Diabetes Flashcards
What is normal blood glucose level?
Fasting = 4-6 mmol/L
After meal = less than 7.8 mmol/L
What is the normal response to high blood glucose levels?
Insulin is released by beta cells of the pancreas so that fats take in glucose from the blood
What is the normal response to low blood glucose levels?
Glucagon is released by alpha cells of the pancreas so that the liver releases glucose cells into the blood
What is the difference between type 1 and type 2 diabetes?
Type 1 = no insulin is released
Type 2 = cells dont respond to insulin
What are the symptoms of type 1 diabetes?
Frequent urination excessive thirst extreme hunger dramatic weight loss Irritability Fatigue Nausea
What are the symptoms of type 2 diabetes?
Increased thirst Night time urination Blurry vision Unusual fatigue Dark skin around the neck or armpits
What characteristics do you need to diagnose diabetes?
Diabetes symptoms +
random plasma glucose over 11mmol/L or fasting over 7
OR
no diabetes symptoms but positive results in the two tests
OR
HbA1c over 48mmol/mol
What does the treatment for diabetes aim to achieve?
Keep patient feeling well
Prevent hypoglycaemia
Delay the onset of micro and macrovascular problems
What is the main determinant of microvascular problems?
Tight glycaemic control
What is the main determinant of macrovascular problems?
Hypercholesterol
Smoking
Obesity
What are the 5 main complications from diabetes?
Poor healing - AMPUTATION HEART DISEASE KIDNEY FAILURE STROKE Damaged blood vessel in the retina - BLINDNESS
What is the treatment for type 1 diabetes?
Insulin (pump or pen device)
What is the treatment for type 2 diabetes?
ORAL FORM Metformin Sulphonylureas Glitazones DPP4 inhibitor SGLT2 inhibitor INJECTABLE FORM GLP-1 agonist Insulin via pen devices
What is the difference between different types of insulin?
Rate of absorption
Peak onset of action
Duration of action
Where can insulin be injected?
Bum
Upper outer thigh
Upper outer arm
Abdomen
What is insulin pump therapy?
Pump attached to stomach and injects insulin automatically
Insulin must be kept in the fridge, unless being used - then room temperature OK
What is the duration of action of insulin?
Rapid acting = 1-4 hours
Short acting = 1-7 hours
Intermediate acting = 1 -10 hours
Long acting = 1-24 hours
What is metformin?
Treatment for type 2 diabetes
1st line for obese type 2
Dose max 2g per day with or after meals
+VES
Prevents any cardiovascular complications with diabetes
Doesnt cause hypoglycaemia
Aids weight loss
-VES Gastrointestional changes – diarrhoea, vomiting, loss of appetite Lactic acidosis B12 deficiency
What are sulphonylureas?
Eg GLICLAZIDE - stimulates pancreatic beta cells to produce insulin
Dose 160 mg twice a day taken before meals
Weight gain
Hypoglycaemia
What are glitazones?
Eg Pioglitazones Improve insulin resistance Dose max 45g once daily at any time Fluid retention Haematuria Increased risk of bone fracture Weight gain Hepatotoxicity
What are the effects of incretin hormones (GLP)?
Stimulates release of insulin in the presence of glucose
Reduce apatite
Reduces hepatic gluconeogenesis
Delays gastric emptying
What inactivates GLP?
DPP4
What are SGLT2 inhibitors?
Eg Dapaglifozin Taken orally, 5 or 10mg Increase frequency of UTI Increase frequency of thrush Modest diuretic effect ( due to osmotic diuresis from urinary glucose excretion)
What is the action of SGLT2
SGLT2 are responsible for 90% of glucose reabsorption in the kidney
What is hypoglycaemia?
Refers to any episode of low blood glucose
What are the symptoms of hypoglycaemia?
1) Autonomic – due to activation of autonomic nervous systems ( sweating, tremor, anxiety, palpitation, etc)
2) Neuroglycopaenic – due to reduced glucose delivery to the brain ( poor concentration, odd behaviour, dizziness, blurr vision etc )
3) Coma / death
What is the treatment for hypoglycaemia?
Glucose tablet or drink, jelly babies if mild
Im glucagon or Intravenous glucose if severe
What are the consequences of hypoglycaemia?
1) Quality of life
2) Fear of further hypoglycaemia – poor control of diabetes
3) Falls – leading to fracture
4) Cardiovascular – prolongation of QT interval, leading to arrthymia and death
5) Repeated hypoglycaemia
- Probably cognitive impairment
- Hypoglycaemia unawareness
6) Driving consequences
What is the law surrounding hypoglycaemics driving?
- Must have awareness of hypoglycaemia
- Not more than one hypoglycaemia needing third party assistance in last 12 months
- Appropriate blood glucose monitoring
What is diabetic ketacidosis?
Acute insulin deficiency causing
1) less glucose uptake - hyperglycaemia - polyuria, thrist
2) Lipolysis leading to the formation of fatty acids - ketone formation - ketoacidosis - nausea and respiratory compensation
Who is prone to diabetic ketoacidosis?
Type 1 diabetics
How do we diagnose diabetic ketoacidosis?
Capillary blood glucose > 11 mmol/l
Capillary ketones > 3mmol/l
Venous pH
What is the treatment for diabetic ketoacidosis?
1) Fluid resuscitation is main priority – to correct dehydration and hypotension
( a typical patient of 70kg would have lost about 7 liters of fluids at
presentation )
2) Insulin infusion – to shut down production of
ketone and improve acidosis
3) Screen and treat for any underlying infection
4) DVT prophylaxis
Aim for resolution of DKA within 6-12 hours
