Diabetes Flashcards by Niamh Sands

What is the difference between diabetes mellitus and insipidus

DIABETES MELLITUS - abnormality of GLUCOSE regulation

DIABETES INSIPIDUS - abnormality of RENAL FUNCTION (WATER)

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What percent of diabetes is type 1

-90% type 2

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What is type 1 diabetes

Autoimmune destruction of pancreatic Beta cells

Usually diagnosed in children and young adults but can develop at any age

Interplay between genetic and environmental factors

Rate of destruction determines the clinical presentation

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Why can some patients with type 1 be diagnosed witb type 2 diabetes at first

Due to late presentation of the disease 80-95% of the pancreatic beta cells are destroyed at time of diagnosis

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What does beta cell destruction subsequently cause

hyperglycaemia

Ketoacidosis (Body cells cannot access glucose for metabolism so they start to metabolise fat which results in Ketones as end product)

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Production of what substance is directly correlated to insulin levels

C-Peptide levels
Low C-peptide usually indicates low insulin secretion and can be used to detect diabetes

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What antibodies are present in people with T1DM

GAD glutamic acid decarboxylase

ICA Islet cell antibodies

IAA insulin autoantibodies

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What antibodies will be much higher than normal in patients with T1DM

ICA IAA

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What are diabetic symptoms type 1

polyuria

polydipsia

Tiredness

Unintentional weight loss

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What are some signs of acute diabetes

Hyperglycaemia with diabetic symptoms

Ketoacidosis

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What are the symptoms of diabetic ketoacidosis

Symptoms include:

Thirst

Increased urination

Confusion

Blurred vision

Stomach pain

Nausea/ vomiting

Sweet/ fruity smelling breath- (pear drops)

Loss of consciousness

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How is DKA (diabetic ketoacidosis) treated

Early signs of DKA can be treated with insulin and fluids

If not treated early, pt will require URGENT hospital treatment

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What does LADA stand for

Late autoimmune diabetes in adults

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What are the features of LADA

GAD associated - generally lower AB levels

less weight loss, less ketoacidosis

may masquerade as ‘non-obese’ type 2

variable period until insulin required

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What is type 2 diabetes

MOST COMMON

Established type 2 diabetes is characterized by defective and delayed insulin secretion and abnormal postprandial suppression of glucagon

-over exposure to glucose leads to inneffective insulin secretion

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What surgery is shown to improve T2D

Bariatric surgery has shown promising results in terms of remission of type 2 diabetes as most people go into partial or complete remission afterwards.

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What is the pathogenesis of T2DM

usually IGT (impaired glucose tolerance) for some time

often retinal damage at diagnosis (7-10yrs IGT)

ability to secrete insulin falls with time

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Signs/symptoms of T2DM

Rarely acute presentation

polyuria, polydipsia, tiredness
-But these are usually present!

unusual infections

diabetic complications e.g.Cardiovascular

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How does insulin resistance occur in T2DM

Beta cell response to hyperglycaemia is inadequate

elevated basal insulin levels

failure of gluconeogenesis suppression

insulin stimulated glucose uptake is reduced

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What are the effects of T2DM on the body

Impaired glucose tolerance

Hyperinsulinaemia

Hypertension

Obesity with abdominal distribution

Dyslipidaemia (High VLDL, Low HDL)

Procoagulant epithelial markers

Early & accelerated atherosclerosis

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What medication can induce diabetes

Corticosteroids

Immune suppressants – Cyclosporin, Calcineurin inhibitors (Tacrolimus, Serolimus)

Cancer medication – Imatinib, Nilotinib

Antipsychotic Medicines – clozapine, olanzapine, quetiapine

Antiviral – protease inhibitors

Why might medication induce diabetes

Interferes with the secretion of Insulin or Glucagon

Alters tissue uptake of Glucose

What are the investigations for diagnosis of diabetes

Random Plasma Glucose (RPG)
-11.1mmol/L and above on 2 occasions is diagnostic of DIABETES

GTT indicated if fasting sample indicates Impaired Fasting Glucose

HbA1C(glycated haemoglobin)
-Blood test that shows average blood sugar levels for the last 2-3 months. Glycated Hb is when glucose sticks to haemoglobin in red blood cells. RBC lifespan is 2-3 months so readings taken quarterly.
-48mmol/mol and above (6.5%) diagnostic of diabetes
-Does not require a fasting sample
-Reliable measure of chronic hyperglycaemia/ how well diabetes is being controlled over time

What is the glucose tolerance test

Patient fasts before test. During test they drink glucose solution which contains 75g of sugar

What do the results of the GTT show

**Before test (mmol/L) ** FPG 6.0 and below Normal FPG 6.1-6.9 Impaired fasting glucose FPG 7.0 and above Diabetes **2 hour plasma glucose (mmol/L)** 7.7 and below normal 7.8-11.0 Impaired Glucose Tolerance (IGT) 11.1 and above Diabetes

What HbA1C level indicates diabetes

48mmol >

What would a HbA1c result of 42-47 mmol show

Impaired or pre-diabetes

What are the differences between type 1 and 2

1 younger not overweight short/acute onset insulin deficient 2 older overweight gradual onset insulin resistant

How can diabetes be managed

Education - awareness Healthy living advice - diet, exercise etc Blood glucose management - set targets to maintain Prevention from associated diseases - antiplatelet drugs, statins, antihypertensives (periodontitis)

When is insulin prescribed

Type 1 - from diagnosis Type 2 - with inadequate control on oral meds

What type of route is insulin administered by

Subcutaneous injection

Whar monitoring devices are available for insulin

Continuous glucose monitoring Closed loop system

What diet restrictions do people with T2DM have

avoid refined CHO encourage high fibre food reduce fat, esp. saturated

What medications are available for T2DM

Biguanides - Metformin DDP-4 inhibitors block the enzyme metabolising incretin GLP-1 mimetics Sulphonylureas

How does Metformin manage T2DM

first line drug for T2DM enhance cell insulin sensitivity reduce hepatic gluconeogenesis preferred in the obese

What do DDP-4 inhibitors do

block the enzyme metabolising incretin Improves insulin response to glucose Reduces liver gluconeogenesis and delays stomach emptying

Why can GLP-1 mimetics help diabetes type 2

Increase the level of incretin -injection daily/weekly

What is a potential negative effect of sulphonylureas

can cause hypoglycaemia due to increasing pancreatic insulin secretion

What are chronic complications of diabetes

Cardiovascular disease Peripheral Vascular disease Increased risk of infection Retinopathy Nephropathy Neuropathy

What are potential acute complications of diabetes

Hypoglycaemia Hyperglycaemia Ketoacidosis

What is hypoglyceamia

Blood glucose levels below 4mmol

When does hypoglycemia occur

Type 1 DM Type 2 DM when taking sulphonylurea or insulin insulin/drug without food!

How is hypoglycemia treated

Needs to be treated quickly Eat/drink something that will increase blood sugar If someone becomes unconscious- glucagon injection then food/drink when they regain consciousness.

What are the oral manifestations of diabetes mellitus

Dry Mouth Burning Mouth Fungal Infections Enlarged Salivary glands Periodontal disease Impaired wound healing Halitosis Taste alteration

What are some factors to remember when treating those with diabetes

Risk of acute medical emergencies- hypoglycaemia Reduce stress- increases adrenaline which interferes with insulin activity and may precipitate a hypoglycaemic event. Be aware of diabetic complications IHD, dehydration, neuropathy, eyes Infection risk Poor wound healing Link between DM and periodontal disease

What are macrovascular and micovascular complications of diabetes

Macrovascular -Coronary Artery Disease -Peripheral Ischemia- causes poor wound healing e.g diabetic foot ulcers -Stroke -Hypertension Microvascular/ Small vessel disease -nephropathy (renal disease) -eye disease- Cataracts, Maculopathy, Proliferative retinopathy -Peripheral neuropathy

What cause diabetic ulcers

Peripheral neuropathy Peripheral vascular disease Delayed wound healing Increased risk of infection

What are cataracts

Lens of eye becomes clouded and allows less light in

What nervous conditions can the affects of diabetes cause

General sensation -‘glove & stocking’ Motor neuropathy -weakness and wasting of muscles Autonomic regulation -awareness of hypoglycaemia lost -postural reflexes -bladder & bowel dysfunction

Would insulin requirements be increased or decreased when undergoing surgery with diabetes

Increased in T1DM due to more glucose production caused by hormone changes (epinephrine, cortisol,GH) and less muscle uptake so metabollic acidosis is more likely T2DM may require insulin cover perioperatively