Diabetes Flashcards
Male presents with painful itchy penis with thick white discharge/exudate on retracted foreskin. Diagnosis, cause and investigations?
Candidal balanitis
Differentials:
* STD
* Poor hygiene
* Balanitis circinata- skin conditon associated with reactive arthritis= ring shaped dermatitis on glans of penis
Risk factors:
* Diabetes
* Oral antibiotics
* Poor hygiene
* Immunosuprresion
Investigations:
* Urine dip
* Swab
* Blood sugar
Diagnostic criteria for diabetes?
In symptomatic patients:
* Fasting glucose test greater than or equal to 7
* Random glucose test greater than or equal to 11.1
If patient is asymptomatic then the above needs to be met on 2 seperate occasions
HbA1C- equal or greater than 48= T2D diabetes
* If asymptomatic a second one should be done
Modifiable/non modifiable risk factors for T2D?
Non-modifiable:
* Older age
* Ethnicity
* Fam history
Modifiable:
* Obesity
* Sedentary lifestyle
* High carb diet
Presentation of diabetes?
- Tiredness
- Polyuria and polydipsia
- Unintentional weightloss
- Oral thrush
- Slow wound healing
- Glucose in urine
- Acanthosis nigircans- thickening and darkening of skin- associated with insulin resistance
HbA1c reading for pre diabetes?
HbA1c- 42-47 mmol/mol
HbA1c reading that indicates T2D?
Above 48 mmol/mol
HbA1c treatment targets for new type 2 diabetics?
48 mmol/mol
Measured every 3-6 months until under control and stable
HbA1c treatment target for patients requiring more than 1 antidiabetic medication?
53 mmol/mol
Medical management of Type 2 diabetes?
1st line:
* Metformin
* Then add an SGLT-2 inhibito e.g. dapagliflozin if the patient has existing cardio disease or HF
2nd line- add sulfonylurea, pioglitazone, DPP-4 inhibitor or SGLT2 inhibitor
3rd line:
* Triple therapy with metformin and 2 of the 2nd line drugs
* Insulin therapy
Significant potential side effect= ketoacidosis
Action of metformin and side effects?
Increases insulin sensitivity and decreases glucose production by the liver
Does not cause weight gain but may cause weight loss
Side effects:
* Gasto symptoms- pain, nausea, diarrhoea- can try modified release to help these
* Lactic acidosis- secondary to acute kidney injury
SGLT-2 inhibitors action and side effects?
SGLT-2 inhibitors end with the suffix- gliflozin
SGLT is found in proximal tubules of the kidneys- acts to reabsorb glucose from the urine back into the blood- SGLT-2 inhibitors stop this causing more glucose to be excreted in the urine
= lower HbA1c, lower BP, weight loss and improves heart failure
Side effects:
* Hypoglycaemia
* Glycosuria
* Increased urine output and frequency
* UTI and thrush- key
* Weight loss
* Diabetic ketoacidosis- key
Action of pioglitazone and side effects?
Thiazolidinedione- increases insulin sensitivity and decreases liver production of glucose
Side effects:
* Weight gain
* Heart failure
* Increased risk of bone fractures
* A small increase risk of bladder cancer
Action of Gliclazide and side effects?
Sulfonylureas stimulate insulin release from the pancreas
Side effects:
* Weight gain
* Hypoglycaemia
Types of insulin (5)
Rapid acting insulins e.g. Novorapid-start working after 10 mins and last 4 hours
Short-acting insulins e.g. Actrapid start working around 30 mins and last about 8 hours
Intermediate acting insulins e.g. Humulin 1 start working around 1 hour and last about 16 hours
Long acting insulins e.g. Levemir/Lantus- start working in around 1 hour and last 24 hours or longer
Humalogs- contain rapid and intermediate
1st line treatment to manage hypertension in patients with type 2 diabetes?
ACE inhibitors
What is type 1 diabetes?
Autoimmune disorder where the insulin producing beta cells of the islets of langerhanns in the pancreas are destroyed by the immune system= reduction in insulin production