Diabetes Flashcards
diabetes mellitus
type 1: requires insulin from day 1
type 2: acquired insulin resistance
can also be secondary to other causes: pancreatitis and CF steroid induced haemochromatosis endocrine - acrmegaly, cushing's
diagnosis of diabetes
type1:
Sx + BM>11mmol/L with or without weight loss
urine shows glucose and ketones
occasionally use islet cell antibodies and c peptide levels
type 2:
Sx + glucose >11mmol/L NO KETONES
asymptomatic random glucose >11, fasting glucose >7
HbA1C > 48mmol/mol on two occasions
gestational:
occurs during any trimester of pregnancy
not present prior to pregnancy
woman reverts back to normal after pregnancy, but with increased risk of T2DM (50%)
type 1 DM
usually adolescent onset, but can occur at any age
caused by autoimmune destruction of insulin secreting pancreatic beta-cells
patients are prone to weight loss and ketoacidosis
ass. w/ other autoimmune disease (>90% carry HLA DR3)
~30% concordance in identical twins
4 genes are important, one, 6q, determines the islet sensitivity to damage
LADA
late autoimmune diabetes of adults
type of type 1 DM, with slower progression to insulin dependence in later life
type 2 DM
most commonly affected are asian, men and elderly
most are >40yo, but now often seen in teenagers
caused by decreased insulin secretion and/or increased insulin resistance
aas. w/ obesity, lack of exercise, calorie and alcohol excess
~80% concordance in identical twins, indicating stronger genetic link than T1DM
typically progresses from a preliminary phase of impaired glucose tolerance or impaired fasting glucose (offers a unique window for lifestyle intervention)
other causes of DM
steroids
anti-HIV drugs
newer anti-psychotics
thiazides
pancreatic:
pancreatitis, surgery where 90% of pancreas is removed, trauma, pancreatic destruction (haemochromatosis, CF), pancreatic cancer
Cushing’s, acromegaly, phaeochromocytoma, hyperthyroidism, pregnancy
gestational diabetes
increased risk of:
miscarriage, pre-term labour, pre-eclampsia, congenital malformations, macrosomia and a worsening of diabetic complications eg retinopathy, nephropathy
increased risk if:
>25yo, FH, high BMI, non-caucasian, HIV, previous GDM
discontinue all oral hypoglycaemics other than metformin
do fasting blood glucose 6 weeks postpartum - 50% will go on to develop T2DM
metabolic syndrome and insulin resistance
obesity (BMI > 30) plus 2 or: BP >130/85 triglycerides > 1.7mmol/L HDL > 1.03 (m) or 1.29mmol/L (f) fasting glucose >5.6 DM
20% of DM are affected, weight, genetics and insulin resistance all important in aetiology
possible consequences of metabolic syndrome
vascular events eg MI, but may not increase risk higher than individual risk factors DM neurodegeneration microalbuminuria gallstones cancers eg pancreas fertility problems
Rx metabolic syndrome
exercise reduce weight mediterranean diet anti-hypertensives hypoglycaemics (metformin + glitazones) statins
general treatment advice in DM
educational
lifestyle advice
advise informing DVLA and not to drive if having hypo spells
loss of hypoglycaemic awareness may lead to loss of license, permanently if HGV
insulin in T1DM
education about self adjusting doses in the light of exercise, BMs and calorie intake
sub cut insulins are short-, medium-, or long-acting
use short acting before a meal on a background of a long acting dose used at bedtime
Rx for T2DM
metformin (a biguanide) initially - increases insulin sensitivity and helps weight
if HbA1C > 53 after 16 weeks, add:
sulfonylurea eg gliclazide - increases insulin secretion
if HbA1C > 57 after 6 months consider insulin
OR
a gliatazone, which increases insulin sensitivity
types of T2DM medications
biguanides eg metformin - increases insulin sensitivity
sulfonylureas eg gliclazide - increases insulin secretion
insulin
glitazone - increases insulin sensitivity
sulfonylurea receptor binders - increase B-cell insulin release
