Diabetes Flashcards
Complications of Diabetes
1 . Macrovascular disease - CAD, cerebrovascular and peripheral vascular disease)
- MIcrovascular disease - retinopathy, nephropathy, peripheral neuropathy
Pathophysiology of Type 1 DM
Autoimmune destruction of beta islets in the pancreas (auto antibodies)
Pathophysiology of Type 2 DM
Slow decline of pancreatic beta cell function (overall reduction in insulin secretion overtime) + insulin resistance
Percentage of Different Causes of Diabetes
Type 1 - 5%
Type 2 - 90%
Gestational
Drug induced (immunosuppression - cyclosporin or tacrolimus, antipsychotic medications & HIV protease inhibitors - …navir)
Pancreatitis
Cystic Fibrosis
MODY - maturity onset diabetes of young
LADA - latent autoimmune diabetes of adults
Screening period for gestational diabetes + how to screen
24-28 weeks of pregnancy + OGTT (75g)
How to diagnose Diabetes Mellitus
Fasting Glucose >/= 7
Random Glucose >/= 11.1
HbA1c >/= 6.5%
OGTT (75g) - 2 hours post BSL >/= 11.1
Management of Diabetes
Diet
Exercise
Pharmacotherapy (OHAs + Insulin)
Insulin Pumps
Surgery (Bariatric or Bypass/Roux-en-Y)
List the situations where HbA1C is INACCURATE
Haemodialysis
Haemolytic Anaemia
Haemoglobinopathies
- result in falsely lowered results as Hb does not last 120 days
Main adverse effect of sulfonylurea (glicalazide + glimepride)
HYPOglycaemia
Hypoglycaemic Agent that DECREASES weight
GLP-1 mimetics - Exenatide [BYETTA} + Liraglutide
Contraindication to Thiazolidinediones (…glitazones)
CCF and fluid overload (as it can exacerbate the problem)
Adverse Effect if Biguanides
GI upset (diarrhoea and abdo pain) Lactic Acidosis (rare) Cease if there is acute or chronic liver dysfunction or acute renal impairment
MOA of DPP4 (…gliptins)
Slow gastric emptying and suppression of glucagon secretion
MOA of GLP-1 mimetics
Slow gastric emptying, suppression of glucagon secretion, increase satiety
Diabetic Retinopathy features
Non proliferative: Oedema Hard exudates Tiny haemorrhages Microaneurysms Soft exudates (cotton wool spots) Proliferative: Angiogenesis / Neovascularisation Intraocular bleeding Retinal detachment (secondary fibrosis and contraction)
Treatment for Diabetic Retinopathy
Laser Photocoagulation Burn off part of the retina (1/3) but this results in poor blood flow to the remaining 2/3 But there is loss of peripheral vision Alternative treatment is injection of VEGF inhibitors every 4-8 weeks Bevacizumab Ranibizumab
Mechanisms that prevent hypoglycaemia
Insulin secretion switches OFF Mechanisms for glycogenolysis BSL < 4 - glucagon and adrenalin release BSL < 3.3 - cortisol and growth hormone release
Causes of fasting hypoglycaemia in non-diabetic patients
Insulinoma Insulin injection Ingestion of sulfonylurea
Testing for hypoglycaemia in non-diabetics
Confirm Whipple’s Triad:
Hypoglycaemic symptoms
Low plasma glucose (on LAB test, not glucometer)
Prompt resolution of symptoms post glucose ingestion
How much does 1 unit of insulin equate to in carbohydrates (grams)
1unit = 10-15g
