Diabetes Flashcards
Typ I Diabetes - Clinical Features
acute onset of
* polydipsia
* polyuria
* polyphagia
* weight loss
* Fatigue
Secondary enuresis
Ketoazidosis
Typ I Diabetes - Investigation
- Next step - urine dipstick
- Best step - random glucose 11.1mmol/l, TPO a/b, Tissue tranglutaminase a/b
Typ I Diabetes - Management
- admit for insulin therapy
- follow up: HbA1c every 3 month 7% or less)
- Vaccination: Pneumococcal, Influenza, dTpa
Typ II Diabetes - Clinical features
- Asymptomatic
- Metabolic Syndrome
- Acanthosis nigrans (neck, axilla)
- skin tags
- hirsutism
- recent skin/genital infection
- chronic fatigue
Typ II Diabetes - Investigation
- next step: random blood glucose equal or >11.1mmol/L
- best step – fasting blood glucose – equal or > 7.0 mmo/L. HbA1c equal or more than 6.5% (on two occasions).
- OGTT if uncertain level of blood glucose
Typ II Diabetes - Screening
- No Risk Factors every 3 from 40 years using AUSDRISK
- Aboriginal and Torres Strait Islander people should be screened annually with blood testing (FBG, RBG or HbA1c) from18 years
- With Risk Factors from 30 years every 3 years ( FBG or HbA1c)
- Impaired FG every 12 month ( FBG, HbA1c)
Typ II Diabetes -AUSDRISK score
AUSDRISK score Risk of developing type 2 diabetes within five years:
** ≤5 ** 1 in 100
** 6–8 ** 1 in 50
** 9–11 ** 1 in 30
** 12–15 ** 1 in 14
** 16–19 ** 1 in 7
** ≥20 ** 1 in 3
Typ II Diabetes - Managment
- Life-style modification. Consider hypoglycemic drugs
- follow up: HbA1c every 3 months (target equal or less than 7 %). Monitor late complications.
- Vaccination: Pneumococcal, Influenza, dTPA.
Typ II Diabetes- Riskfactors
- AUSDRISK score of ≥12
- all people with a history of a previous cardiovascular event (acute myocardial infarction
or stroke) - women with a history of gestational diabetes mellitus
- women with polycystic ovary syndrome
- patients on antipsychotic drugs
Typ II Diabetes- Late complication
Autonomic neuropathy
- Postural hypotension (faints on standing, eating, or hot bath)
- Resting tachycardia
- Urine retention
- Erectile dysfunction
- Nocturnal diarrhoea
- Gastroparesis (impaired gastric emptying)
- Delayed or incomplete bladder emptying
- Loss of cardiac pain (silent ischaemia)
- Hypoglycemic unawareness
Autonomic neuropathy is a type of nerve damage that affects the autonomic nervous system (ANS), which controls involuntary body functions such as heart rate, blood pressure, digestion, and bladder function.
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Causes:
- Diabetes: The most common cause of autonomic neuropathy, particularly in long-term, poorly controlled diabetes.
- Other Conditions: Can also be caused by autoimmune diseases, infections, certain medications, and inherited disorders.
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Symptoms:
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Cardiovascular:
- Orthostatic Hypotension: Dizziness or fainting when standing up due to a sudden drop in blood pressure.
- Resting Tachycardia: Abnormally high heart rate at rest.
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Gastrointestinal:
- Gastroparesis: Slowed movement of food through the stomach, causing nausea, vomiting, bloating, and unpredictable blood sugar levels.
- Constipation or Diarrhea: Alternating or persistent issues with bowel movements.
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Genitourinary:
- Bladder Dysfunction: Difficulty starting urination, incontinence, or incomplete emptying of the bladder.
- Sexual Dysfunction: Erectile dysfunction in men and vaginal dryness in women.
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Sweating Abnormalities:
- Excessive sweating (hyperhidrosis) or lack of sweating (anhidrosis), affecting temperature regulation.
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Pupillary Response:
- Issues with the pupils adjusting to light changes, leading to problems with vision in low light.
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Cardiovascular:
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Diagnosis:
- Clinical Evaluation: Based on symptoms and medical history, particularly in people with conditions like diabetes.
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Tests:
- Heart Rate Variability Tests: To check how the heart responds to deep breathing or other changes.
- Tilt Table Test: To evaluate blood pressure and heart rate response when moving from lying down to standing.
- Gastric Emptying Study: To assess for gastroparesis.
- Urine Tests: To evaluate bladder function.
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Treatment:
- Managing Underlying Conditions: The best way to treat autonomic neuropathy is to control the underlying condition, such as managing blood sugar levels in diabetes.
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Medications:
- Blood Pressure Medications: To manage symptoms like orthostatic hypotension.
- Digestive Aids: Such as prokinetic agents for gastroparesis.
- Medications for Bladder Control: Including anticholinergics for overactive bladder or catheters for severe cases.
- Erectile Dysfunction Medications: Like phosphodiesterase inhibitors (e.g., sildenafil).
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Lifestyle Changes:
- Dietary Adjustments: Eating smaller, more frequent meals and avoiding large amounts of fat for gastroparesis.
- Physical Therapy: To help manage symptoms and improve quality of life.
- Symptomatic Treatment: Addressing specific symptoms like sweating abnormalities or visual disturbances.
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Prognosis:
- Autonomic neuropathy can significantly impact quality of life and may lead to serious complications if not managed effectively. However, early diagnosis and treatment of the underlying cause can help manage symptoms and slow progression.
Autonomic neuropathy is nerve damage that affects the involuntary functions of the body, such as heart rate, digestion, and bladder control. It is commonly caused by diabetes but can result from other conditions as well. Symptoms vary depending on the affected organs but can include dizziness, digestive problems, bladder issues, and sexual dysfunction. Treatment focuses on managing the underlying condition and relieving symptoms to improve quality of life.
More complications seen in Diabetes mellitus
- Acute painful neuropathy: Burning pain in feet, shins, thigh.
- Mononeuritis multiplex:
✓ Cranial nerves (III, IV, VI, VII).
✓ Foot drop.
✓ Meralgia paresthetica.
✓ Tarsal tunnel syndrome. - Proximal motor neuropathy (Diabetic amyotrophy) -painful, asymmetrical muscle wasting of quadriceps andpelvic girdle. Pain typically worse at night.
- Diabetic cheiropathy (Prayer Sign)
- Dupuytren’s contracture
- Carpal tunnel syndrome
- Charcot joint
Secondary Causes
of Hyperglycemia:
- Diseases of Pancreas
(Pancreatitis,Neoplasia,Cystic fibrosis,Haemochromatosis) - Endocrinopathies
(Cushing, Acromegaly, Pheocromocytoma, Hyperthyroidism) - Drug induced
(antipsychotic, thiazid diuretics, oestrogen, GCS) - Genetic syndromes
(Turner, Down, Klinefelter)
Diabetic foot ulcer- Presentation
- Caused by peripheral neuropathy (80%), peripheral
- arterial disease (10%), deformity (Charcot foot).
- Painless, punched – out.
- Most common localisation - first metatarsal area, heel.
Diabetic foot ulcer - Investigation
Investigations:
* Blood glucose levels
* ABPI, +/- Duplex US (to rule out arterial disease).
* Microbiology swab (if signs of infection).
* X – ray of bone (if deep ulcer based on probe to bone)
