Diabetes Flashcards
Diabetes diagnosis
with symptoms
fasting > 7
random > 11.1
HbA1c > 48 mmol/mol
pre-diabetes
HbA1c 42-47 mmol/mol
T1 diabetes gene assoc?
HLA DR3, DR4
Diabetes management
- Metformin
- DPP-4i - sitagliptin
- Pioglitazone (ttd)
- Sulfonylurea - gliclazide
- SGLT-2i - (glifozin)
sulfonylureas action
enhance endogenous insulin secretion (B-cells)
sulfonylureas examples
Gliclazide
biguanides action
- increase glucose uptake
- decrease hepatic gluconeogenesis
- increase peripheral insulin sensitivity
biguanides example
METFORMIN
sulfonylureas side effects
weight gain
hypoglycaemia
hyponatraemia
biguanides side effects
GI upset: nausea, diarrhoea
lactic acidosis
DPP-4 inhibitors example
sitagliptin
DPP-4 inhibitors action
- increase incretin levels
- prevents peripheral breakdown (longer action)
- inhibits glucagon secretion
DPP-4 inhibitors side effects
well tolerated
pancreatitis risk
thiazolidinediones action
Activate PPARG receptor in adipocytes
adipogenesis & FA uptake
thiazolidinediones side effects
weight gain
fluid retention
bladder cancer
thiazolidinediones example
pioglitazone
SGLT-2 inhibitors
selective sodium glucose contransporter 2 inhibitors
inhibits glucose reaborption in kidney
SGLT-2 inhibitors example
-gliflozins
empagliflozin
SGLT-2 inhibitors side effects
UTI (bacteria love sugar)
weight loss
GLP-1 agonists action
mimics incretin
inhibits glucagon secretion
GLP-1 agonists example
-tide
GLP-1 agonists side effects
N & V
pancreatitis
who do I NOT give metformin to
GFR <30
increased chance of lactic acidosis
if HbA1c still >58
add gliptin first, then another
if 3 not effective add a GLP-1 agonist
ACE inhibitors in T2D
reno-protective
against nephropathy
afrocarribean (offer + CCB/thiazide)
BP target in T1D, albuminuria, metabolic syndrome
130/80
140/90 - otherwise
what drug do I avoid when already on thiazide
beta blockers
impaired insulin secretion
insulin resistance
impaired response to hypoglycaemia
basal bolus
rapid acting insulin with meals
long acting insulin at bedtime
biphasic 30/70 mixed insulin - T2D uncontrolled
30% rapid
70% intermediate
increase night dose slowly?
acanthosis nigricans
associated w T2 diabetes
best investigation for dm
HbA1c
glycated Hb
reflects exposure over last 6-8wks
serum osmolality
2x (Na + K) + Urea + Glucose
DKA path?
infection, missed insulin, MI
uncontrolled lipolysis
FFAs –> ketones
DKA features
abdominal pain polyuria, dipsia dehydration kussmaul resp acetone breath
DKA diagnosis
glucose >11
ph <7.3
ketones >3 or ++
bicarb <15
DKA mgmt?
0.9% saline 1L over 30 minutes (if sbp <90)
when glucose <15mmol/L start 5% dextrose infusion
IV insulin 0.1 units/kg/hr
K replacement (insulin)
HHS path?
hyperosmolar hyperglycaemia state - T2D
osmotic diuresis w loss of Na/K
- severe dehydration, high glucose
- raised serum osmolarity >320
- hyper-viscous blood
- clot risk
HSS diagnosis
hypovolaemia
hyperglycaemia >30mmol/L
without sig ketone/acidosis
serum osmolarity >320
HSS management
IV 0.9% saline - gradually normalise osmolality
if need to normalise glucose - insulin
LMWH
Insulin side effects
weight gain
…
complications of DM
end-stage renal failure
autonomic symptoms of hypoglycaemia
Sweating Hunger Anxiety Tremor Palpitations
neuroglycopenic symptoms of hypoglycaemia
Confusion Drowsiness Seizures Coma Personality change
causes of hypoglycaemia
exogenous insulin/gliclazide insulinoma liver failure addisons alcohol
investigating DKA in ED
VBG
Diabetes insipidus
- nephrogenic = no response to ADH
- cranial = pit dysfunction, no ADH (treat w desmopressin)
Water deprivation test
low, high = cranial
low, low = nephrogenic
T1D antibodies
Anti-islet
Anti-GAD
diabetes screening for complications
Macro - Pulses - BP - Cardiac auscultation Micro - Fundoscopy - ACR + U+Es - Sensory testing plus foot inspection
