Diabetes Flashcards
What is the definition of diabetes?
Disorder of the metabolism causing excessive thirst and the production of large amounts of urine
Metabolic disease characterised by hyperglycaemia resulting from defect in insulin secretion, production or both
5 types of diabetes?
Type 1 Type 2 MODY Gestational Other - caused by steroids
What is type 1?
Auto immune - Pancreatic beta cells destruction
Insulin dependant
What is type 1 characterised by?
Presence of anti GAD / anti islet cell antibodies
When is a person thought to have type 2 diabetes?
When they don’t have the 1, monogenic diabetes or other medical conditions or Tx suggestive of secondary diabetes
What is MODY?
Monogenic Diabetes (genetic)
Secondary causes of diabetes?
Drugs
Pancreatic pathology
Endocrine causes
Who discovered insulin in the treatment of diabetes and when?
Banting Best MacLeod Collio 1922
How did they figure out it helped in diabetes?
Dog pancreas removed and treated with insulin injections
Who was the first person to receive insulin to treat their diabetes?
Leonard Thompson
When is type one usually diagnosed?
Childhood
What do people wit type 1 have high levels of in their blood?
Anti islet cell antibodies
What is an insulin pump?
It administers short acting insulin through out the day
The rate can vary depending on the demand
Amount of insulin depends on carbohydrate intake
What is a continuous glucose monitor?
Takes subcutaneous measurements and sends them to the pump
What does the patient still have to decide on if they have a continuous glucose monitor?
How much insulin to take
When is type 2 usually diagnosed?
> 40
What is type 2?
Insulin resistant
What is the underlying physiology of type 2?
Insulin resistance
Beta cell dysfunction
What happens if you are insulin resistant?
Problem with downstream signalling from insulin receptors so the glucose can’t get into the cells and the blood sugar rises
What do people have before developing type 2?
Impaired glucose tolerance
What are the causes of insulin resistance?
Ectopic fat accumulation
Increase inflammatory mediators
Reduction in insulin
What is insulin resistance associated with?
Intra abdominal obesity Medication Smoking Genetics Inactivity Fetal malnutrition Endothelial disease Polycystic ovaries Ageing Hypertension
How are you tested for diabetes? (type 2)
Fasting glucose level >7
Given a high sugar drink and tested 2 hours later and if level >11.1 = diabetes
Treatment for type 2?
Life style changed - can stop need for meds Oral mono therapy Oral combination Injectable and oral therapy Drugs - metformin / sulphonylurea
What is the reference range when monitoring glucose ?
~4-6%
What is the target range when monitoring glucose levels in diabetics?
6.5 - 7.5%
What is the target glucose level pre meals and post meals?
Pre meal = 4-7
Post meal =
What are the aims of therapy in diabetes?
Prevent hyperglycaemia
Avoid hypoglycaemia
Reduce chronic complication
What are some macrovascular complications?
IHD
Stroke
What are some microvascular complication ?
Neuropathy
Nephoropathy
Retinopathy
What is diabetes the leading cause of in the UK?
Blindness
Dialysis
Amputation
What is done when screening for microvascular complications?
Annual urinary albumin creatinine ratio to screen for kidney disease
Annual retinal photograph
Annual foot screening
What do the CVR guidelines state about statins?
Give them to diabetics >40 regardless of baseline cholesterol
What happens when glucose falls?
Release of counter regulatory hormones
Stimulate glycogenolysis
What is reduced hypoglycaemia awareness?
Repeated exposure to hypo reduced warning signs
Precipitating factors of hypoglycaemia?
Dosage of insulin Error in does administered Timing of meds Alcohol Exercise Renal, adrenal, pituitary insufficiency
What is DKA?
Diabetic Ketoacidosis
What is HNC/HONK?
Hyperosmolar non ketotic coma
What type of diabetes do DKA and HNC/HONK occur?
DKA = type 1 HNC/HONK = type 2
Precipitating factors of DKA
Acute illness Injury or infection Medications Poor compliance or error in compliance with tx Psychological / social issues
What other conditions does diabetes make people at risk to?
Stroke
Visual impairment
Renal disease
Cardiovascular disease
Why is there an increased risk of a hyper/hypo in patients with tooth ache
Poor oral intake
Sepsis
Sleep deprivation
All resulting in pt modifying their normal drug regime
