Diabetes Flashcards
How to diagnose diabetes?
Symptoms and random plasma glucose > 11.1mmol/l
Fasting plasma glucose >7mmol/l
HbA1c>48mmol/mol
No symptoms - OGTT fasting >7 or 2h value >11.1mmol/l
Symptoms of diabetes?
Thirst - osmotic activation of hypothalamus
Polyuria - osmotic diuresis
Weight loss and fatigue - dehydration, lipid and muscle loss
Pruritis vulvae and balanditis - vaginal candidiasis
Hunger
Blurred vision
Clinical features of newly diagnosed type 1 diabetes?
Short history (weeks) of severe symptoms
Weight loss
Moderate or large urinary ketones
2/3 indicate type 1 diabetes = immediate insulin treatment needed at any age
Commonest age type 1 is diagnosed? Prebalence?
5-15yrs
3/1000 in children and adolescents
250,000 in UK
Aims of type 1 treatment?
Relieve symptoms and prevent ketoacidosis
Prevent microvascular and macrovascular complications
Avoid hypoglycaemia
Microvascular complications?
30% - diabetic nephropathy = CV mortality with no nephropathy x2 but with nephropathy x30
Nepropathy = tend to develop retinopathy and neuropathy with major effect on QoL
How to treat type 1 diabetes?
Restoring insulin concentrations as diabetes consists of autoimmune destruction of the beta cell
Insulin treatment:
- Twice daily mixture of short/medium acting insulin
- Basal bolus, (once or twice daily medium acting insulin plus pre meal quick acting insulin)
Ability to judge carbohydrate intake
Awareness of blood glucose lowering effect of exercise
What occurs when your glucose falls too low?
Feel horrible as adrenaline release = dizzy, hot, increase HR, frightened, sweating, hunger
Dilemma for those with type 1 diabetes?
Setting higher glucose targets will reduce the risk of hypoglycaemia but increase the risk of diabetic complications
Setting lower glucose targets will reduce the risk of complications but increase the risk of hypoglycaemia
Conclusions of type 1 diabetes?
2/3 of pts expect a reasonable life expectancy
Tight glucose control = increases this proportion but with hypoglycaemia and weight gain
Prevalence of type 2 diabetes?
2.7 million in the UK, i.e., ~1 in 20
>360 million worldwide
Pathogenesis of type 2 diabetes?
Major CV risk (x3-4)
- Insulin resistance
- Central obesity
- Hypertension
- Early hyperinsulinaemia
- Increased thrombogenesis
- Abnormal lipids (low HDL cholesterol)
- Hyperglycaemia
What drives type 2?
Obesity
Lack of physical exercise
What causes type 2 diabetes?
Insulin resistance demands increased production of insulin to maintain normal glucose levels
Progressive failure of insulin secretion
Complications in type 2 diabetes?
Macrovascular affect majority:
- MI, stroke, peripheral vascular disease
- Microvascular affect 20%
Life expectance decreased by 5-10 yrs
Type 2 diabetes treatment?
Weight loss and exercise to reverse hyperglycaemia
Medication to control BP, BG and lipids = reduce risk of macrovascular disease
Treatment pathways in pts with type 2 diabetes?
Diet = metformin (reduces BG by improving glucose uptake and reduces CV disease) = sulphonylurea (act by stimulating release of insulin from pancreatic beta cells = weight gain and hypoglycaemia) = insulin OR pioglitazone, DPPIV inhibitor
Define diabetic ketoacidosis
Hyperglycaemia
Venous bicarbonate less than 15mmol/l
Ketones
Causes of diabetic ketoacidosis
Infecs
Omission of insulin
New diagnosis
Diabetic ketoacidosis mortality?
1-5%
Elderly - associated with late diagnosis
Young - severe DKA recognised late, rare and poorly understood condition of cerebral oedema in children
Define hyperosmolar hyperglycaemic state (HHS) /hyperosmolar non-ketotic coma (HONK)
Hyperglycaemia (over 50mmol/l)
Hyperosmolarity (over 350mosmoles/l)
Accompanied by dehydration
Who is at risk to Define hyperosmolar hyperglycaemic state (HHS) /hyperosmolar non-ketotic coma (HONK)?
Poorly controlled type 2
Newly diagnosed type 2 diabetes pts, often elderly
Symptoms and signs of hypoglycaemia?
Autonomic = sweating, tremor, palpitations
Neuroglycopenic = loss of concentration, drowsiness, anger/sadness, confusion
How to manage hypoglycaemia?
Pt conscious = oral glucose = check BG after 10 mins
Pt unconscious = glucagon 1mg (IM), IV glucose (100mls, 10% dextrose) = check BG after 10 mins
THEN identify cause, re-educate, adopt measures to avoid hypos
How to monitor diabetes?
Venous BG HbA1c Capillary BG Blood ketones Urinary ketones
Diabetes link to dentistry?
Increased rate of gingivitis/periodontitis/caries/candidiasis/endocarditis Stress Hypoglycaemic meds Type 1 = sjorgrens more likely Early recognition of type 2
