus divided b/w meals (regular aspart lispro glulisine)
Dosage for T2DM
0.1 - 0.2 units/ kg/ day
Premixed on 0.2unit/kg/day, 2/3 dose given in morning, 1/3 in evening before last meal
Insulin dose adjustment
Based on Blood glucose levels
Rules of 1500 to 2200
Higher the rule lower the risk of hypoglycemia
1800/TDD = correction factor (CF)
Dose adjustment = (Current blood glucose - target blood glucose) ÷ CF
Insulin dose adjustment
Carbohydrates
Rule of 500
500/TDD = x grams of carbohydrates
Dawn phenomenon somogyi phenomenon
Dawn phenomenon:
Fasting hyperglycemia due to counter regulatory hormones
Evening dose should be increased or moved closer to bedtime
Somogyi Effect:
Rebound hyperglycemia
Decrese evening insulin dose
Rout of insulin administration
SC
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