Diabetes Flashcards
Diabetes
high glucose levels due to insufficient insulin
where is insulin produced
beta islet of langerhan cells in the pancreas
types
Type 1 and type 2
Type 1 pathology
B cells islet of langerhan are destroyed so not producing insulin
Type 2 pathology
Insulin being produce but because of build up of adipose tissue or excess FA in blood, insulin isn’t sensitive
causes of type 2
obesity
bad diet
signs of type 1
polyuria polydyspepsia wetting bed increased thirst weight loss not thriving
signs of type 2
polyuria
polydipsia
obesity
investigation
random glucose test - >11
fasting glucose test - >6.9
HbA1c - >48
OGTT - >11
criteria for the investigations
symptomatic + 1 test
asymptomatic + 2 tests
management type 1
give insulin
can have it as a pump, injection
types of insulin given
long-acting and short acting
management type 2
lifestyle factors and education metformin sulfalazine thiazolidime DPP-4 3GLT-2 GLP-1
insulin
cautions and side effects of type 2 medications
metform - GI disturbance, stop if eGFR<30
Sulfonylureas - hypoglycaemic, weight gain (caution in elderly)
thazolidinediones - avoid in ostoeoporosis (post menopausal women), avoid in bladder cancer, heart failure, weight gain
SGLT-2 inhibitors - uro/genital infections, weight loss
DDP4 - reduce dose in renal and stop in acute pancreatitis, weight loss
complications of diabetes
increase CVS risk diabetic foot ulcers retinopathy neuropathy nephropathy DKA hypoglycaemic
DKA
uncontrolled lipolysis resulting excess FA and ketones
causes:
infection
missed insulin dose
MI
signs: abdo pain vomiting weak fruity breath deep breathing (fever if infection)
investigations: urinalysis pH <7.3 CAP blood - >11 (+ diabetes) or >13 CAP ketones - >3
management:
IV fluids
fixed rate insulin AFTER commencing fluid
stop short acting insulin, continue long acting
blood glucose <15mmol/l - start 5% dextrose
correct electrolyte imbalance
complication:
children - cerebral oedema
hypoglycaemic state
low glucose levels
causes:
diabetes medications
adrenal insufficiency
alcohol
signs: tremor sweating irritable drowsy nausea
investigation:
blood glucose
management:
if there is IV access, give IV
short acting insulin - lucozade/IV insulin
long acting insulin - biscuits, toast
severe:
IM glucagon
monitor serum osmolality for clinical improvement
what can you check to differentiate between type 1 and type 2
C-peptide
anti-glutamic acid decarboxylase
what BP is aimed in diabetics
140/90
what organisms causes diabetic foot ulcers
staph aureus
pseudomonas aeruginosa
when should a statin be offered for type 1 diabetics
over 40 yrs old
have had had diabetes for >10yrs
CVD risk
presence of nephropathy
what does it mean to have an impaired glucose tolerance
fasting glucoses levels between 6.1 and 7
how my hypoglycaemic events does it take for px to surrender driving licence and in what time frame
at least 2 events in 12 months
what does an unrecordable glucose reading mean
high levels
how often does a patient need to monitor diabetes during the day
at least 4 times a day
including before each meal before bed
