Diabetes Flashcards
What is type 1 diabetes?
This is where autoimmune beta cell destruction occurs in the islets of Langerhan in the pancreas.
Clinical features of T1DM?
Polyuria Polydipsia Weight loss Fatigue Infections DKA
What is T2DM caused by?
Resistance to the peripheral action of insulin
Is there a genetic component in T2DM?
Yes, if one genetically identical twin has it there is a 90% chance the other twin gets it
What are the clinical features of diabetes?
80% overweight
Polyuria
Polydipsia
20% present with complications of T2DM e.g. ischaemic heart disease, CVD, foot ulcers of visual changes)
How do we manage T1DM?
Insulin to control
What are side effects of insulin?
Hypoglycaemia
Weight gain
Lipodystrophy
What is the first line drug in T2DM?
Metformin in the majority of cases
What drugs can be used if metformin is not appropriate/enough?
Sulfonylureas
Gliptins
Pioglitazone
How do sulfonylureas work?
Stimulate pancreatic beta cells to secrete insulin
Examples of sulfonylureas?
Gliclazide
Glimepiride
Side effects of sulfonylureas?
Hypoglycaemia
Weight gain
Hyponatraemia
MOA of gliptins (DPP-4 inhibitors)?
Increases incretin which inhibits glucagon secretion
How does pioglitazone work?
Increases fatty acid uptake and adipogenesis - thiazolidinedione
Side effects of pioglitazone?
Weight gain
Fluid retention
How do we diagnose diabetes?
Fasting glucose >7
Random glucose >11.1
^ provided they’re symptomatic
If patients are asymptomatic, those readings must be found twice
Also glucose tolerance test:
Give 75g oral glucose
See if glucose is about 11.1 after 2 hours, (7.8+ indicates impaired tolerance)
> 6.5% HbA1c can also be used to diagnose diabetes
What is a HbA1c?
A way of monitoring diabetes control. It measures the percentage of glycosylated haemoglobin in the blood over the past 2-3 months.
How do we differentiate complications of DM?
Microvascular vs macrovascular
What are the microvascular complications of DM?
Retinopathy
Nephropathy
Neuropathy
What are the sick day rules in diabetes?
Don’t stop medications even if you’re not eating too much - cortisol from illness increases glucose levels in the blood, just monitor more closely your blood sugar levels.
Only exception is maybe metformin (which you may potentially need to stop if becoming dehydrated because of AKI)
Features of diabetic retinopathy
1/3 people with diabetes get diabetic retinopathy
5% are blind within 30 years
The pathology is that you get thickening of the basement capillary membrane which results in: Haemorrhage Hard exudates Occluded vessels Macular oedema
How can we treat diabetic retinopathy?
Yearly eye checks (before developing the condition) - manage glycaemia/BP
Laser retinal photocoagulation in later stages
What is diabetic nephropathy?
This is where you get thickening of the glomerular basement membrane eventually leading to reduced eGFR
What are indicators of diabetic nephropathy?
Albuminuria
Symptoms of diabetic nephropathy?
Oedema
HTN
Uraemia
How do we manage diabetic nephropathy?
ACEi
Good glycaemic control
Aspirin
What are the characteristics of diabetic neuropathy?
Sensory loss NOT motor loss
Glove and stocking
Loss of vibration sense (first)
How do we treat painful diabetic neuropathy?
First-line:
Amitryptlline, duloxetine, pregabalin or gabapentin
Cataracts and diabetes?
Usually get cataracts 10-15 years earlier
Macrovascular diabetes complications?
Cerebrovascular risk - 2x
Coronary artery disease - 3x
PVD - 40x
What is diabetic foot a result of?
PAD
Peripheral neuropathy
Features of diabetic foot
Loss of sensation
Absent foot pulses
Reduced ABPI
Intermittent claudication
Complications:
Calluses, ulceration, Charcot’s arthropathy, cellulitis, osteomyelitis, gangrene
How do we manage diabetic foot?
Screen for it on an annual basis:
Palpate the pulses
10g monofilament used on the sole of foot to check for neuropathy
