Diabetes Flashcards
Pathophysiology of diabetes type 2
Resistance to insulin means it cannot work effectively and the body cannot utilise glucose
Beta cell function declines over time
Risk factors for type 2 diabetes
Obesity Poor diet Alcohol Smoking Hypertension Family history
Symptoms of diabetes
Polyuria, polydipsia, weight loss
Others = fatigue, hunger, thrush, blurred vision
Investigations of diabetes
Fasting plasma glucose >7mmol/L
Random plasma glucose >11mmol/L
HbA1c >48mmol/L
Management of type 2 diabetes
Diet and lifestyle advice: weight loss, increased exercise
Pharmacological:
Metformin = 1st line agent
Sulphonureas eg. Glicazide
Mechanism of action of Metformin
Biguanide
Acts to increase sensitivity to insulin (unknown mechanism)
Increases skeletal and adipose glucose uptake.
Lowers CVS events, LDLs and VLDLs
ADRs of Metformin
GI disturbance
Lactic acidosis
Sulphonylureas mechanism of action
Acts as an insulin release stimulant:
Antagonises B-cell K+/ATP channels, depolarises cell, increases fusion rate of insulin vesicles
ADRs of sulphonylureas
Risk of hypoglycaemia
GI disturbance
Weight gain
Treatment of type 1 diabetes
Insulin injections - stimulate uptake of glucose, inhibits gluconeogenesis and glycogenolysis
Can use long acting or short acting
Give 2 different insulin regimes used in type 1 diabetes
Premixed regimen: 2 injections a day that are a mixture of long acting and fast acting insulins.
Basal bolus regimen: long acting insulins give basal level, then supplement with fast acting at meal times.
Gives better glucose control, but means more injections
Diabetes differential diagnosis
Metabolic syndrome
Endocrine tumour
Chronic pancreatitis
Renal glycosuria
Microvascular complications of diabetes
Retinopathy
Nephropathy
Neuropathy
Macrovascular complications of diabetes
Coronary artery disease
Peripheral arterial disease
Stroke
Pathophysiology of diabetes type 1
Autoimmune destruction of pancreatic B-cells, leading to insufficient insulin production
