diabetes Flashcards
what type of reaction is type 1
delayed as T cells attack
why do people loose 1 in type 1
essentially the cells are starving so they resort to other methods
how does diabetes affect the stomach
patients have gastroperis, delayed gastric emptying so they complain of getting full early on and feeling nauseas and vommiting
how does diabetes affect the RBCS
CBC: increased HTC( why) and also has shown increased viscosity of the blood as the morphology of rbc changes (shape, size)
Hypochromia – An anemia of the RBCs, observed as a paler than normal color, due to a reduction in haemoglobin which reduces oxygen affinity
Anisocytosis – RBCs in diabetics are unequal in size.
Poikilocytosis – Variations in RBC shape, with up to almost a third of red cells being unequal in size, compared to below 2% in non-diabetic patients.
rbc also have an increased diameter
how does diabetes affect the liver
Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes.
RF FOR TYPE 2
BMI >25kg/m2, 1 st degree relative with DM, Arterial hypertension >140/90mmHg, PCOS HDL <0.9mmol/l and/or TAG >2.2mmol/l History of CVD Polycystic ovarian syndrome
VALUE range for random
11.1
VALUE range for fasting
7
prediabteic values
FPG 6.3-7.0 or 2hr oGTT 7.8-11.1
notes say for fating - 5.6-6.9
normal hb a1c values
4- 6.2 % - lecture confirmed
what’s important about hba1c
B HbA1C should not be used for dx if: Young pt (child) or is suspected of
having DM1, pregnancy, medications which cause hyperglycemia - steroids,
antipsychotic
threshold for glycated
6.5%
acute complications
hypoglycaemia, ketoacidosis, nonketotic
hyperosmolar coma
what classes as hypoglycaemia for a person with diabetes vs a non diabetic
non diabetic - 2.8 mol
diabetic - 4mmol
how does alcohol affect blood sugar levels
Alcohol makes your blood sugar levels drop by inhibiting the liver’s ability to release glucose. initially however it can cause a raised spike in levels
factors of hypoglycaemia
too much insulin skipped a meal gastropareisis increases sensitivity to insulin clearance of insulin
tx severe hypoglycaemia
or intramuscular Glucagon 1mg - wake up slice of bread long release
10% Glucose 200ml/hr if patient is conscious
10% Glucose at 200ml/15 mins if patient is unconscious
triad of DKA
ketonuria /ketonemia
acidosis
hyperglycaemia
definition of ketonemia in DKA
> 3 mmol
normal osmalitty of blood
280-300
smality values in DKA
> 350
when to give bicarb
only in < рН6.9, give 100mmol 8.4%
sodium bicarbonate + 20mmol KCl are infused for 45 min.
what’s the difference between non ketogenic and dka
there is hyperflycmeia >30 mol but no ketones
mortality is higher
PH is >7.3 (but occacionlay a mild acidosis can develop)
MARKED VOLUME DEPLETION
not as acute as DKA
more likely to see in elderly than young unlike in DKA
don’t give insulin unless dingifacnt changes?
what sodium electrolyte is more likely in ska
hyponatremia is commonly seen ( vommiting, ) Dilutional hyponatremia is common due to water driven into the intravascular space from inside cells.
but hypernatremia can be too
tx of HHS
LMWH - prevent clots
rehydration with 0.9% saline
correct hypoklameia
only give insulin if ketonemia or
only glucose is not falling by 5mmol/L/h with rehydration or if
ketonemia is present
microangiopathy examples
eyes and kidneys
rubeuosis iridis
New vessel formation on iris - can lead to glaucoma cos they block the angle of the eye
changes of kidney
glomerular hypertyophy mesangial proliferation hyalinosi s glomerular sceloris BM thickening
advice for diabetics
stop smoking
monitor bP - <130/80 mmHg with proteinuria
fat levels . if you have proteinuria keep it lower
control body weight keep BMI <25
proliferative retinopathy
comes after non proliferative, more advanced and poorer outcome, associated with neovascurilisation but with fragile vessels, and so associated with vitreous hemroggabe + tractional retinal detachment due to fibrosis of vessels
the vessels can also lead to glaucoma as they block the angle of the eye prevent draining
how to manage a patient with macroalbuminera
- keep blood pressure <125/75
- antiaggrgants for thrombosis - peeign out antithrombin
- reduce protein intake up to < 0.8g/kg body weight daily
- EPO if HB less than 115
type of macroangipathy
Coronary vascular disease
- Cerebrovascular disease
- Peripheral vascular disease
RF for macroangipathy
Poor glycaemic control - HbA1c >6.5% Arterial hypertension Dyslipidaemia (↑LDL and ↓HDL) Obesity - Overweight BMI >25 Smoking
examples of autonomic neuropathy
gastropareiss, fixed tachycardia, ED, retrograde ejaculation , urinary retention or incontenice, orthostatic hypotension (drops by more than 30) ,
classification of diabetic neuropathy
autotomic
peripheral
metabolic syndrome
when 3 of the 5 is diagnose
d
- diabtes
- hypertension
- low HDL and elevated LDL
- elevated TAG
- obesity
dx of type 1
anemia
but also diabetes is often misdiagnosed as a UTI, strep throat or viral infections like infectious mono
advice for gasttoprepris
avoid fatty foods, can take metoclorprmaide
why is there s.o.b in dkah
ketones build up faster than the kidneys can remove them from the body. This results in a buildup of ketones, which is toxic. The body may try to use the lungs to expel the excess ketones, which causes shortness of breath
diagnostic criteria for hhs
Severe hyperglycaemia >30mmol/L hyperosmolarty > 320mOsm/Kg – Normal pH >7.3 No ketonemia < 3mmol/L High blood sodium and urea aka Hypovolemic Hypernatremia: dehydration - relative increase in sodium Hypokalemia
