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Clinical Pharmacy PH2506 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diabetes mellitus- UK prevalence

A
  • 3.6 mil people in the UK- just over double the figure in 1996
  • UK orevakence estimated to be 5 million by 2025
  • 590,000 people in UK with diabetes but not diagnosed
  • Nearly 2 out of 3 adults in UK are overweight or obese
  • If current trends persist, 1 in 3 people will be obese by 2034 and 1 in 10 will develop type 2 diabetes
  • > 5 million people have non-diabetic hyperglycaemia puuting them at risk of developing type 2 diabetes
  • Considerable increase in morbidity and premature death (type 2 die 6-10 years earlier than non-diabetics, with type 1 15 years earlier but this is improving)
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2
Q

Diabetes mellitus- financial cost

A
  • Cost to NHS around 10% of its budget: £1 million an hour or £24 billion a year with the cost of treating rising
  • Cost of absenteeism, early retirement and social benefits total at £15.5 billion per annum
  • Drugs only account for a portion of costs (£768 million)
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3
Q

Common types of diabetes

A

TYPE 1
-Absolute insulin deficiency
-Peak incidence between 9-14 years old but can occur at any age
-Of those with diabetes- 10% of adults and 98% of children
TYPE 2
-Relative insulin deficiency caused by disorders of insulin action and insulin secretion (insulin resistance)
-Peak incidence after age of 40, but increase incidence in younger people because of increased obesity
-Of those with diabetes- 90% of adults and 2% of children
-6x more common in south asian than Europeans (also develop at earlier age)
-Pre-diabetes is a metabolic syndrome, linked to obesity, which is a pre cursor to type 2
Gestational- (only diabetic while pregnant, but will go)
-Diabets first diagnosed in pregnancy

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4
Q

diabetic complication

A
  • Most diabetics do not die from metabolic complications (hypoglycemic coma or ketoacidosis from hyperglycaemia, these are not common causes of death)
  • Common causes of death is CVS complications (microvascular complications) e.g. heart attack, stroke
  • Also high morbidity due to microvascular complications e.g. neuropathy, retinopath , neuropathy also depression and dementia
  • Only 40% of people achieving targets recommended to decrease risk of complications
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5
Q

Key diabetic complications

A
  • Stroke
  • Eye damage (glaucoma, cataracts)
  • MI
  • Kidney damage
  • Impotence or difficulty passing urine
  • Numbness (neuropathy) and reduced blood supply (microvascular)
  • Neuropathy is also responsible for erectile dysfunction in men
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6
Q

Diagnosis- symptoms

A

TYPE 1
-Usually acute
-Weight loss, polyuria, polydipsia (go many times), fatigue and ketoacidosis
TYPE 2
-Often insidious, goes unnoticed for years, with complications being the first obvious symptoms
-Thrist, polyuria, weight loss, chronic skin infections, vaginitis, dry eyes or blurred vision

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7
Q

Diagnosis- HbA1c

A
  • Glycated Hb
  • Measures glucose control over past 2-3 months
  • WHO recommoned for diagnosis (>48 mmol/mol) in asymptomatic individuals
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8
Q

Diagnosis- glucose measurement

A

-Random venous plasma glucose conc >11.1 mmol/L
OR
A fasting plasma concentration >7.0mmol/L (Whole blood >6.1 mmol/L)
OR
plasma glucose concentration > 11.1 mmol/L drink 75g anhydrous glucose in oral glucose tolerance test (OGTT)- if plasma glucose is greater than 11 2 hours later than you have diabetes

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9
Q

Diagnosis- glucose measurements

A
  • Diagnosis should never be made based on a finger prick test
  • Should be confirmed by an accredited lab based on a venous blood sample (plasthma glucose conc tends to be 10-15% > than whole blood)
  • If fasting or random values are not diagonstic, the OGTT should be used
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10
Q

Diagnosis- new tests

A

C-peptide test
-Released at same time as insulin
-Useful marker of insulin production
GAD Ab test
-Glutamic acid Decarboxylase AutoAb test
-Is body producing Ab that destroy its own GAD cells
-Differentitate between type 1 diabetes or latent autoimmunee diabetes of adulthood (LADA)

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11
Q

Glucose control

A
  • In absence of diabetes, human blood glucose levels are maintained between 4-6 mmol/L
  • The tighter the glycaemic control the greater the reduction in microvascular complications, but risk of hypo’s
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12
Q

Monitoring blood glucose control

A

HBGM (Human blood glucose monitoring)
-Essential for those on insulin
-Educational value
-Overused in Type 2 diabetes not on insulin
Urine dipstick testing (used to test hyperglycaemia)
Venous blood glucose (fasting)
HbA1c (glycated Hb)
-Aim for between 48-59 mmol/mol (6.5-7.5%)

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13
Q

Ketones

A
  • May be presenting feature in type 1
  • Can occur if patient forget to take insulin or if there is increase insulin demand e.g. infection, stress
  • Insulin lack –> increased breakdown of proteins in order to generate energy
  • Measure ketones with urine dip-stick
  • When ketones are high or very high known as diabetic ketoacidosis (DKA)
  • Ketoacidotic coma can be life-threatening
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14
Q

Microvascular complications

A
  • 80% of diabetics die from cardiovascular disease
  • Diabetics are 2-3x more likely to have a stroke compared to non-diabetics
  • So essential to have tight control of BP and ChE
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15
Q

Blood pressure measurement

A
  • Sphygmomanometer
  • Increasing electronic
  • Must be regularly calibrated
  • BP target lower in diabetics (<140/80 mmHg)
  • Even lower if have kidney, eye or cerebrovascular damage (<130/80 mmHg)
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16
Q

Cholesterol ChE

A

Full lipid profiles (fasting)

  • Total ChE <4 mmol/L
  • LDL ChE <2 mmol/L
  • HDL ChE
  • Triglycerides
17
Q

Microvascular- nephropathy

A
  • Poor control leads to enlargement of kidneys and initially a higher GFR
  • Renal damage causes HTN, HTN causes renal damage
  • Single largest cause of end-stage renal failure in westernised countries
  • In UK , 1000 diabetic patients start kidney dialysis each year
18
Q

Nephropathy- annual monitoring

A

-Microalbuminuria (urinary albumin secretion is 30-300 mg.day) give early warning of diabetic nephropathy
-Measure by either test on 24 hour urine collection or increasingly a single dipstick urine test
-Abnormal ACR (albumin:creatiaine ratio)=
+ACR >2.5 mg/mol for men
+ACR >3.5 mg/mol for women
-Frak proteinuria (300mg per day) marks development of clinical nephropathy
-Measure using urine dipstick
-U&Es
-Must start ACEI or ARB even if they dont have HTN, this will slow nephropathy

19
Q

-Microvascular- ocular

A
  • Transient visual disturbances due to osmotic changes (hyperglycaemia)
  • Retinopathy- Diabetes is the single largest cause of blindness in people of working age
  • Cataracts develop earlier in diabetics
  • Glaucoma may be primary or secondary to retinopathy
20
Q

Retinopathy

A
  • Asymptomatic until well advanced
  • Classified into stages- background, pre-proliferative, proliferative, advanced and maculopathy
  • DUE HIGH GLUCOSE
21
Q

Ocular disease- annual monitoring

A 
Visual acuity 
-6m from snellen chart with and without pin-hole 
Retinal examination 
-Opthalmoscope 
-Retinal imaging camera
22
Q

Microvascular- neuropathy

A
  • Commonest is distal peripheral neuropathy
  • Motor neuropathy leading to muscle weakness, wasting and pain
  • Automatic neuropathy can affect any part of the sympathetic or parasympathetic nervous systeme.g. erectile dysfunction, bladder instability
23
Q

The diabetic foot

A
  • Peripheral neuropathy can be painful, but eventually leads to loss of sensation
  • Vascular disease leads to ischaemia
  • So have a goot rhat doesn’t deal an insult and has poor blood flow, coupled with high glucose levels
  • Small injuries rapidly develop into ulcers, infection sets in, followed by gangrene
  • Every week, over 135 leg, foot, toe amputations are carried out on people with diabetes in the UK (80% of these are preventable)
24
Q

Diabetic foot- monitoring

A
  • By patient, check feet daily, encourage use of chiropody service for foot care
  • Annually general foot exam, foot pulses (blood flow, doppler) and microfilament (press parts of the foot for feelings)
  • If high risk, regular care/assessment by podiatrist
25
Q

Monitoring for the diabetic patient

A
  • Glycaemic control- blood glucose and HbA1c
  • Ketones if necessary
  • BP
  • ChE
  • Renal function- SrCr, microalbumuria, proteinuria
  • Eye disease- visual acuity, retinal examination
  • Peripheral neuropathy- foot examination, foot pulses and microfilament
  • ALL AT LEAST ANNUALLY, some at least 3-6/12

Clinical Pharmacy PH2506 (20 decks)

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