Diabetes Flashcards
Define DM:
Metabolic disorder of multiple aetiologies characterised by chronic hyperglycemia with disturbance of carbohydrate, protein and fat metabolism resulting from defects from insulin secretion, resistance or both
WHO criteria for DM:
Fasting plasma >7mmol/L
Oral glucose tolerance test/ Random Plasma: >11.1mmol/L
HbA1c >6.5% / 48mmmol
*need one abnormal value + symptoms
**need two abnormal values if asymptomatic
Important out with unequivocal hyperglycemia, these results should be repeated on another day.
***only oral glucose tolerance test needed for GDM
Can diabetes be diagnosed via urine dip stick?
No.
There are two phenotypes that lie somewhere between typical T1DM and typical T2DM, what are they?
Mature onset diabetes of the young
Secondary DM
What are some commonly associated hereditary markers of T1DM?
HLA DR3
HLA DR4
What is a common antibody found in Type I?
Glutamic Acid Decarboxylase - GAD
What’s a useful marker for endogenous insulin secretion?
C - peptide
Outline disease progression of Diabetes Type I:
- Genetic Risk factor
- HLA DR3 - Immune activation
- Immune response
- antibody made - Stage I
- 2 autoantibodies made
- normal blood glucose - Stage II:
- abnormal blood glucose - Stage III
- clinical diagnosis - Stage IV
- long standing diabetes
What are some supposed risks for T1DM?
Viral infections
- entovirus
Immunization
Diet
- early exposure to cows milk
Obesity
Vit D deficiency
If you have a first degree relative with T2DM, how much more likely are you to develop type II?
5-10x more likely
What’s the most common cause of MODY?
Single gene change.
HNF- alpha
disrupt normal insulin cascade production
what are the main features of MODY?
< 25 years old
runs in families
Manaed by diet, medication and occasionally insulin.
Define Gestational Diabetes:
Where the first onset is recognised during pregnancy
Fasting >5.1
OGTT: >8.5
When should GLP-1 be offered?
BMI >30kg/m2
in combination with oral glucose lowering drugs
in treatment where oral glucose lowering drugs haven’t been sufficient
Type II and cardiovascular disease
When should SGLT2 inhibitors be offered?
Type II add on therapy to metformin
Type II and cardiovascular disease
- proven cardiovascular disease benefits
How does metformin achieve its action?
Working on the AMP - activated protein kinase - AMPK
- insulin signallying
- energy balancing
- metabolism of glucose and lipids
in consequence there is:
- reduced hepatic gluconeogenesis
- increase in peripheral insulin sensitivity
- reduced uptake from intestines
What is the stages of insulin?
Pre
Pro
Insulin + C peptide
If you have a twin with T1DM, what is the increased risk?
36% of developing it
If you carry out a random plasma glucose test and the result comes back >6.1, what should your next step be?
Carry out a fasting plasma glucose test
What are the typical loses during DKA?
Fluid loss of 6-8L
K+ 300- 1000
What methods can be used for glycaemic control?
Short term:
Home blood glucose monitoring
Long term:
HbA1c. Target is 53mmol/ 7%
Education that is needed prior to discharge of a newly discovered diabetic:
- never stop insulin
- How to use the insulin - pens etc
- outline the base regime of insulin use
- sick day rules
- hypo’s
- alcohol
- smoking
- driving
- exercise
- diabetes UK
- contact diabetes specialist nurse
- reasons why long term control is important
- pregnancy planning
What s a complication of gestational diabetes?
shoulder dystocia
very large babies
What features are typical of a T2DM?
>30s gradual onset diagnosis often missed 25-30% typically over weight not associated with ketoacidosis negative autoimmune markers
If there is a 1% drop in HbA1c what effects may this have?
33% risk reduction in albuminuria
21% reduction in retinopathy
25% reduction in peripheral vascular disease
How much higher is cardiovascular disease in those with T2DM?
2-5x higher
What’s the target blood pressure in people with T2DM?
130/80
Name the long acting insulins in order of their duration from shortest to longest
Detimer
Glargine
Degludec
Name a rapid acting insulin
novorapid
Name an intermediate acting:
NPH
Humulog Mix
Out line the management of HHS:
- fluid replacement - 0.9% saline
- move to 0.45% if no improvement in blood osmolality following fluid replacement
- insulin
if glucose still high despite fluids given - no more than 5mmol/ hour
- Low molecular weight heparin
- prevent DVT
In DKA, what levels would Potassium Chloride be given at?
20mmol if <3.5mmol/L
10mmol if 3.5-5mmol/L
none if >5mmol/L
When do you give dextrose in DKA?
Blood glucose below <14mmol
In the carb counting, what is dose of insulin for carbs?
1 unit for 10g of carbs
therefore - 50g = 5 units of short acting insulin
Who mainly uses the twice daily mix insulin or once daily insulin regimen?
Type II diabetics
State the times that insulines take to act:
Rapid:
15 mins till in blood
30-90mins - peak
5 hours
Short acting:
30 mins till in blood
2-4 hours peaks
4-8 hours
Intermediate acting:
2-6 hours in blood
4-14 hours - peaks
20 hours
Long acting:
6-14 hours till reaching blood
doesn’t peak
24 hours long
If some is highly hyperglycaemic but has normal electrolytes/ normal kidney functioning - what is the most appropriate step?
Sub- Cut insulin
What the biggest cause of Diabetic ketoacidosis - and list some other causes:
Poor insulin compliance
Acute illness
First time presentation
Steroid use
What are the diagnostic criteria for keto acidosis:
Glucose: >13.9 mmol
Acidosis: <18mmol/L
Ketonaemia: 3 mmol/L
or
Ketones in urine >++
What tests would you organise in someone with DKA?
Blood glucose
Ketones
- blood
- urine
FBC
U&Es
- looking for level dehydration
- K+
Osmolality
ABGs
- looking for acidosis
What is the treatment for DKA:
Achieved in two stages:
0-4 hours:
- IV fluids
- Insulin - regular
- Glucose
- even when glucose level starts to rise - continue glucose.
*Potassium
Stage Two: >4 hours.
*maintain blood glucose at 9-14 mmol/L
*do not remove until HCO3- normal
and
patient eating normally
What is the treatment of HHS?
IV saline
- first 0.9%, consider switching to 0.45% if osmolality not improving
Insulin
- slow infusion
LMWH
- DVT risk
What is the type of diabetes that is associated with adult onset, that causes type 1 and is also implicated with other autoimmune disease.
List these and list the genes associated.
Autoimmune Polyendocrine syndrome 2 Triad of: - addisons - T1DM - autoimmune thyrotiis
Others include:
- Coeliac
- alopecia
- Myasthenia gravis
HLA DRQ
HLA DR3
HLA DR4
