Diabetes Flashcards
what is diabetes mellitus?
a group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both
what is the normal level of HbA1c?
41m/m and below
what is the level of HbA1c needed to diagnose diabetes?
48m/m and above
what is teh normal level for fasting glucose?
6 mmol and below
what is the level of fasting glucose needed to daignose diabetes?
7mmol and above
what is the normal level of 2hr glucose in OGTT?
7.7mmol and below
what is the level of 2hr glucose in OGTT needed for a diagnosis of diabetes?
11.1mmol and above
what is the level of random glucose needed for a diagnosis of diabetes?
11.1mmol and above
what characterises T1DM?
pancreatic beta cell destruction
what antibodies are presetn in T1DM?
anti-GAD
anti-islet
T2DM is a diagnosis of ______
exclusion
if a person does not have type 1, monogenic or secondary diabetes they are thought to have type 2
T1DM is not diagnosabel before what age?
1yr- neonatal diabetes can be transient
what is the pathogenesis of T1DM?
cell failure and absolute insulin deficiency
what is the pathogenesis of T2DM?
hyperinsulinaemia
insulin resistance
what are some useful discriminatory tests for diabetes?
GAD/anti-islet cell antibodies
ketones
C-peptide (plasma)
what type of diabetes may patients presenting with ‘typical’ type 2 diabetes have?
LADA- late onset type 1 diabetes
who is affected by type 4 diabetes?
pregnant women
type 4 diabetes is also referred to as what?
gestational diabetes
what does HbA1c provide a measure of?
glucose control over the past 2-3months
what are the three main types of complicartion in diabetes?
macrovascular
microvascular
psychiatric/psychological
what are the macro-vascuar complications of diabetes?
heart disease and stroke
what are the micro-vascualr complication of diabetes?
retinopathy
nephropathy (kidney damage)
neuropathy (peripheral nerve damage)
what is the UK prevelance of diabetes?
0.3-0.4%
how many people have been diagnosed with diabetes worldwide?
20 million
T1DM is defined as?
a state of absolute insulin deficicency
how is a diagnosis of diabetes made?
fasting glucose: > 7mmol
random glucose: > 11.1mmol
and symtpoms/repeat test
what can be seen under microscope in T1DM?
lymphocytes attacking the islets
what can be seen under microscope in T2DM?
amyloid deposit
50% of familial risk of T1DM is related to which genes?
HLA genes
what is the ‘classic triad’ in diagnosing diabetes?
polyuria (excessive urine production)
polydipsia (excessive thirst)
weight loss
describe the management of a newly diagnosed patient with T1DM (5 points)
blood fluocse and ketone montoring
insulin (usually basal bolus)
carbohydrate estimation
dieticain contact
medical clinic review
what is looked at duting the annual review of T1DM?
weight
blood pressure
bloods: HbA1c, renal function and lipids
retinal screening
foot risk assessment
children are more likely to develop diabetes if which one of their parents has the condition?
three times more liekly ot develop diabetes if father has condition
20% of patients with which condition will develop secondary diabetes?
cystic fibrosis
what are the possible diagnoses in someone presenting under 30yrs with diabetes?
T1DM
T2DM
MODY
LADA
secondary diabetes
children diagnosed under the age of 6months are much more likely to have which type of diabetes?
monogenic
what is present to establish a diagnosis of LADA?
elevated levels of pancreatic auto-antibodies
when would you suspect LADA?
young adults 25-40
usually non-obese
auto-antibody +ve
assoc autoimmune conditions
what are the clinical findings in Bardet-Biedl syndrome?
often very obese
polydactyly
visual/hearing impairment
diabetes
what are some common autoimmune conditions associated with diabetes?
thyroifd disease
coeliac disease
pernicious anaemia
IgA deficiency
what are the symptoms associated with coeliac?
bloating
diarrhoea
malabsoprtion
what is associated with anaemia in diabetes?
low albumin
low calcium
what is asscoiated with thyroid disease in diabetes?
FHx
weight change
deterioration n HbA1c
hypoglycaemia
what devices are there available to self administer insulin?
disposable pen
re-usable cartridge pen
continous subcutaneous insulin infusion pump
insulin is secreted at a low _____ rate which accounts for 50% of insulin prod
basal
what is the name given to the insulin secreted in relation to post-meal glucose
post-prandial insulin
what is seen to be the best regime in mimicing physiological insulin production?
basal bolus
other than basal bolus what ohter two kinds of insulin regime are there?
twice dialy
once daily
what is the target for blood glucose pre meal in T1DM?
4-7mmol
what is the target for blood glucose 1-2 hours after the beginning of a meal in T1DM?
<10mol/l
what is the onest of action in prandial insluin analogues?
10-15mins
what is the duration of prandial insulin analogues?
4-5hrs
what is the onset of action of soluble prandial insulin?
30-60mins
what is the duration of prandial soluble insulin?
5-8hrs
what are the two types of basal insulins?
isophane ‘basal’ insulins
analogue basal insulins
most patients with T1DM should be on which type of insulin?
analogue basal insulin
what is DAFNE?
Dose Adjustment For Normal Eating
what is advanced carbohydrate counting?
synchronizing the amount of insulin taken to the amount of carbohydrate consumed
who is advanced carbohydrate counting suitabel for?
those on multiple daily injections (MDI)
people on continous subcutaneous insulin infusion (SCII) pumps
isulin sensitivity factor is also known as what?
correction factor
what is the ratio of insulin to carbs?
i unit of insulin per 10g CHO
in carbohydrate counting how many units of insluin should be given if consuming 65g of carbs?
6.5 units of insulin
insulin pumps deliver continous adminstration of _____ _____ insulin subcutaneously
short acting
at what rate do insulin pumps deliver insulin?
basal rate
this can be programmed in advance and set to different rates at different times of the day
what are some examples of different meal bolus profiles with an insulin pump?
standard
dual
multiple
short extended
long extended
what are some tests used to evaluate metabolic control?
home blood gluocse monitoring
urine testing (glucose/ketones)
glycated hemoglobin (HbA1c)
how is HbA1c formed?
non-enzymatic glycation of haemoglobin on exposure ot glucose
HbA1c measures average blood glucose over what period of time?
6-8 weeks
what are the targets for HbA1c?
53mmol- good control
48mmol- very good control
what are methods available to monitor yur blood glucose?
fingerstick testing
continous glucose monitoring
what are the factors affecting insulin absorption through injection?
temperature
injection site
injection depth
exercise
pen accuracy
leakage
what can occur at the site of insulin injection when used multiple times?
lipohypertrophy- accumulation of fat
whata are the blood glucose targets pre-prandial and post meal?
pre-prandial: 4-7mmol
post meal: <10mmol
when would insulin be prescribed IV?
diabetic ketoacidosis
hyperosmolar hyperglycaemic state
acute illness
fasting patients
how often should blood glucose be tested when on IV insulin?
Houlry
what is the target for blood glucose when on IV insulin?
5-12mmol/L
other than injection what are the other formulations of insulin?
inhlaed
oral
what are some non-insulin adjunct therapies in T1DM?
metformin
leptin
GLP-1
SGLT2
what are some more drastic surgical treatments of diabetes?
kidney-pancreas autotransplantation
islet autotransplantation
what are the 4 key steps in islet cell transplantation?
- pancreas donation and retrieval
- islet isolation
- islet culture
- islet transplantation
which type of diabetes carries a higher genetic risk?
T2DM
what level of HbA1c is the cut off for poor control?
75mmol
what is the natural history of T2DM?
inc in weight and insulin resistance
what accelerates the presentation of T2DM?
obesity
what two things affect the rate of progression and severity of beta cell destruction in T2DM?
genetics
environmental stress
CVD risk in diabetic is best treated throught the use of what drugs?
statins
anti-hypertensives
what is the mechamism of metformin?
decreases hepatic gluconeogenisis
increases peripheral glucose uptake
what are some potential side effects of metformin?
GI
lactic acidosis
what is the first line drug treatment of T2DM?
metformin
what are the SIGN treatment steps for T2DM?
- metformin
- metformin + one of SU/ TZD/DDP-4/ GLP-1/insulin
- metformin + two from above
what is the mechanism of sulphonyurea?
blocks B-cell KATP channel
increases 1st and 2nd pahse insulin secretion
what are some potential side effects of sulphonyurea?
abnormal LFTs
inc CHD in elderly potentially
does increasing the dose of Sulphonyurea increase its efficacy?
no- efficacy is reduced at higher doses
is it more beneficial to inc the dose of a drug or to add in another therapy?
better to add in further drug
describe the incriton effect?
increased stimulation of insulin elicited by oral gluocse compared to IV
what would a graph showing insulin secretion stimulated by oral and IV glucose look like? (incriton effect)
oral curve woul dbe much greater in comaprison to the flat IV curve
metformin works by lowering insulin _______
resistance
metformin can cause weight gain/loss/nothing?
often weight loss althoug pretty neutral
is metformin safe in pregnancy?
yes
why cant many patients not tolerate metformin?
GI upset
a side effect of metformin is its interference with the absorption of what?
vit B12
folic acid
metformin can cause which organ failure?
liver failure
renal toxicity
sulphonylureas are what kind of drug?
insulin secretagogues
what SU is first generation?
tolbutamide
what are some second generation SUs
Glicazide
Glibenclamide
Glipizide
which generation of sulphonylureas is short acting and which is fast acting?
first generation- fast 4-6hrs
second generation- slow 16-24hrs
what si teh main side effect of sulphonylureas?
Hypoglycaemia
who is at most at risk of a hypo due to sulphonylurea drugs?
elderly
chronic kidney disease
sulphonylureas can cause weight gain/loss/nothing
weight gain
