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Med 3 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Treatment of T 1 diabetes

A

Fluids and electrolytes - to balance dehydration and acidosis (ketosis)

Insulin - to maintain normoglycaemia / establish dosage regimen

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2
Q

Acute complications of diabetes

A

Hypoglycaemia (T1 and 2)
Diabetic ketoacidosis (T1)
Hyperosmolar hyperglycaemic state (T2)

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3
Q

Chronic complications of diabetes

A

Long term / secondary complications

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4
Q

What are the blood glucose levels for hypoglycaemia

A

Blood glucose <4 mmol/L

Symptoms present = 3mmol/L

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5
Q

Hypoglycaemia in T1

A

Insulin overdose

Excessive exercise or inadequate CHO intake relative to insulin dose

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6
Q

Hypoglycaemia in T2

A

Sulphonylureas (elderly) -

Hepatic or renal disease, some drugs

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7
Q

Signs and symptoms of hypoglycaemia

A

Palpitations, tremors, sweating, anxiety - counter regulatory activity of SNS

Dizziness 
Hunger 
Irritability 
Headache 
Tingly lips

As progresses:
Loss of concentration, slurred speech, behaviour / mood changes, seizures, loss of consciousness
- glucose deficiency in brain

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8
Q

Hypoglycaemia treatment

A

Conscious
- sugary drink / food

Glucogel (40% dextrose gel) recommended by NICE

10-15 minr recovery then a snack for sustained carbohydrates

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9
Q

Unconscious treatment for hypoglycaemia

A

Glucose iv 20% or 10% or glucagon IM, IV or SC

But not after alcohol (because it is metabolised in the liver)

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10
Q

Diabetic ketoacidosis

A 
(Diabetic coma) 
Omission or reduction in insulin dose 
Illness / infection 
Emotional upset particularly in adolescence 
Menstruation / pregnancy ketosis
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11
Q

Treatment for diabetic ketoacidosis

A

Insulin (iv infusion)
Replacement of fluids, electrolytes (NaCl 0.9%) may need KCl, glucose 10%
Suppress ketogensis, reduce blood glucose and correct electrolyte balance

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12
Q

What is hyperosmolar non ketotic coma

A

Severe hyperglycaemia without ketosis (T2 DM)

Managed as DKA (less insulin)

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13
Q

What is the HbA1c test

A

Indicator of glycaemic control during the last 2-3 months
Recommended 48-59mmol/mol
(6.5-7.5%)

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14
Q

Micro vascular long term complications of DM

A

Retinopathy (eye disease)
Nephropathy (kidney disease)
Neuropathy (nerve damage)

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15
Q

Macro vascular long term complications of DM

A

Cardiovascular disease (ischaemic heart disease)
Cerebral vascular disease (stroke)
Peripheral vascular disease

Effects the medium - large vessels in the body

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16
Q

Define insulin resistance

A

Reduced ability of the hormone insulin to stimulate whole body glucose metabolism in obesity, T2D and even offspring of T2D

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17
Q

What is metabolic syndrome

A

A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus eg

Central obesity 
Triglycerides >1.7mmol/L 
HDL cholesterol <1 mmol/L (M)
<1.3 mmol/L (F) 
Blood pressure >130/85 mmHg 
Fasting glucose >5.6 mmol /L
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18
Q

What is poor glycaemic control / excessive hyperglycaemia associated with

A

Long term microvascular complications (eyes, kidneys and PNS) and macrovascular disease (increased risk for stroke and myocardial infarction) that increase morbidity and mortality

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19
Q

Nutritional therapies for T1 diabetes

A

Integrate insulin regime into lifestyle
Adjust insulin regimen to match CHO intake
Consistent day-to-day carbohydrate intake
Adopt a balanced diet

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20
Q

Nutritional therapies for T2 diabetes

A

Lifestyle changes to improve glycaemia, insulin sensitivity’s dyslipidaemia, and blood pressure
Reduce energy intake/ weight loss (at least 5%)
Weight loss is highly effective in preventing from prediabetes to T2D and in managing cardio metabolic health in T2D
600 kcal/day for 8 weeks resolves T2 diabetes

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21
Q

How does a very low calorie diet help T2

A

Normalises beta cell function which is associated with a decrease in pancreatic lipid content

22
Q

Dietary carbohydrate recommendations

A

Consistent day to day - 50% of energy requirements

Low glycaemia index

Low CHO diets may confer short term benefits but restrict essential nutrients incl fibre from fruits and vegetables

Diets containing >30g of fibre per day improve glycaemic control

Knowing basic information on CHO content of meals

23
Q

Dietary protein recommendations

A

0.8 to 1g/kg/ day

Can increase acute insulin responses

Satiating - minimise appetite

High protein intake may promote weight loss and preservation of lean body mass but it may impair renal function in individuals with chronic kidney disease

24
Q

Dietary fat recommendations

A

Limit fat to <35% of energy requirements

Saturated fats <7% of total energy, dietary cholesterol <200mg/day

Replace with mono or poly unsaturated fast to improve glycaemia, lipaemia and insulin sensitivity

25
Q

Role of exercise in management of diabetes

A

Reduces blood glucose conc and controls glycaemia and reduce cardiovascular risk factors

Aim for at least 150min per week of moderate to vigorous physical activity over at least 3 days

Aerobic and resistance exercise exert similar benefits but combining the 2 forms of exercise may confer greater benefits

Combining hypocarolic diets with exercise increases body weight and fat loss and better preserve lean body mass

26
Q

Who is screened for diabetes

A

1) white people ages >40 and people from BAME groups ages >25 with one or more risk factors:
- first degree family history of diabetes
- BMI of 25-30
- waist measurement of >37 inches for white and black men and >31.5 inches for white black and Asian women and >35 inches for Asian men
2) people with atherosclerosis or hypertension
3) women who have gestational diabetes
4) PCOS + BMI >30
5) people who have IGT or IFG
6) people with severe metabolic health porblems (antipsychotics)
7) people with high triglycerides

27
Q

Type 1 vs type 2 symptoms

A

More acute onset in T1
T2 progesrrive and symptoms gradual
T2 takes 10 years on average to present

28
Q

Classifications of diabetes

A 
T1 
T2 
Gestational 
Secondary 
Drug induced 
Pancreatic disease 
Insulin resistance syndrome
29
Q

What is gestational diabetes

A

Risk assessment at first PN visit
Screen those at very high risk immediately
Otherwise check at 24-28 weeks
Glucose tolerance test

30
Q

What is MODY

A

Maturity onset diabetes of the young

Early onset diabetes 
Not insulin dependent 
Autosomal dominant inheritance 
Caused by a single gene defect altering beta cell function 
Obesity is unusual
31
Q

Diagnostic criteria for MODY

A

Early onset diabetes - before 25 in at least 1 and ideally 2 family members

Not insulin dependent diabetes - off insulin treatment or measurable C peptide at least 3 (ideally 5) years after diagnosis

Autosomal dominant inheritance - must be diabetes in 1 parent and ideally grandparent or child

Caused by a single gene defect altering beta cell function, obesity unusual

32
Q

Major causes of insulin resistance

A

Obesity

Lipodystrophy - cannot store fat under skin result in ectopic fat - fat goes straight into pancreas or liver

Insulin receptor mutation

Very rare other genetic causes

33
Q

Treatment goals

A

To keep blood sugar as normal as possible without serious high or low blood sugars (HbA1c)

To prevent tissue damage caused by too much sugar in the blood stream

  • lipids
  • blood pressure
  • screening for complications (eyes, feet, kidneys)
34
Q

Dietary recommendations for diabetes

A

Dietary fat should provide 25-35% of total intake of calories but saturdated fat intake should not exceed 10% of total energy

Protein intake can range between 10-15% total energy
Requirement increase for children and during pregnancy. From both animal and vegetable sources

Carbs 50-60% - complex and high in fibre

Excessive salt intake avoided especially in those with hypertension and nephropathy

35
Q

Exercise guidelines

A

Physical activity promotes weight reduction and improves insulin sensitivity thus lowering blood glucose levels

30 mins of moderate intensity exercise per day

People should be educated about risk of hypoglycaemia and how to avoid it

36
Q

Oral anti diabetic agents

A

Biguanides- metformin
Insulin secretagogues - sulphonylureas
Insulin secretagogues - non sulphonylureas
A-glucosidase inhibitors
Thiazolidinediones
Dipeptidylpeptidase inhibitors
Sodium glucose co transporter 2 inhibitor

37
Q

Describe the pelvic floor

A

Consists mostly of flat muscles that line a cup shaped space. It is therefore flexible and can buffer the significant variations in pressure in the abdominopelvic cavity

38
Q

What are the main contributing risk factors for diabetic foot disease

A

Peripheral arterial disease and loss of sensation

39
Q

What is diabetic foot disease

A

A complication of DM
2 main risk factors: neuropathy (loss of protective sensation)
Peripheral arterial disease

Presents with loss of sensation, absent foot pulses, reduced ankle brachial pressure

40
Q

How does metformin work

A

Increases insulin sensitivity and decreases hepatic gluconeogenesis

41
Q

What is the main focus of diabetic management

A

Reducing the incidence of macrovascular (ischaemic heart disease, stroke) and microvascular (eye, nerve and kidney damage)

42
Q

What is T1 diabetes mellitus

A

Autoimmune disorder where the insulin producing beta cells of the iselts of langerhans in the pancreas are destroyed by the immune system

Results in an absolute deficiency of insulin resulting in raised glucose levels
Tends to develop in child / early adult life and typically present unwell possibly in diabetic ketoacidosis

43
Q

What is diabetic ketoacidosis

A

Serious complication of diabetes that can be life threatening

Excessive thirst, frequent urinaiton, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath

44
Q

What is type 2 diabetes mellitus

A

Caused by a relative deficiency of insulin due to an excess of adipose tissue

Not enough insulin to go around all the excess fatty tissue, leading to blood glucose increasing

45
Q

What is diabetes inspipidus

A

A condition characterised by either a decreased secretion of ADH from the pituitary (cranial DI) or an insensitivity to ADH (nephrogenic DI)

46
Q

Causes of cranial diabetes insipidus

A 
Idiopathic 
Post head injury 
Pituitary surgery 
Craniopharyngiomas 
Infiltrative
47
Q

Causes of nephrogenic diabetes insipidus

A

Genetic: mutation in the gene that encodes the aquaporin 2 channel
Electrolytes: hypercalcaemia, hypokalaemia
Lithium: desensitised the kidneys ability to respond to ADH in the collecting ducts
Dee clock line

48
Q

What is fetal macrosomia

A

Newborn baby larger than average

Weighs more than 8lbs 13 oz

49
Q

Mode of action of novo rapid

A

Rapid acting insulin that helps to normalise the glucose level by moving glucose into cells

50
Q

Menmonic for causes of hypercalcaemia (chimpanzees)

A 
Calcium supplementation 
Hyperparathyroidism 
Iatrogenic drugs (thiazides) 
Milk alkali syndrome 
Paget disease of the bone 
Acromegaly and Addison’s disease 
Neoplasia 
Zolinger-Ellison syndrome 
Excessive vit D 
Excessive vit A 
Sarcoidosis

Med 3 (10 decks)

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