Diabetes Flashcards
define DM
metabolic disorder characterized by persistent hyperglycaemia (random plasma glucose more than 11 mmol/L) with disturbances of carbohydrate, protein, and fat metabolism resulting from defects in insulin secretion, insulin action, or both
type 1 DM pathophysiology
absolute insulin deficiency
autoimmune destruction of insulin producing beta cells
type 1 DM tx
insulin
complications of type 1 DM
Microvascular complications — retinopathy, nephropathy, and neuropathy.
Macrovascular complications — such as myocardial infarction, stroke, and peripheral arterial disease.
Metabolic complications — diabetic ketoacidosis (DKA) and hypoglycaemia (blood glucose less than 3.5 mmol/L).
Psychological complications — anxiety, depression, and eating disorders. In addition in children and young people, behavioural and conduct disorders, family/relationship difficulties, and risk-taking behaviour (including non-adherence to recommended treatment).
Increased risk of developing other autoimmune conditions — including thyroid disease, coeliac disease, Addison’s disease, and pernicious anaemia.
Reduced quality of life and life expectancy.
diagnosis DM type 1
hyperglycaemia with one or more of the fx:
Ketosis.
Rapid weight loss.
Age of onset younger than 50 years (although type 1 diabetes should not be discounted if the person is aged 50 years or older).
Body mass index (BMI) below 25 kg/m2 (although type 1 diabetes should not be discounted if the person presents with a BMI of 25 kg/m2 or above).
Personal and/or family history of autoimmune disease.
children type 1 DM diagnosis
hyperglycaemia + Polyuria., Polydipsia. Weight loss., Excessive tiredness.
referral type 1 DM
if diagnosed - immediate referral to MDT diabetes specialist team
primary care management type 1DM
- appropriate access to specialist team
- education, support for them and family, inuslin tx, managing hypoglycaemia, sick day rules
- manage pt if ill
- identify complications
- minimise risk of long term complications
- screen for other autoimmune conditions where appropriate
- lifestyle factors
- regular check ups
risk factors type 1 DM
genetic - sibling - 6-7% risk, child 1-9%
environment - diet, vit D exposure, obesity, early onset exposure to viruses, decreased gut microbiome
if clinical diagnosis require investigations type 1 DM
C peptide and/or specific autoantibody titres
… as atypical features, guide use of genetic testing, guide tx if classification uncertain
DKA sx
Increased thirst and urinary frequency.
Weight loss.
Inability to tolerate fluids.
Persistent vomiting and/or diarrhoea.
Abdominal pain.
Visual disturbance.
Lethargy and/or confusion.
Fruity smell of acetone on the breath.
Acidotic breathing — deep sighing (Kussmaul) respiration.
Dehydration, which can be classified as:
Mild — only just clinically detectable.
Moderate — dry skin and mucus membranes, and reduced skin turgor.
Severe — sunken eyes and prolonged capillary refill time.
Shock (resulting from severe dehydration)
DKA glucose level
> 11mmol/L
assessment DKA
assess for precipitating factors:
- infection
- physiological stress
- non adherence to tx
- other medocal conditions
- drug tx
investigations DKA
blood ketones
->3mmol/L
although if low - does not exclude
hypoglycaemia sx
Hunger.
Anxiety or irritability.
Sweating.
Tingling lips.
Irritability.
Palpitations.
Tremor.
As blood glucose levels fall lower, the person may experience:
Weakness and lethargy.
Impaired vision.
Incoordination.
Reduced orientation.
Confusion.
Irrational behaviour.
Emotional lability.
Deterioration of cognitive function (when blood glucose levels fall lower than 3.0 mmol/L).
Severe hypoglycaemia may result in:
Convulsions.
Inability to swallow.
Loss of consciousness.
Coma.
target HbA1C adults type 1 DM
48mmol/mol
measure every 3-6 months
sick day rules type 1 DM
never stop insulin
check blood glucose more regularly
check blood or urine ketones regularly
maintain normal meal pattern where possible
drink at least 3L of fluid
blood pressure targets type 1DM
For adults with a urine albumin:creatinine ratio (ACR) less than 70 mg/mmol, aim for a clinic systolic blood pressure less than 140 mmHg (target range 120 to 139 mmHg) and a clinic diastolic blood pressure less than 90 mmHg.
For adults with an ACR of 70 mg/mmol or more, aim for a clinic systolic blood pressure less than 130 mmHg (target range 120 to 129 mmHg) and a clinic diastolic blood pressure less than 80 mmHg.
In adults aged 80 or more, whatever the ACR, aim for a clinic systolic blood pressure less than 150 mmHg (target range 140 to 149 mmHg) and a clinic diastolic blood pressure less than 90 mmHg.
first line BP for type 1 DM and CKD
ARB
define type 2 DM
persistent hyperglycaemia (HbA1c more than 48 mmol/mol [6.5%] or random plasma glucose more than 11.1 mmol/L) is caused by a combination of deficient insulin secretion and resistance to the action of insulin
risk factors type 2 DM
obesity and inactivity; diet; family history of type 2 diabetes; Asian, African, and Afro-Caribbean ethnicity; drug treatments such as long-term corticosteroids; and history of gestational diabetes.
complications type 2 DM
Macrovascular — cardiovascular disease (CVD) including ischaemic heart disease, stroke disease, and peripheral arterial disease.
Microvascular — diabetic kidney disease, retinopathy, peripheral and autonomic neuropathy.
Foot problems — including foot ulcer, deformity, infection, and Charcot arthropathy.
Metabolic — dyslipidaemia, potentially life-threatening hyperglycaemic emergencies (diabetic ketoacidosis and hyperosmolar hyperglycaemic state).
Psychosocial impact — including anxiety, depression, eating disorders, behavioural and emotional problems.
Reduced life expectancy.
diagnosis type 2 DM
persistent hyperglycaemia
polydipsia, polyuria, weight loss, tiredness; enuresis, behavioural changes, and impaired growth (in children); signs of acanthosis nigricans (suggesting insulin resistance).
