Diabetes Flashcards
Risk factors
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
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.
3 month checks for T2DM Px
Blood sugar checks (HbA1c test)
- every three months when newly diagnosed and every 6 months when stable
Annual diabetic review
Weight, height, BMI
Feet
- skin (ulcers, infection, pallor, fissures
- nails (dystrophy)
- web spaces (cracking, maceration)\
- deformities (Charcot joints)
- arteriopathy: temperature, pulses, capillary refill
- neuropathy: 10g monofilament sensation, vibration sense with 128 Hz tuning fork, proprioception, ankle jerks
Eyes
- Xanthelasma/cataract/opthalmoplegia
- Visual acuity
- Ophthalmoscopy (diabetic review)
Cardiovascular
- Pulse
- Blood pressure,
- Heart sounds,
- Carotid bruits
Blood pressure, cholesterol and kidneys
Checks for high blood pressure, heart and kidney disease.
Insulin injection sites (lipodystrophy)
Treatment
Lifestyle: Diet, Exercise and physical activity, alcohol intake, smoking and drug misuse, periodontitis
Diabetic -
FIRST LINE = metformin (biguanide = increases preipheral sensitivity to insulin)
2. If HbA1c > 58 mmol/L (7.5%) = + SULFONYLUREA (glicazide = increase insulin secretion)
3. Persistantly high = third drug = DPP4 inhibitor (sitagliptin) or SGLT-2 inhibitor
4. last result = consider giving insulin
