Diabetes Flashcards
Questions to ask in diabetes history
o Polyuria, nocturia, polydipsia o Weight loss/ gain o Fatigue, mood changes o Blurred vision o Frequent bacterial/ yeast infx o Leg sensory changes o Cuts/ wounds that heal slowly
Microvascular complications from diabetes
- retinopathy
- nephropathy
- erectile dysfunction
- absent foot pulses
- ischaemic skin changes on foot
- abnormal vibration sense on foot
Macrovascular complications from diabetes
- stroke
- heart attack
- hypertension
- intermittent claudication
Normal fasting blood glucose for healthy patient (without diabetes)
3.9-5.5
Normal HbA1C for healthy patient (without diabetes)
20-41.4
Which patient populations would be screened for T2DM
- previous gestational diabetes
- age >65
- blacks + South Asians >35
- all pts who have MI, angina, stroke
- PCOS pts who are obese
- > 50 + obese/ family history/ hypertension
What blood/ bedside tests would be done in diabetes screening
" Fasting plasma glucose/ oral glucose tolerance test " HbA1c " Creatinine, eGFR " Cholesterol " Urine micro albumin
Why is HbA1c a better test for diabetes compared to oral glucose tolerance test
- more reliable (encompasses more readings compared to 1 moment from 1 day)
- easier to measure complications risk
- doesn’t require fasting
- not affected by stress, diet, exercise
MoA of metformin
Decreases insulin resistance
first line drug
MoA of sulfonylurea
Increases insulin secretion from pancreatic b-cells
good second line drug because less risk of hypoglycaemia
What BM level is considered hypoglycaemia
<4 mmol/L
How to treat hypoglycaemia patient
Dextrosol tablets (if conscious) IV dextrose (if unconscious)
Recheck BM after 10-15min, repeat treatment if still hypoglycaemic
What does HbA1c measure
3 month average plasma glucose concentration
Autonomic symptoms in hypoglycaemia
- sweating, anxiety, tremor, palpitations
- pallor
(early adrenergic features may be absent in patients with longstanding diabetes)
Neurogenic symptoms in hypoglycaemia
- confusion
- coma, drowsiness
- seizures
- personality change
- focal neurology
Difference between definition of DKA and HHOS
DKA has hyperglycaemia, acidosis, ketosis
HHOS has hyperglycaemia, increased water reabosrption, no ketosis
Why is there no ketosis in hyperosmolar hyperglycaemia state
The low insulin levels are still sufficient to inhibit hepatic ketogenesis
Symptoms of of DKA
- polyuria
- polydipsia
- weight loss
- reduced GCS
- dehydration (low BP, high HR)
- Kussmaul respiration
- abdominal pain
What is kussmaul respiration
increased respiration to compensate acidosis
What causes abdominal pain in DKA
Abdo pain secondary to metabolic acidosis
Is DKA or HHOS more life-threatening
HHOS
- higher mortality rate
- frequently leads to coma
DKA and HHOS - which occur more in type 1/2 diabetics
DKA: more in type 1
HHOS: more in type 2
Is a hypoglycaemic event a contraindication to driving?
No if had prodrome.
Contraindicated if no prodrome (can drive again if he regains awareness of hypoglycaemia).
