Diabetes Flashcards
What are the symptoms of T2DM?
Normally asymptomatic but:
- Polydipsia, polyuria,
- Blurred vision
- Recurrent infections
- Tiredness
- Acanthosis nigricans suggests insulin resistance
What is the diagnostic criteria of T2DM?
- Symptomatic = single abnormal HbA1c >48mmol/ml or 6.5%
- Asymptomatic = 2 raised BM tests 2 weeks apart
What is the diagnostic criteria of T1DM?
Symptoms - ketosis, rapid weight loss, <50yo, FH
- Random venous plasma glucose >11 mmol/l
- Fasting plasma glucose conc >7mmol/l
What is the ongoing management of a patient with T2DM?
- Initial diagnosis need HbA1c every 3 months and then every 6 months after that
- Annual review w diabetic specialist nurse
- Diabetic MOT - weight, BP, waist circumference, diabetic foot check
- Retinal screen every 2 years if low risk
What are the microvascular complications of diabetes?
- Retinopathy
- Diabetic kidney disease - due to nephropathy, HTN, renal atheroma and ischaemia
- Neuropathy, autonomic (gastroparesis, unexplained diarrhoea, erectile dysfunc) and peripheral (numbness, burning pain, paraesthesia)
What are the macrovascular complications of diabetes?
Atherosclerotic cardiovascular disease
including coronary heart disease, cardiomyopathy, peripheral artery disease, arrhythmias.
What is asked about during the annual diabetic review w the specialist diabetic nurse?
- Check CVS RF - smoking status, BM control, BP, albuminuria, lipids
- Ask about sx of autonomic neuropathy and peripheral neuropathy
What can affect the accuracy of HbA1c?
Measures glucose bonded to Hb so any condition that prolongs the life of an erythrocyte can affect HbA1c:
- Anaemia - Fe def, B12, folate
- Splenectomy
- Renal failure
- Medications
- Stress levels and general health
Biguanides:
- MOA
- Benefits
- Example
eg. metformin - inhibits gluconeogenesis
Benefits - can limit weight gain and there isn’t a high risk of hypoglycaemia.
Biguanides:
- SE
- Contraindications
SE - GI upset
Contraindications - if impaired renal function
DPP-4 inhibitors:
- MOA
- Benefits
- Example
eg. sitagliptin - increase incretin levels and promotes insulin secretion
Benefits - suppresses appetite, no risk of hypoglycaemia as glucose dependent
DPP-4 inhibitors:
- SE
- Contraindications
SE - GI upset and risk pancreatitis
Contraindications - pregnancy and hx pancreatitis
Thiazolidinediones:
- MOA
- Benefits
- Example
eg. pioglitazone - increase insulin sensitivity and glucose utilisation
Thiazolidinediones:
- SE
- Contraindications
SE - weight gain, GI upset, fluid retention, hypoglycaemia risk, bladder cancer
Contraindications - don’t use in HF due to fluid retention
Sulfonylurea:
- MOA
- Benefits
- Example
eg. gliclazide - increase insulin secretion
Sulfonylurea:
- SE
- Contraindications
SE - GI upset, hypoglycaemia, weight gain
Contraindications - those at risk of hypoglycaemia, hepatic and renal disease
SGLT-2 inhibitors:
- MOA
- Benefits
- Example
eg. dapaglifozin - reduce glucose absorption at tubule so increase excretion
Benefit - no risk hypoglycaemia, weight loss
SGLT-2 inhibitors:
- SE
- Contraindications
SE - UTI and genital infection
Contraindications - not to patient at risk DKA
GLP-1 mimetics:
- MOA
- Benefits
- Example
eg. exenatide - injectable med, increase glucose dep synthesis of insulin
Benefit - no risk hypoglycaemia, weight loss
What are some of the RF for hypoglycaemia in T2DM?
- Increasing age and loss of awareness of hypoglycaemia, some of the sx of hypoglycaemia eg. reduced consciousness, slurred speech can be explained as sx of old age
- Comorbidities
- Renal impairment
- Loss of insulin secretion
