Diabetes Flashcards
what is type 1 DM?
autoimmune destruction of?
insulin deficiency due to autoimmune destruction of insulin secreting pancreatic beta cells
in type 1 DM does diet and medications help?
no - persistent hyperglycaemic state
when do you tend to develop T1DM?
childhood and adulthood
which type of DM is more prone to DKA?
T1DM
which type requires insulin more?
T1DM
what is T2DM?
body isn’t responding to insulin due to excess adipose tissue
which type of DM has a HLA association?
what is it?
T1DM - HLA D3 + D4 association
which pts is T2DM found commonly in?
Asians
elderly
men
what is prediabetes?
for those that don’t meet criteria for a formal diagnosis.
what is gestational diabetes?
pregnant women have a raised blood glucose
what is maturity onset diabetes of young? (MODY)
Autosomal dominant
affecting insulin production in young
presents like T2DM
what is latent autoimmune diabetes of adults (LADA)?
how does patient present?
adults who present with auto-immune related diabetes
think of patients who are ketotic and respond poorly to oral hypoglycaemics
how would you expect a T1DM patient to present?
polydipsia (thirst)
polyuria
weight loss
nausea and vomiting
may present with DKA:
abdo pain
vomiting
reduced consciousness
how would you expect a T2DM patient to present?
polydipsia (thirst) polyuria Blurred vision Candidal (vaginal/penile infections) Skin infections (cellulitis)
why do you get polydipsia and polyuria?
water being dragged out following excess glucose being excreted in urine (glycosuria)
RF for T2DM
Old age obesity HTN FHx Gestational Diabetes black, hispanic CVS disease
what are the four ways of checking your blood glucose?
- Finger-prick bedside glucose monitor
- One-off blood glucose (fasting or non-fasting)
- HbA1c (measures amount of glycosylated Hb + represents average blood glucose over past 3 months.
- Glucose tolerance test – fasting glucose is taken and then 75g glucose load is taken. Then 2hrs later a second blood glucose is taken.
why is HbA1c good?
represents average blood glucose over 3 months
what is the criteria for diagnosing DM in a symptomatic patient with regards to:
- fasting glucose
- glucose tolerance test/random glucose
fasting glucose >7 mmol/L
random glucose/glucose tolerance test >11.1 mmol/L
what is the criteria for diagnosing DM if someone is asymptomatic with regards to:
- fasting glucose
- glucose tolerance test/random glucose
- HbA1c
- fasting glucose >7
- random/glucose tolerance test >11.1
BUT Both have to be above on two separate occasions
- HbA1c >48 mmol/mol or >6.5%.
what is the criteria for pre-diabetes
- fasting glucose
- HbA1c
fasting glucose = 6.1 - 6.9
HbA1c = 42 - 48
why is HbA1c sometimes misleading?
increased if there is an increase in red cell turnover
in general for DM what sort of conservative measures can a patient take to help control their diabetes?
exercise - increases insulin sensitivity
food - high fibre and low glycaemic index sources of carbs, low sat fat and fat dairy products.
Tx for T1DM (Managing mesurements)
HbA1c - how often should it be measured and what is the target?
Self monitoring of blood glucose:
- how often?
- when?
- when should you increase frequency of measurements?
- target?
HbA1c
- every 3-6 months
- target of 48 or less than 6.5%
blood glucose
- 4 times a day
- before each meal and once before bed
- if hypoglycaemic episodes
- target of 5-7 mmol/Lon waking and 4-7 mmol/L during the day
Tx for T1DM (insulin)
- what is the insulin regimen of choice + how often do you take it?
- if you wanted just a once daily insulin injection - what is it? how does it work?
- when do you offer Novorapid and why?
- when would Metformin be indicated in a T1DM patient?
- basal-bolus Detemir twice daily
- basal-bolus Glargine - long acting so good for overnight
- before meals - rapid acting
- if patient has BMI over 25
Tx for T2DM
- how often do you check for HbA1c? what is the target?
- what does metformin do?
- when do you avoid metformin?
- SE of metformin?
- every 3-6 months, target is 48 mmol/l
- increases insulin sensitivity
- if patient has a low GFR due to risk of lactic acidosis
- diarrhoea
Tx for T2DM
Alongside metformin: there are four classes of drugs that can be given adjunct to metformin, explain the following four classes:
DPP4-inhibitors?
Glitazone?
Sulfonylurea?
SGLT-2 inhibitor?
DPP4 inhibitors (DPP4 enzyme inactivates GLP-1 which stimulates insulin secretion - therefore they increase insulin secretion) i.e. Gliptin/Sitagliptin
Glitazone increases insulin sensitivity but SE: osteoporosis, CCF, fluid retention
i.e. Pioglitazone
Sulfonylurea increases insulin secretion but increases weight + appetite, + risk of hypoglycaemia
i.e. Glicazide
SGLT-2 inhibitors block reabsorption of glucose in kidneys promoting excretion
i.e. Empagliflozin
Tx for T2DM
what is GLP-1 mimetic?
example?
who is it indicated in?
glucagon-like-peptide 1
Exenatide
indicated if BMI >35
or if BMI <35 and triple therapy was ineffective /insulin is contraindicated
Tx for T2DM
if starting insulin: what do NICE recommend and how often?
Human NPH insulin (isophane)
BD or at bedtime
Tx for T2DM (metformin is tolerated)
1) Metformin
if HbA1c is >58
2) Metformin + 1 out of 4
(DPP4 inhibitor, sulfonylurea, glitazone, SGLT2 inhibitors)
if HbA1c is >58
3) Metformin + (2 out of 4 OR insulin)
if triple therapy not effective or insulin is contraindicated:
4) Metformin + sulfonylurea + GLP-1 mimetic
for those that metformin is tolerated
Tx for T2DM (metformin not tolerated)
1) 1 out of 3
(DPP4 inhibitor, sulfonylurea, glitazone)
if HbA1c >58
2) 2 out of 3
if HbA1c >58
3) insulin
Tx for T2DM (metformin not tolerated)
