Diabetes Flashcards
Features of metabolic syndrome?
Increased BP Increased waist circumference Increased TGs Increased fasting glucose Reduced HDL
Catabolic hormones that are involved in diabetic ketoacidosis?
Glucagon
Catecholamines
Cortisol
GH
What type of diabetics get DKA?
Type 1 only
Process of ketoacidosis development in T1DM?
1) Glucagon = Increased PEPCK = more gluconeogenesis = less oxaloacetate
2) Therefore acetyl CoA accumulates
3) In T1DM, no insulin = hormone sensitive lipase activation = lipolysis = ketogenesis
Main complications of diabetes?
- Retinopathy
- CVD (2-3x risk of CHD or stroke)
- Nephropathy (leading cause of kidney transplants)
- Erectile dysfunction (~50% of men with long term diabetes)
- Foot problems
What is charcot arthropathy?
Bone & joint destruction from minimal trauma, common in diabetics
In what situations should metformin not be used?
Patients with AKI
Acutely unwell/dehydrated patients (lactic acidosis risk)
Mode of action of the sulphonylureas? example of one?
Stimulate the pancreas to release insulin, gliclazide.
Example of a GLP-1 agonist?
Exanatide
Mode of action of GLP-1 agonists
Stimulate the release of insulin from the pancreas and delay gastric emptying.
When should you not use GLP-1 Agonists?
suspended in patients with N&V, due to delay in gastric emptying
Problems with Sulphonylureas?
Risk of hypos. cannot be used in renal impairment.
Mode of action of SGLT2 antagonists?
Cause raised glucose excretion in kidneys.
Cautions with using SGLT2 inhibitors?
- Increased UTI risk
- Used with caution with diuretics
- Suspended in dehydration
- Patients on an SGLT2 will always have positive urine dipsticks
What is the target for pre-meal glucose in diabetics?
4-12mmol/L
What is the target for bedtime glucose in diabetic inpatients?
8-10mmol/L
Minimum target for elderly/ill diabetics?
6mmol/L
Symptoms of hyperglycaemia?
- Thirst
- Polyuria
- Blurred vision
- Nausea
- Fatigue
- Headaches
- Drowsiness
(imagine being drunk)
Blood glucose level to be considered a hyper- or a hypoglycaemia?
> 12mmol/L hyper
Symptoms of hypoglycaemia?
- Sweating
- Palpitations
- Shaking
- Hunger
- Confusion
- Drowsiness
- Speech difficulty
- Headache
- Nausea
What other conditions are usually present in metabolic syndrome?
Obesity
NAFLD
Vascular and clotting abnormalities
Three areas of the body that insulin causes the uptake of glucose?
Muscle, fat, liver
How does glucagon and insulin effect hepatic release of glucose?
Glucagon causes the release of PEPCK, which stimulates hepatic glucose release
Insulin directly inhibits hepatic glucose output.
How does pancreatic islet destruction lead to hyperglycaemia in T2DM?
Alpha cells hypertrophy and release more glucagon.
Beta cell number decreases, less insulin is released.
Biochemical features of DKA?
Ketosis- raised ketone bodies (urine)
Acidosis- reduced pH (blood gases)
Hyperglycaemia- raised blood glucose
Causes of diabetic foot ulceration?
Neuropathy
Ischaemia (peripheral vascular disease, small vessel disease)
Infection
Two main types of insulin administration regimens?
Premixed insulin - has both a short acting and a basal component
Basal - bolus insulin take long acting once daily and short acting with food.
Percentage of inpatients with diabetes?
15-20%
hospital actions that can promote safe diabetes care?
Identification of diabetic patients
Appropriate blood glucose monitoring
Action on abnormal BG trends
Care of foot disease
If a diabetic patient is eating less, how would you adjust their insulin?
reduce fast one, review long acting, but never withhold
How many times do you do BG monitoring for a stable patient with diet controlled diabetes?
Once a week
How many times do you do BG monitoring for a patient with insulin/medication controlled diabetes?
Twice a day
Causes of hyperglycaemia in diabetic patients?
Missed medication
DKA or HHS
Infections
Steroid/antipsychotic medication
Other pancreatic disease
Actions to consider in a hyperglycaemic attack?
Assess the patient (Drowsy, vomiting)
Insulin dose right?
Exclude DKA/HHS
check ABG, VBG, U&E etc
perform full exam for sepsis
When might you use a variable rate IV insulin infusion? (sliding scale)
Recurrent vomiting
Severe illness
Causes of hypoglycaemia in hospital?
Missed, smaller or delayed meals
Change in timing of the usual largest meal of the day, snacks
Nausea & vomiting
? Gastric surgery
Reduced appetite
Excess insulin (wrong dose given etc.)
What is lipohypertrophy?
Build up of fat in the skin due to repeated use of same injection sites
