diabetes

Question 1

pathophysiology of type 1 and 2?

Answer 1

type 1: autoimmune destruction of beta cells in pancreas by anti-GAD and anti-ICA -> insulin deficiency

type 2: insulin resistance / pancreatic beta cell dysfunction

Question 2

symptoms?

Answer 2

hyperglycemia symptoms
polyuria, polydipsia, polyphagia, weight loss, vomiting
increased susceptibility to infections and poor wound healing. blurry vision

acanthosis nigricans is typical for type 2 diabetes

Question 3

diagnosis?

Answer 3

if pt is symptomatic:
-hyperglycemia symptoms
-RBS is >11

if pt is asymptomatic you need 2 or more abnormal tests:
RBS > 11
fasting glucose > 7
OGTT > 11.1

hba1c >6.5 is abnormal
c-peptide caan differentiate the types
if high = insulin resistance
if low = deficiency
antiglutamic acid decarboxylase antibodies for type 1

Question 4

oral drugs for type 2 diabetes

Answer 4

metformin: best initial drug. can cause lactic acidosis

sunfonylureas: can cause hypoglycemia

GLP-1 analogue: help with weight loss

SGLT2 inhibitors: cause urinary tract infections, genital candidiasis

Question 5

insulin therapy types

Answer 5

rapid acting: lispro aspart
short acting: actrapid given 30min before meals as bolus 1 unit for every 10g of carb

long acting: degludec and glargine given at night as basal

Question 6

hypoglycemia diagnosis, symptoms, tx

Answer 6

RBS less than 3
tremor, sweating, tachycardia, palpitations, confusion, polyphagia, seizure
tx for alert pts is oral glucose / fast acting carb
iv dextrose for pts with altered mental status

Question 7

hyperosmolar state

Answer 7

affects mainly type 2 diabetes, happens gradually. RBS is >33 but no ketones or acidosis. theres high osmolality >320 and altered mental status/ stupor/ coma

happens in old pts due to stress
tx is like DKA