Diabetes Flashcards
How many types of diabetes mellitus exist?
Type 1 (insulin dependent)
Type 2
Gestational - during pregnancy
Describe type 1 diabetes
Peak age for diagnosis 9-14
Autoimmune condition - not caused by lifestyle
Pancreas stops producing insulin
Need to take insulin for life
How common is type 1 diabetes?
Roughly 345,000 people live with type 1 in the UK
Describe type 2 diabetes
Occurs in people >40
Increasingly more frequent in children due to obesity
Insulin resistance and decreased production
Genetic and lifestyle factors
What is gestational diabetes?
Occurs between 24-28 weeks of pregnancy
Caused by hormones produced during pregnancy causing insulin resistance
What are the risk factors associated with gestational diabetes?
Obesity
Previous gestation diabetes
Previously had a large baby
Family history of diabetes
Asian/ African/ middle eastern background
Where are the micro vascular complications of diabetes seen?
Eye
Kidney
Nerves - Neuropathy
Where are the marcovasculature complications of diabetes seen?
Brain
Heart
Extremities
How is the eye damaged due to diabetes?
High blood glucose levels
High blood pressure
Damage eye blood vessels and cause retinopathy, cataracts and glaucoma
Explain how the kidney is damaged due to diabetes
High blood pressure - Damages small blood vessels
Excess blood glucose - overworks the kidneys resulting in neuropathy
Explain how nerves are damaged in diabetes
Hyperglycaemia - damages nerve in PNS
Results in pain and numbness
Feet wounds likely go undetected and get infected potentially leading to gangrene
How is the brain affected by diabetes?
Increased risk of stroke and cerebrovascular disease
Transient ischaemic attack
Cognitive impairment
How is the heart affected by diabetes?
High blood pressure
Insulin resistance
Increase risk of coronary heart disease
Describe the effect diabetes has on the extremities
Peripheral vascular disease from narrowing blood vessels
Increased of insufficient blood flow to legs
Feet wound go undetected and heal slowly which can contribute to gangrene
Why is insulin important?
Regulates
Carbohydrate ]
Fat ] Metabolism
Protein ]
What types of insulin exist?
Animal (pork and beef)
Human
Human analogues
How can insulin be classified?
Short duration, rapid onset
Intermediate action
Slow onset, long periods of time
What are the genetic factors in developing type 2?
Ethnicity
Higher rates in African, African-Caribbean and south Asian peoples
What are the environmental factors associated with type 2?
Obesity
Physical activity
Dyslipidaemia
Existing CVD
Medications (corticosteroids)
What dietary changes should be made to alleviate type 2?
Increase vegetables, whole grains and fibre
Reduce processed fats/ meats, sugar, salt
Eat more fish, beans, pulses, lentils
What other changes should be made by those with type 2?
Weight loss
Exercise
Smoking cessation
What are the two ways of diagnosing type2?
HbA1c
Fasting venous plasma glucose
Why is HbA1c ideal testing?
Represents average plasma glucose over the previous months without fasting
What is the cut off for HbA1c?
Above 48 mmol/mol
Should repeat the test
When is fasting venous levels used?
During pregnancy, anaemia, end stage CKD
What are the aims of managing type 2?
Lower blood glucose levels
Provide relief of symptoms
Prevent micro / macro complications
What symptoms are seen with type 2?
Thirst
Polyuria
Nocturia
Blurred vision
Infections
What things are monitored in type 2 patients?
Blood glucose
Weight, height, BP, lipids
Renal function
Retinopathy
Podiatry
Distal pulse checks
What is the difference in HbA1c targets for newly diagnosed and older patients?
New - tight glycaemic targets to improve short term micro and long term macro and mortality
Old - relaxed glycaemic targets, tight targets won’t help micro/macro but may cause harms
What is the optimum BP for type 2?
<130/80 mmHg
<140/80 mmHg
Where should you go to get information on best medications, efficacy, safety and cost?
NI formulary website
What are the two dipeptidyl-4 inhibitors (DPP-4)?
1st choice - sitagliptin tablets
2nd choice - linagliptin tablets
What hypoglycaemic agents and anti diabetic treatments exist?
Biguanides
Sulfonylureas
DPP-4 inhibitors
Thiazolidinedione
Sodium glucose Co transporter 2 inhibitors (SGLT2)
Glucagon like peptide 1 agonists (GLP-1)
When should SGLT2 inhibitors be used instead of metformin?
Patient has heart failure
Established atherosclerotic CV disease
High risk of CV disease
Why are biguanides (metformin) first line treatments?
Reduced mortality
Decreases hepatic glucose production
Increases insulin sensitivity
No weight gain or hypoglycaemia
What is the side effect of metformin?
Nausea
Can be avoided when starting low and incrementally increasing the dose
Where is SGLT2 found?
The proximal convulted tubule of the kidneys
What do SGLT2 inhibitors do?
Reduce absorption of filtered glucose in the kidney
Increases the excretion of glucose into the urine
What are the side effects seen with SGLT2 inhibitors?
Genitourinary infections
Excess diuresis
Weight loss
Small reduction in BP
Increased risk of diabetic ketoacidosis
What do DPP-4 inhibitors do?
Increase secretion of insulin and lowers glucagon release
What effects are seen with DPP-4 inhibitors?
No effect on weight gain
Modest effects on HbA1c
Low risk of hypoglycaemia
Small increased risk of acute pancreatitis
What do thiazolidinediones do?
Reduce insulin resistance
What adverse effects are seen when using thiazolidinediones?
Increased risk of heart failure, bladder cancer and fractures
Significant weight gain and fluid retention
Low risk of hypoglycaemia
Can use in renal impairment
What do sulfonylureas do?
Stimulate release of insulin from the pancreas
What effects are seen when using sulfonylureas?
Hypoglycaemia
Weight gain
Avoid in renal impairment
How are GLP-1 agonists delivered?
Subcutaneous injection
What do GLP-1 agonists do?
Stimulate insulin secretion
Reduces glucagon secretion
Reduces gastric emptying
What side effects are associated with GLP-1 agonists?
Nausea reduced appetite
Weight loss
Low risk of hypoglycaemia
Can be used in moderate renal impairment
Rare reports of acute pancreatitis
What are the three examples of GLP-1 agonists?
Liraglutide
Dulaglutide
Semaglutide
What would the features of an ideal diabetic drug include?
Effect on blood glucose
Effect on mortality & CV outcomes
Test ability and quality of life
Reduced adverse effects
Reasonable cost
Ease of administration
