Diabetes Flashcards
What is the epidemiology of type 1 diabetes
8% of patients, highest in Caucasians
what is the aetiology of type 1 diabetes
human leukocyte antigen associated immune mediated disease - antibodies attack pancreatic cells
pathophysiology of type 1 diabetes
5-10% of pancreatic beta cells remaining
symptoms of type 1 diabetes
polyuria, polydipsia, fatigue, blurred vision and DKA
diabetic ketoacidosis
hyperventilation, nausea, weakness, ketone breath caused by very low blood sugar levels
type 1 diabetes treatment
first line is basal bolus insulin - insulin detemir and rapid acting analogue
type 1 blood glucose testing
4 times a day - before meals (4-7 mmol/l), after meals (5-9mmol/l) on waking (4-7mmol/l)
hbA1c target
48mmol/mol or 6.5%
epidemiology of type 2 diabetes
90% of cases, incidence increases with age
aetiology of type 2 diabetes
genetics, obesity and age
pathophysiology of type 2 diabetes
50% of pancreatic beta cells remaining but down regulation of insulin receptors
symptoms of type 2 diabetes
often insidious, can manifest as complications or frequent UTIs, candida or skin infections
diagnosis of diabetes
random venous plasma of >11.1 mmol/l or fasting of >7 mmol/l WITH symptoms, or 2 results without symptoms
Hyperosmolar non ketonic coma (HONK)
Similar to DKA, but no production of ketones due to endogenous insulin, no ketones are produced
treatment for type 2 diabetes
- metformin (+ SGLT2 if high cardiac risk)
- SGLT2 if not already on
- +/- other therapies
- dual therapy + metformin + insulin
- triple therapy + insulin (if tolerated - switch for GLP-1 if not)
blood pressure treatment for diabetic patients
- ARB/ACEi
- CCB/TLD
- TLD/CCB
hypercholesteremia treatment
all diabetic patients >40 or who have further complications need to be on atorvastatin 20mg
blood glucose testing for type 2 patients
no requirements - unless pregnant or uncontrolled hypos
metabolic syndrome
combination of medical disorders when occurring together increase CVD risk and type 2 diabetes
physiology of DKA
increase in counterregulatory hormones, increases hepatic glucose. lipolysis increases and more acetylcoa is produced in the liver, exceeding metabolism so ketones are produced
mild hypoglycaemia symptoms and treatment
palpitations, tremor, hunger, fatigue - treated by quick acting sugar and a sustained release carb in the next meal
moderate hypoglycaemia symptoms and treatments
behaviour change, restlessness, agitation, drowsiness and confusion - treated with glucogel or IM glucagon
severe hypoglycaemia treatment and symptoms
aggression, coma, unresponsiveness - treated by IV glucose or IM glucagon
microvascular complications of diabetes
retinopathy, neuropathy, nephropathy, foot disease
retinopathy symptoms
blurred vision, diplopia, glaucoma
retinopathy risk factors
hypertension, hyperglycaemia, nephropathy, pregnancy and smoking
retinopathy treatment
prevention! control of blood pressure and sugar
retinopathy
starts with small haemorrhages and abnormal hardened spots which progress to retina infarction
nephropathy symptoms
proteinuria and microalbuminuria - different degrees of proteins in the urine
nephropathy
leading cause of end stage renal failure
nephropathy treatment
aggressive blood pressure control and a hbA1c <6%
type 1 diabetics blood pressure goal
<130/80
type 2 diabetics blood pressure goal
140/90
neuropathy
nerve disease, leads to ED, hypotension and diarrhoea
neuropathy symptoms
leg numbness, unsteadiness and decreased vibration sense
neuropathy treatment
blood sugar optimisation and pain relief
diabetic foot disease
a mix of macro and microvascular disease, caused by peripheral neuropathy
diabetic foot disease symptoms
ulceration, infection, gangrene
diabetic foot disease treatments
management, risk reduction, urgent referrals and maintaining blood flow
sick day rules
more frequent glucose testing, more fluids, do not stop taking insulin
