Diabetes Flashcards
what is type 1 diabetes
insulin producing beta cells of the islets of langerhans in the pancreas are destroyed by the immune system
deficiency of insulin and raised glucose levels
presentation of T1DM
triad of hyperglycaemia
- polyuria
- polydipsia
- weight loss
ideal blood glucose concentration
4.4-6.1mmol/L
what is insulin and how does it work
hormone produced by beta cells in the islets of langerhans in the pancreas
anabolic hormone
acts to reduce blood sugar levels
- causes cells in the body to absorb glucose from the blood and use for fuel
- causes muscle and liver cells to absorb glucose from the blood and store as glycogen (glycogenesis)
how to measure ketone levels
urine dipstick
ketone meter in the blood
pathophysiology of DKA
occurs because of inadequate insulin
typical scenarios of a DKA
initial presentation of type 1 DM
an existing type 1 diabetic who is unwell for another reason, often infection
an existing type 1 diabetic who is not adhering to their insulin regime
key features of a DKA
ketoacidosis
dehydration
potassium imbalance
what is type 2 diabetes
caused by a relative deficiency of insulin due to excess of adipose tissue
what is MODY
a group of inherited genetic disorders affecting the production of insulin
younger patients developing similar symptoms to those with T2DM
what is latent autoimmune diabetes of adults
small group of patients who develop autoimmune diabetes later in life
often misdiagnosed as T2DM
diagnostic criteria for diabetes in a symptomatic patient
fasting glucose > 7
random glucose > 11.1
HbA1c results that show diabetes
> 48 mmol/mol
presentation of DKA
abdominal pain
polyuria, polydipsia, dehydration
kussmaul respiration (deep hyperventilation)
acetone-smelling breath
investigations for T1DM
urine should be dipped for glucose and ketones
fasting glucose and random glucose
diabetes specific autoantibodies good for distinguishing between T1 and T2
what investigations should be done if adult presents with atypical features of T1DM (higher BMI, age, slow evolution)
C peptide or diabetes specific autoantibody titres
how to diagnose type 2 diabetes
plasma glucose or HbA1c
diagnostic criteria for type 2 diabetes if the patient is asymptomatic
criteria apply but most be demonstrated on two separate occasions
blood glucose targets for patients with T1DM
5-7 mmol/l on waking
4-7 mmol/l before meals
management of type 1 diabetes
insulin
add metformin if BMI > 25
most common precipitating factors of a DKA
infection
missed insulin doses
MI
diagnostic criteria of DKA key points
glucose > 11 or known diabetes
pH < 7.3
bicarb < 15
ketones > 3 or urine ketones ++
management of DKA
fluid replacement: isotonic saline
insulin: IV infusion, once BM over 14 start dextrose infusion
correction of electrolyte disturbance
long acting insulin continued short acting stopped
management of diabetic neuropathy
first line: amitriptyline, duloxetine, gabapentin or pregabalin
tramadol
ABG in a DKA
metabolic acidosis with partial respiratory compensation and an increased anion gap
