Diabetes Flashcards
What microvascular complications does diabetes cause?
Retinopathy
Neuropathy
Nephropathy
What macrovascular complications does diabetes cause?
Stroke
MI
Renovascular disease
Limb ischaemia
What is MODY?
Maturity onset diabetes of the young
Autosomal dominant form of type 2 DM affecting young people.
What is the WHO criteria for the diagnosis of DM?
- Raised fasting plasma glucose >7 mmol/L
- Random plasma glucose >11.1 mmol/L.
If symptomatic, one value only but if asymptomatic then two values.
For borderline cases: OGTT 2h value >11.1 mmol/L.
- HbA1c > 48 mmol/L
What is impaired glucose tolerance?
Fasting plasma glucose < 7mmol/L
OGTT 2 hour between >7.8 - 11.1 mmol/L
How do you treat a patient with impaired glucose tolerance?
Lifestyle intervention to stop progression to diabetes.
What are other causes of DM?
Medications: steroids, anti-HIV drugs
Pancreatic: pancreatitis, surgery, trauma, cancer
Cushing’s disease, acromegaly, pheochromocytoma, hyperthyroidism, pregnancy.
Define metabolic syndrome?
Central obesity (BMI>30) plus two of:
- BP >130/85
- raised triglycerides
- low HDL
- fasting glucose >5.6 mmol/L
- T2DM
What is the cause of T2DM?
Combination of insulin resistance and pancreatic beta-cell dysfunction.
What should you consider in an older patient presenting with diabetes, which you assume is T2, but not responding to oral hypoglycaemics?
LADA - latent autoimmune diabetes in adults.
A form of T1DM that progresses to insulin dependence later in life.
How would you test for LADA?
Measure islet cell antibodies
What auto-antibodies are present in T1DM?
Islet cell antibodies (ICA)
Anti-glutatmic acid decarboxylase (GAD)
What diet would you recommend a patient with type 2 diabetes?
Low carbohydrate Low‑glycaemic‑index sources of carbohydrate e.g. fruit, veg, grains, pulses High fibre Oily fish Limit saturated fats
How do fingerpick glucose levels influence insulin doses?
Before meal - informs about long acting dose
After meal - informs about short acting dose
What is the blood pressure target for people with diabetes?
140/80
130/80 if kidney, eye or cerebrovascular disease
What is the target HbA1c for patients not at risk of hypoglycaemia?
48 mmol/mol (6.5%)
What is the target HbA1c for patients at risk of hypoglycaemia (taking drug associated with)?
53 mmol/mol (7.0%)
What level of HbA1c might you consider intensifying drug treatment?
58 mmol/mol (7.5%)
What should you look out for in patients taking insulin? How can these complications be prevented?
Injection site for infection and lipohypertrophy (fatty change)
Adv to rotate injection sites
How is the raised risk of CVD managed in patients with DM?
Statin therapy for all patients regardless of lipid levels
How is the risk of nephropathy reduced?
ACE-I renoprotective if microalbuminuria present - negative urine dip but Urine A:CR >3
What are the 4 stages of diabetic retinopathy?
Background retinopathy
Pre-proliferative
Proliferative
Maculopathy
What might you see on fundoscopy in a patient with background retinopathy?
Microaneurysms - dots Haemorrhages - blots Hard exudates (lipid deposits)
What might you see in pre-proliferative retinopathy?
Cotton wool spots (infarcts)
Venous beading
What happens in proliferative retinopathy?
New blood vessels form in response to VEGF growth factor released by the retina.
What is a risk of maculopathy?
Retinal detachment
How can you educate patients in diabetic foot care?
Daily foot inspection - mirror for sole
Comfortable shoes
Regular chiropody to remove callus’
What might you find on neurological examination of a diabetic patient?
Decreased sensation in the stocking distribution
Charcot joint
Absent ankle jerk reflex
What areas must you assess when presented with a diabetic foot ulcer?
Neuropathy - clinically
Ischaemia - doppler
Bony deformity e.g. Charcot joint - X-Ray
Infection - swabs, blood culture, X-Ray
What are the 4 types of diabetic neuropathies?
Symmetric sensory polyneuropathy
Mononeuritis multiplex
Amyotrophy
Autonomic neuropathy
How would you expect symmetric sensory polyneuropathy to present?
Tingling, numbness or pain in glove and stocking distribution
How would you expect amyotrophy to present?
Painful wasting of quadriceps and other pelvifemoral muscles
What are signs of autonomic neuropathy?
Postural BP drop Gastroparesis - early satiety, bloating, N+V Urine retention Erectile dysfunction Diarrhoea
What is a Charcot joint?
Neuropathic arthropathy
Bony destruction and deformity of a weight bearing joint secondary to neuropathy
What investigations are needed when a patient presents with hypoglycaemia in the acute setting?
Capillary blood glucose Urine dip Plasma insulin C-peptide Sulphonylurea levels ABG - check acid-base status
What blood result would indicate endogenous insulinaemia, possibly due to insulinoma?
C-peptide raised
What are the causes of hypoglycaemia in a patient without diabetes?
Drugs - beta blockers
Endocrine - pituitary insufficiency, Addisons disease, insulinomas
Liver failure
Malaria
Post-gastrectomy hypoglycaemia - low ghrelin (suppresses insulin release)
How could you test for Addison’s disease as a cause of hypoglycaemia?
Synacthen test
How are people with IGT or IFG managed?
Lifestyle modifications
Annual review
How is true hypoglycaemia confirmed?
Whipples triad:
- symptoms/signs of hypoglycaemia
- low plasma glucose
- resolution of symptoms once glucose back to normal
What is the gold standard for diagnosis of insulinoma?
72 hour fast
How might diabetes present as complications of the disease?
Recurrent infections - skin, thrush
Poor wound healing
T1 - DKA
How does T1DM typically present?
Younger age Weight loss Polydipsia Polyuria Lethargy DKA
How does T2DM typically present?
Tiredness Polyuria Polydipsia Recurrent infections - skin,UTI HHS
