Diabetes Flashcards
what is diabetes?
disorder of the metabolism causing excessive thirst and the production of large amounts of urine
two categories of diabetes?
mellitus
insiupidus
same symptoms
what is diabetes mellitus?
group of metabollic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both
types of diabetes?
type 1
type 2
MODY
gestational
what is type one diabetes?
pancreatic beta cell destruction/insulin required for survival
= anti GAD, anti islet cell antibodies
what is type two diabetes?
if patient does not have type one, monogenic or result of other medical condition/tx = secondary diabetes
what are secondary causes of diabetes?
diabetes as a result of drugs
pancreatic pathology
endocrine cause
when was insulin discovered?
1922 - banting, best, macleod, collip - discovered insulin. Removed pancreas of a dog - treatment by insulin injections
when was the 1st diabetes patient treated with insulin?
1922 in toronto - 14yr old leonard thompson
Type 2 diabetes caused by?
insulin resistance and beta cell function has core defects
genetic susceptibility, obesity and western lifestyle lead to what that causes type 2 diabetes?
insulin resistance and beta cell dysfunction
normally what happens to insulin?
insulin binds to a receptor triggering production of glucose transport proteins to allow glucose to enter cell q
if someone is insulin resistance what happens?
receptor not as responsive to the binding insulin molecule, therefore there is less glucose entering the cell and a build up of glucose in the blood
some causes of insulin resistance?
ectopic fat accumulation and increase in free fatty acids
increase in inflammatory mediators CRP
the increase in free fatty acids and CRP mediators results in?
inhibition of insulin via serine kinases responsible for phosphorylation of insulin receptor substrate 1 (IRS1)
= reduction in insulin stimulated glycogen synthesis due to reduced glucose transport
insulin resistance associated with?
intra abdominal obesity inactivity meds genetics smoking fetal malmutrition endothelial disease aging hypertension
what is the therapy staircase for type 2 diabetes?
diet and exercise
oral monotherapy
oral combination
injectable and oral therapy
lifestyle changes for type 2?
weight loss
smoking cessation
improve diet
exercise
drugs to treat type 2?
metformin - biguanide
sulfonylureas
insulin
considerations for drug choices in type 2?
duration of diabetes degree of improvement required mode of delivery adverse effects pt preference cost
what is HbAIC?
measure of blood glucose over a prolonged period pf 6-8 weeks
ref range = 6.6-7.5%/ 48-58 mmol
how to do home blood glucose monitoring?
target should be between 4 and 7 before meals and under 10 after meals
reducing chronic complications allows?
avoidance of microvascular disease
avoidance of acute metabolic complications - DKA
reduced physiological morbidity
macrovascular disease?
IHD, stroke
microvascular disease?
neuropathy
nephropathy
retinopathy
what is diabetes the leading cause of?
blindness
dialysis
amputation
how to screen for microvascular complications?
- annual urinary albumin creatinin ratio ACR for diabetic kidney disease
- annual retinal photograph
- annual foot screening
what is metabolic syndrome?
central obesity
high bp
high triglycerides - low hdl cholesterol
insulin resistance
how is cholesterol treated in diabetes?
lipid lowering statins in all diabetic patients over 40 regardless of baseline cholesterol
ensure bp is what in a diabetic pt?
aspirin and diabetes?
not recommended for primary prevention but may be used in secondary prevention if CVR >10% in 10 years
what happens when glucose falls?
there is a release of counter regulatory hormones - glucagon, adrenaline and cortisol
aim is to stimulate glycogenolysis
side effects = sweats, palpitations, flushing
symptoms of hypoglycaemia?
sweats, shakes, flushing, palpitations = autonomic
neuroglycopenic= confusion, reduced gcs, collapses, seizures, coma
what happens with repeated exposures to hypo’s?
a gradual reduction in warning signs
progressive loss of counter regulatory hormone response = glucagon, adrenaline
more likely to have neuroglycopenic symptoms
precipitating factors for hypoglycaemia?
dosage of ohg/insulin errors in dose given timing of meds - esp insulin delay in meals exercise alcohol co morbidity - e.g renal insufficiency adrenal insufficiency pituitary insufficiency
hyperglycaemia in type 1? type 2?
1 - diabetic ketoacidosis DKA
2 - hypermolar non ketotic coma
hyperglycaemic b/c?
acute illness co morbidity injury/infection meds poor compliance/errors in compliance with tx psychological or social issues
in hyperglycaemia measure?
ketones
acidosis
need iv fluids and insulin
increased risk of hypo/hyperglycaemia in emergency patients bc
poor oral intake
sepsis
sleep deprivation
= modification of normal drug regime
higher risk of perio disease in diabetic pt’s because?
high glucose = poor healing and increased infection risk
small blood vessel damage = reduced blood flow
increase BG monitoring when?
during acute illness
what is the bg for a hypoglycaemic pt?
what patients should ketone monitor?
type 1 diabetic patients
what is being measured with a ketone monitor?
beta hydroxybutyrate
what is the range for ketone monitoring?
0-8mmol/l
what is the normal ketone measurement?
insulin secreted at s low basal rate is responsible for how much of insulin produced?
50%
post meal glucose stimulates?
post prandial insulin
what types of insulin are available?
long acting
short acting
rapid acting
how can insulin be administered?
syringe
disposable pen
reusable cartridge pen
continuous subcutaneous insulin fusion pump
what is a CSII?
for type 1 programmable infusion pump self managed pulsates alanouge insulin continuously bolus dose of insulin pumped out at mealtimes calculated on CHO content of food
management of diabtes during illness?
increased monitoring
insulin increased b/c body response to stress
what can corticosteroids precipitate?
hyperglycaemia
