Diabetes Flashcards
Define the bascis of diabetes.
A group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both
What are the 4 criteria of which any can be used to diagnose diabetes?
HbA1c 48mmol/mol +
Fasting glucose - 7mmol/L+ 2hr glucose in OGTT 11.1mmol/L+
Random glucose 11.1mmol/L+
What are the 4 main types of Diabetes?
Type 1
Type 2
Other specific types
Gestational Diabetes
What are the 2 cardinal symptoms of diabetes?
Polydipsia (excessive thirst)
Polyuria
Give a list of other syptoms that can occur with any diabetes in general?
Thrush (candidal or other infection)
Blurred vision
Weakness fatigue
What are the 3 main microvascular complications in diabetes?
Nephropathy
Retinopathy
Neuropathy
Define gestational diabetes.
any degree of glucose intolerance arising or diagnosed during pregnancy
Which autoantibodies are normally present in T1DM?
anti-GAD and /or anti-islet cell antibodies
What is type 2 DM?
A diagnosis of exclusion - not type 1 and not some other specific type
Does autoimmune destruction to the beta-cells occur in type 2 DM?
No
It is not an AI disease
Give 5 specific types of diabetes? Not incding T1, T2 or gestational diabetes
LADA MODY Drug induced NND Endocrine disease Wolfram syndrome
How does type 1 DM usually present?
Pre-school or peri-puberty Usually lean Acute onset of severe symptoms Often severe weight loss ketonuria with/wo metabolic acidosis No evidence of complications
What is the basis pathogenesis of T1DM?
Interaction between genes imparting susceptibility and resistance –> Variable insulinitis and beta-cell sensitivity to injury –>
Pre-diabetes –> Overt diabetes
What is your risk of havin T1DM if both of your parents have it?
~30%
Briefly describe the management of type 1 DM.
BG and ketone monitoring Insulin CHO estimation Dieticia and DSN contact Annual review assessment Record severe hypoglycaemia episodes and DKA
What is the typical presentation of T2DM?
Middle aged/ elderly Usually obese Pre-diagnosis duration of ~6-10 years Insidious onset Ketonuria – minimal or absent Evidence of microvascular disease/complications at diagnosis in 20-50 %
Give the risk factors for the development of T2DM.
Obesity FH Age Ethnicity (Asian, African, Afro-Carribean) PMH - MI or CVA Antipsychotics IGT/IFG
What is a diagnosis of the “metabolic syndrome” made on?
Need insulin resistance and T2DM plus 2 of the following to have the metabolic syndrome:
Micralbuminuria
Obesity (BMI >30 or WHR 1.7, HD <1.0
What are the basic steps of treatment for T2DM?
Therapeutic lifestyle change Monotherapy Combination therapy (w/o insulin) Combination therapy (with insulin)
What does LADA stand for?
Latent autoimmune diabetes of adults
When should you suspect LADA?
AGe 25-40 Usually non-bese Associated AI conditions Male preponderance Auto-antibody positive
What does MODY stand for?
Maturity onset diabetes of the young
What kind of inheritance does MODY express?
Autosomal dominant inheritance - rare
What are the 2 main types of MODY?
Glucokinase and transcripton factors
Which class of diabetic drugs works really well in MODY?
Sulphonylureas
When is neonatal diabetes diagnosed and what is required?
Within the first 3 months of life and insulin treatment is required
What are the 3 macrovascular complications of diabetes?
CVA
MI
PVD
The microvascular diabetic complication of retinopathy can present with what?
Retinopathy
Cataract
Glaucoma
What is the scale used to measure diabetic retinopathy?
Mid non-proliferative Moderate non-proliferative severe non-proliferative Proliferative Maculopathy
What are some further complications caused by the diabetic complication of nephropathy?
Development of HTN
Relentless decline in renal functtio
reduction in GFR
accelerated vascular disease
Which anti-hypertensive drug is particularly good at treating diabetic nephropathy?
ACE Inhibitors
What are the symptoms of peripheral neuropathy?
Numbness tingling burning sharp pain or cramps sensitivity to touch loss of balance and coordination
What can diabetic neuropathy lead to?
infections
ulcers
deformities (charcot foot, rocker bottom foot)
amputations
What is the treatment for diabetic peripheral neuropathy?
Simple analgesia tricyclic antidepressanes gabapentin Duloxetin (SSRI) Stronger opiods (Tramadol) topical capsaicin cream
What other complications can diabetes lead to?
Erectile dysfunction or vaginal dryness
Psychiatric – depression, eating disorder, bi-polar, schizophrenia
What is the target blood pressure for diabetics?
130/80
What other measures besides diabetic drugs can help in controlling diabetes?
simvastatin 40 mg or atorvastatin 10 mg for T2DM regardless of baseline cholesterol
Is low dose aspirin recommended for primary prevention of CV disease in diabetics?
No but can be used for 2y prevention
Why is diabetes monitored?
Guide treatment decisions reduce risk of compications Avoid hypo/hyper/DKA Safe in society Empower patients
What is HbA1c?
Glycated haemoglobin formed by non-enzymatic glycation of haemoglobin on exposure to glucose
What does HbA1c measure?
Average blood glucose over a period of time
What HbA1c needs to be reached before diabetes can be diagnosed?
> 48mmol/mol (6.5%)
What is the targert HbA1c for diabetics?
53mmol/mol
For T1 and T2 DM how many times a day should they be monitoring their blood glucse via home BG monitoring machine?
T1 - 4-8 times a day
T2 - 1-4 times a day
What are the targets for home blood glucose monitoring before and after meals?
before - 4-7mmol/mol
1-2 hours after beginning of meal <10mmol/mol
What is the main purpose of bllod ketone monitoring at home?
Identifies early stages of ketone body formation when the patient often has no symptoms allowing preventative action to be carried out
Patients in DKA are at high risk of what?
Thromboembolism
