Diabetes Flashcards
Compare type 1 and type 2 diabetes.
Type 1: insulin deficiency - body doesn’t make insulin therefore can’t regulate blood sugar levels properly. First develops in children or young adults. Usually develops quickly however in latent onset can develop over several years. High BGL, low insulin levels.
Type 2: Insulin resistance. Either the body isn’t producing enough insulin OR the insulin it is producing isn’t working properly. Gradual onset - over many years. Can live with it for up to ten years without realising you have it. More commonly diagnosed later in life. High BGL & high insulin levels.
What are oral hypoglycaemic agents?
Used for T2 diabetes
Insulin secretagogues - sulphonylureas
Insulin sensitisers - biguanides, thiazolidinediones
How can insulin be administered?
Injections - basal bolus control, split mixed control
Inhalation - more expensive
What is the action of sulphonylureas?
Increase pancreatic insulin secretion
Can cause hypoglycaemia
Treat type 2 diabetes
What is the action of biguanides?
Enhance cell insulin sensitivity
Reduce hepatic gluconeogenesis - synthesis of glucose from molecules that are not carbs (amino & fatty acids)
Preferred Tx in the obese
Treats type 2 diabetes
Compare hypoglycaemia in T1 and T2 diabetics.
T1 - straight forward, blood sugar too low, must have something to eat to keep blood sugar high
*risk of severe hypoglycaemia is greatest for insulin-treated T1
T2 - occurs due to medication (sulphonylurea or insulin) or if they haven’t eaten enough, administer insulin/drug without food
What are the acute complications of diabetes?
Hypoglycaemia
Ketoacidosis in T1
What are the chronic complications of diabetes?
Cardiovascular risk - atherosclerosis
Infection risk - less able immune system, decreased neutrophils, chemotaxis & leukocytes
Neuropathy - affects the longest nerves first, veins & arteries in nerve bundles subject to occlusion, nerves lose blood supply & function, very disabling
Diabetic eye disease - cateracts, maculopathy
Kidney failure - excretion of glucose via urine
What are the symptoms of diabetes?
Polyuria
Polydipsia
Tiredness
What are the signs of diabetes?
Poor wound healing Blurry vision Abnormal infections Thrush/genital itching Weight loss (T1) - body breaks down fat stores
Why does T1 diabetes occur?
Pancreatic B cell destruction
What are the complications of poor wound healing?
If not treated can lead to systemic infection resulting in amputation
Loss of sensation is common - spread from foot up the leg
How are cataracts treated?
Surgery: Incision Iridectomy Removal of lens Insertion of replacement lense
How is diabetic retinopathy treated?
Laser ablation - burning off small b.v. with a laser to remove them
What problems are there when diabetic patients require surgery?
Fasting is a problem especially with T1 as they need insulin to prevent ketosis and need carbohydrate to prevent hypoglycaemia.
More prone to post op infection.
Wisdom tooth surgery - may struggle to eat afterwards, difficult to maintain strict diet
Hormone changes associated with surgery aggravate diabetes
Increased insulin requirements in T1, T2 may require insulin cover perioperatively
