Diabetes Flashcards
What is the major cause of death in DKA in children?
Cerebral oedema
What must you ask in any child presenting with vague symptoms?
Polyuria, polydipsia, nocturnal enuresis
What is T1DM?
Autoimmune destruction of pancreatic ß-cells by anti-GAD and anti-islet cells. Causes hyperglycaemia.
How does T2DM present?
Polyuria, polydipsia, fatigue
In obese person
Often in older person
How does T1DM present?
Polyuria, polydipsia, fatigue
Weight loss
Often in younger person
What is T2DM?
Insulin resistance from chronic hyperglycaemia
How do you diagnose diabetes mellitus?
Random glucose > 7mmol
Fasting glucose > 11mmol
Glucose tolerance test > 11mmol
(repeat tests required)
What autoantibodies are associated with T1DM?
Anti-GAD
Anti-islet cell
What is c-peptide and would it be raised in T1DM and/or T2DM?
Measure of endogenous insulin production
Low in T1DM
Normal/high in T2DM
Name a rapid acting insulin.
Novorapid
Name a long acting insulin
Lantus
What insulin regimen are most T1DM patients on and what does it consist of?
Basal bolus
Long acting basal insulin (lantus)
Short acting insulin (novoarpid) taken before meals
What should the HbA1c target be in
- most diabetics?
- young diabetics?
- 53mmol/mol
2. 48mmol/mol
What is HbA1c?
Glycalated haemoglobin
Measures average glucose levels in blood in last 6-8 weeks
What should diabetic patients blood glucose targets be before meals?
6mM (4-7mM)
What is the pathogenesis of T2DM?
Fat and fatty acid produce inflammatory mediators which inhibit insulin receptor substrate 1 which inhibits insulin function resulting in insulin resistance.
The ß-cells compensate for this by over-secreting insulin but these eventually fatigue resulting in ß-cell dysfunction
What are the main chronic complications of T2DM?
Macrovascular
- MI
- Stroke
Microvascular
- neuropathy
- retinopathy
- nephropathy
What is the stepwise treatment pathway in diabetes mellitus?
- Lifestyle modification
- Lifestyle + oral monotherapy
- Lifestyle + combined therapy
- Lifestyle + injected therapy
What is involved in a diabetic review?
Ask about lifestyle
Visual acuity Leg/foot exam Urinalysis HbA1c U and Es Cholesterol Measure BMI Blood pressure
8 months old boy presents with polyuria, polydipsia and failure to thrive. What is the diagnosis?
Maturity onset diabetes of the young (MODY)
Name 2 genes which are mutated in MODY and which MODY types they cause.
Hepatocute nuclear factor
- MODY1/3/5
Glucokinase
- MODY2
What is MODY treated with?
Sulphonylureas
Patient with BMI 31 presents with polydipsia, polyuria and lethargy. They are autoantibody positive and non-insulin requiring. What is the diagnosis?
Latent onset diabetes of adulthood (LADA)
How do you diagnose LADA?
Elevated pancreatic autoantibodies (anti-GAD, anti-islet cell)
Non-insulin requiring at diagnosis
What must patients do when administering insulin?
Change injection site
Long term use of same injection site causes lipohypertrophy which disrupts insulin absorption
What dose of insulin would a 60kg male get for bolus and basal use?
60kg person gets 18 units insulin a day (weight times 0.3)
18 units divided equally between basal and bolus
Basal - 9 units
Bolus - 9 units (3 units per meal)
What is the
- insulin carbohydrate ratio (ICR)
- insulin sensitivity factor (ISF)/ correction factor (CF)?
- units of insulin requires to clear x grams of carbohydrate
ICR=1:10, 1unit insulin clears 10g carbohydrate - units insulin required to reduce blood glucose by x mM
ICF=1:2, 1 unit insulin lowers BG by 2mM
What dose should be changed if a patient is reporting hypo/hyperglycaemia?
Dose before the hypo/hyperglycaemia
How much should an insulin dose be changed by?
10%
What must you check before changing an insulin dose?
Renal function Injection site (lipohypertrophy) Lifestyle changes
What is the major cause of death in DKA in adults?
Hypokalaemia
Aspiration pneumonia
Co-morbidities
What is the pathophysiology of DKA?
Lack on insulin prevents glucose moving into cells starving them of energy which causes them to release stress hormones.
Stress hormones produce more glucose and breakdown lipids which forms ketone bodies.
Ketone bodies are acidic and cause ketoacidosis.
How does DKA present?
Polyuria, dehydration, breathlessness, vomiting, abdominal pain, sweet breath
What blood tests would you order in suspected DKA? What results would confirm your suspicion?
Urine ketones >3mM
Blood glucose > 11mM
Bicarbonate <15mM
What ketone is used to measure
- blood ketones
- urine ketones?
- ß-hydroxybutarate
2. acetoacetate
Outline management of DKA.
replace losses
IV fluid
IV insulin
Potassium
ECG monitoring for hyperkalaemia
Name 8 symptoms of hypoglycaemia.
Tremor Sweating Anxiety Irritability Tachycardia Headache Hunger Blurred vision
What can cause hypoglycaemia?
Missed meals
Exercise
Alcohol (increases insulin activity)
Over treatment
How do you manage hypoglycaemia in a
- conscious patient
- unconscious patient
Conscious
- 15-20g rapidly absorbed glucose
- recheck BG (if abnormal repear step 1)
- 15g simple carbohydrate
Unconcsious
- 1mg subcutaneous glucagon
What is hyperglycaemic hyperosmolar syndrome?
Hyperglycaemia causes hyperosmolality without ketoacidosis
What is the name given to hyperglycaemia causing hyperosmolality without ketoacidosis?
Hyperoglycaemic hyperosmolar syndrome (HHS)
How does hyperglycaemic hyperosmolar syndrome (HHS) present clinically?
Confusion, dehydration and blurred vision over days to weeks
What blood tests would you order in suspected hyperoglycaemia hyperosmolar syndrome (HHS)?
What results would confirm your suspected diagnosis?
Blood glucose - very high (>30mM)
Ketones - none
U&Es - hyperosmolar
How do you calculate osmolality?
What is a normal result?
2([Na]+[K]) + [urea] + [glucose]
285-295
Outline management of hyperoglycaemic hyperosmolar syndrome (HHS).
Normalise osmolality with
- IV fluid
- IV sodium
(give insulin if ketones or blood glucose not falling in response to fluids)
What are the classes of lactic acidosis?
What causes each?
Type A - hypoxia
Type B - other (DKA, meformin, liver diseas etc.)
How does lactic acidosis present?
Hyperveiltation
Confusion (coma)
What is the initial management of lactic acidosis?
IV fluid
What is charcot foot?
Arthopathy characterised by degeneration of weight bearing foot joints assoaciated with diabetes
What are the different classes of neuropathy in diabates?
Peripheral (distal symmetric aesthesia, proprioception loss)
Focal (one/group of dysfunctional nerve(s)
Proximal (proximal lower limb pain progressing to weakness)
Autonomic (increased sympathetic nervous action eg gastroparesis)
