Diabetes Flashcards
Diabetes diagnosis by random BG
over 11.1 = diabetes
Risks of uncontrolled T1DM during pregnancy
Teratogenic, CNS deformities (spina bifida, anencephaly), great vessels abnormalities, larger birth weight, stillbirth, pre-eclampsia, prematurity
Management of diabetes in pregnancy
T1DM: insulin
T2DM: Metformin or insulin (for pregnancy)
Stop smoking/alcohol, take folic acid
Autoimmune diseases associated with diabetes
Cushings, Acromegaly, Addisons, aplastic anaemia
When can you start diabetes drugs?
If lifestyle changes have been tried for at least 1 month
Which pathway is responsible for macroscopic vascular complications of diabetes?
Poyol pathway/aldose-reductase pathway (active when high IC glucose)
Aldose reductase has a _____ Km compared with glucokinase
High
How often is creatinine checked in diabetes and what does it mean?
Once a year - AKI
Effect of insulin on BP
increases BP (Na retention)
BP target in diabetes
140/80
Capillary microangiopathy
Thickened, permeable, dilated BVs –> neuropathy, nephropathy, retinopathy
Neuropathic foot ulcer
Over areas of high pressure, metatarsal heads or big toe
Ischaemic foot ulcer signs/symptoms
Margins of feet, cold feet, absence of pulses, loss of hair, skin thinning, gangrene
X-ray appearance of charcot arthropathy
bag of bones appearance
Max dose of Metformin
3g per day
When do you have to inform the DVLA?
If on insulin, had >1 severe hypo in last year, neuropathy, retinopathy
Management of DKA
1) Fluids - 500ml 0.9% NaCl in 30 mins (3L by 4 hours)
2) IV insulin 6 units/hour
3) 10% dextrose
3) NG tube, ECG, screen for MI, antibiotic prophylaxis, CXR
4) BG hourly, BK 4 hourly, UandEs every 2 hours
5) K replacement once if less than 5
ECG signs of hyperkalaemia
Tall tented T waves, broad QRS
Why is there hyperkalaemia in DKA?
No insulin to drive K into cells = high EC K, but total body K is low
How long should you wait to stop IV insulin after subQ Insulin given?
30 mins (takes 30 mins for subQ to start working and IV has a half life of a few mins)
When do you stop IV Insulin?
Patient is eating and drinking
Ketones cleared
Bicarbonate is normal
Fasting BG in diabetes
over 7 = diabetes
6 or less = normal
6.1-6.9 = pre-diabetes
Differences in managing DKA in adults and kids
10ml/kg fluids
Fluid restriction (risk of cerebral oedema)
Insulin 1 hour after IV fluids started
How much insulin should you give (carb counting)?
1 unit per 10g
1 unit drops by 2mmol
Macrosomia
Larger birth weight over 4kg
Treatment of MODY
SU - Glibenclamide
Management of gestational DM
Lifestyle, Metformin, Insulin
OGTT 6 weeks post natal
Gestational DM
Mother has a degree of insulin resistance and placental hormones tip over the edge
Increased risk of developing T2DM
Presents in 3rd trimester
BP treatment in pregnancy
Methyldopa, Nifedipine
Diabetes complications
Macrovascular: IHD, Stroke
Microvascular: neuropathy, nephropathy, retinopathy
Psychiatric
ED
Peripheral neuropathy
Pain/loss of feeling in feet or hands
Autonomic neuropathy
Changes in bower/bladder function, sexual response, sweating, HR, BP, hypoglycaemic unawareness
Gastric slowing/gastroparesis, dysphagia
Proximal neuropathy
Pain in thighs/hips/buttocks = weakness in legs (amyotrophy)
Focal neuropathy
sudden weakness in nerve/group of nerves = muscle weakness/pain e.g. CTS, foot drop
Only drug used in end stage kidney failure/dialysis
Pioglitazone (TZD)
Treatment of ED
Lose weight, less alcohol, improve lipids, review drugs, Sildenafil
Treatment of hypoglycaemia
15g carbs/glucose (glucose tabs, gel, lucozade, sweets)
Glucagon 1mg
Hypoglycaemic unawareness
Inability to detect hypo, no symptoms, longstanding DM
Biochemical diagnosis of DKA
Ketnonaemia over 3 (0.06 or less is normal) BG over 11 Bicarbonate less than 15 K over 5.5 Low Na High lactate pH less than 7.3
Complications of DKA
Cardiac arrest
Cerebral oedema
ARDS
Gas in stomach -> aspiration and gastric dilation -> ARDS
HHS
Elderly, MI, sepsis, steroids/diuretics, fizzy drinks T2DM Higher glucose than DKA Bicarbonate raised Elevated osmolality (normal 285-295)
How to calculate osmolality
2 x (Na + K) + urea + glucose
Treatment of HHS
Cautious fluids
Slow insulin
Screen for vascular event
Diet
How is lactate formed?
Anaerobic metabolism of glucose
Lactic acidosis
High lactate High anion gap Type B - diabetes Type A - tissue hypoxia Hyperventilation, confusion, coma
How to calculate anion gap
[Na + K] - [HCO3- + Cl-]
Diagnosis of diabetes by HbA1c
Over 48 = diabetes
42-47 = pre-diabetes
