Diabetes Flashcards
diabetes mellitus
metabolic conditions sharing major characteristic of hyperglycaemia
what to test in diabetes
random sugar, fasting sugar
glucose tolerance test (GTT)
Hb1AC
DM type 1
insulin deficiency
autoimmune destruction of pancreatic B cells
DM type 1 aetiology
genetic and environmental
what happens in type1DM
immune mediated pancreatic B cell destruction
hyperlgycaemia, ketoacidosis
why is having high blood sugar a problem
neuropathy, damage to vascular system, hypertension, risk of MI, angina
ketoacidosis
serious, life threatening
not enoiugh sinulin to allow blood sugar in cells for energy, breakdown of fat for fuel producing acid called ketones
too many keytones - dangerous levels
child vs adult onset of T1DM
child - ketoacidosis, peak incidence 10-14yr
adult - latent autoimmune diabetes, less weight loss/ketoacidosis, mask as non obese type 2
symptoms of T1DM
polyuria, polydipsia, hyperglycaemia, ketoaciddosis
T2DM
most common, px over 40, obese
aetiology of T2DM
defect in insulin synthesis/secretion/action, B cell response to hyperglycaemia is inadequate
inretin inadequate response, increaed GI absorption
INSULIN RESISTANCE
EFFECTS OF T2DM
multisystem impairement - impaired glucose tolerance, hyperinsulinemia, obesity, hypertension, atheroscleorsis
medication induced diabetes
corticosteroids - interferes w liver
immune suppressants
cancer medications
antipsychotic medicines
antivirals
diabetes related to other conditions
endocrine - cushings, phaechromocytoma, acromegaly
pregnacy, festational diabetes
T2DM risk factors
overweight, family history, ethnic groups [asian, afro carribean, middle east], gestational diabetes in previous pregancy
summary of differences in DM
1 - young, thin, diabetic symptoms, ketoacidosis
2 - older, obese, strong familyH, present with complications, rarely ketoacidosis
core DM management
education - understanding, complication avoidance
targets for blood levels
targets for blood sugar levels
pre-prandial - 4-6mmol/L
bedtime - 6-8mmol/L
insulin regimes
basal bolus - more injections, better control
split-mixed - fewer injections, poorer control
how is insulin administered, what issues with this?
subcutaneous injections
need to rotate site as can lead to fat atrophy if continued use
T1DM management
exercise - planned
monitoring - plan dose
nutrition - less than 10% cals from fat, glycaemic index of food
maintain sugar level control
T1DM aim for blood sugar
4-7mmol/L
insulin monitoring options
continuous glucose monitoring system - tracks glucose, inserted under skin
closed loop monitoring - insulin pump and glucose monitor, insulin released when needed
T2DM management
lifestyle - weight loss, diet
medications - metformin
surgery - gastric vertical banding, bariatric
medication for T2DM
METFORMIN - first line, enhances cell insulin sensitivity, reduce hepatic gluconeogenesis
DDP4 inhibitor - block enzyme metabolising incretin, improve insulin response to glucose
incretin = helps insulin last longer
GP1 mimetics - same as DDP4, increase incretin
sulphonylureas - increase insulin, can cause hypoglycaemia
insulin use for T2DM
if px unable to manage glycaemic control with behavuoural changes, weight loss, medication
complications of diabetes
hypoglycaemia, cardiovascular risk, increased atherosclerosis, infection risk, neuropathy, atheroma, small vessel disease, diabetic eye disease
large vessel atheroma diabetic complications
angina, MI, claudication, anuerysm risls
small vessel disease diabetic complication
poor wound healing, easy wound infections, renal disease, eye disease
neuropathy complication
numbness of foot, blister, infection, poor healing, necrosis, amputation
weakness and wasting of muscles
awareness of hypoglycaemia lost, bladder/bowel dysfunction
diabetic eye disease
cataracts - opacity in iris, hazy image, lack of sharpness
maculopathy - lose cone of retina so lose correct vision
proliferative retinopathy - change in blood vessels over retina, haemorrhage in back of eye, treat with lasers
dental treatment + diabetes
tx may affect normal routine
best time of day for appt, morning, length of appt, manage dosage and food needs
dental aspect + diabetes
acute emergencies, complications
INFECTION AND POOR WOUND HEALING
increased risk of decay, periodontal disease, fungal candidiasis
