Diabetes Flashcards by aderonke adesanoye

Type 1 diabetes
- Definition

Absolute endogenous insulin deficiency characterised by hyperglycaemia.

How well did you know this?

Not at all

Perfectly

Type 1 diabetes symptoms

Fatigue
Polydipsia
Polyuria

Weight loss

How well did you know this?

Not at all

Perfectly

Complications of diabetes

Macrovascular
- Ischaemic heart disease
- Cerebrovascular disease
- Peripheral vascular disease

Microvascular
- Retinopathy
- Nephropathy
- Neuropathy

How well did you know this?

Not at all

Perfectly

Auto-antibodies in T1 DM

Islet cell antibodies

Insulin

ZnT8

Glutamic acid decarboxylase

Islet auto-antigen (IA-2)

How well did you know this?

Not at all

Perfectly

Genetic predisposition to diabetes

Polymorphic HLA DR and DQ
- DR3, DR4
- DQ2, DQ8

DR15, DQ6 is protective

How well did you know this?

Not at all

Perfectly

Environmental risk factors for DM

Viral infections
- Coxsackie
- Enteroviruses

How well did you know this?

Not at all

Perfectly

Consequences of insulin deficiency

Inability for cells to utilise glucose.
- Glucose is eventually excreted in urine
- Leading to polyuria, polydipsia, glycosuria.
Triggers increase in hormones to stimulate increase in glucose.
- Adrenaline
- Cortisol
- GH
- Glucagon
Stimulate of gluconeogenesis, glycogenolysis
- Lipolysis in disinhibited
- Proteolysis to release amino acids.
Ketosis
- Lack of insulin to prevent lipolysis
- Ketones and fatty acids= acidosis

How well did you know this?

Not at all

Perfectly

Diagnosis of DM

Random plasma glucose
- >11.1

Fasting plasma glucose
- >6.7

2 hr glucose challenge (75g glucose)
- >11.1

HbA1c
- >6.5% or 48

Ketosis
- elevated

C-peptide fasting
- undetectable/ low

Autoimmune markers
- ZnT8
- Insulin antibodies
- islet cell antibodies
- Glutamic acid decarboxylase.

How well did you know this?

Not at all

Perfectly

Short acting insulin

15-30 mins onset
- Give right before meals

Examples:
- Actarapid
- Humulin S (Neutral insulin)
- Novorapid
- Fiasp
- Humulog
- Apidra

How well did you know this?

Not at all

Perfectly

Intermediate acting insulin

Peak around 6-12 hours
- Given as basal under bolus

Examples
- Humulin I
- Isuman Basal
- Insulatard

How well did you know this?

Not at all

Perfectly

Insulin regimes

Biphasic
- Rapid acting 30 mins before breakfast and dinner
- Intermediate/ long acting in background

Basal-bolus
- Long acting at bedtime
- Short acting before meal
- Allows flexible lifestyle

How well did you know this?

Not at all

Perfectly

Type 2 diabetes
- Definition

Insulin deficiency and peripheral insulin resistance

How well did you know this?

Not at all

Perfectly

Diet management of DM

In T2Dm
- Reduce caloric intake
- Decrease refined carbs, increase complex carbs
- Increase soluble fibres
- Decrease fat and sodium

How well did you know this?

Not at all

Perfectly

Pharmacological management of T2 DM

Metformin monotherapy

How well did you know this?

Not at all

Perfectly

Causes of inaccurate HbA1c

High erythrocyte turnover
- Haemolysis

Abormal haemoglobin
- Sickle cell

How well did you know this?

Not at all

Perfectly

HbA1c targets

If managed by lifestyle/ with or without monotherapy
- 6.5%

If on drug associated with hypoglycaemia
- 7% (53 mmol/mol)

Indication and steps for pharmacological intervention for T2 DM

HbA1c >6.5% on lifestyle interventions
- Metformin, aim for 6.5%

If rises to 7.5%/ 58= Dual therapy:
- DPP4 inhibitor
- Pioglitazone
- SU
- SGLT-2 inhibit
- Aim for 7.0/ 53

If it is still above 7.5%= triple therapy
- DPP-4i + SU
- Pioglitazone + SU
- Pioglitazone/ SU + SGLT-2i

Indication and steps for pharmacological intervention for T2 DM
- If metformin not appropiate to use

Hba1c> 6.5, with lifestyle interventions
- DPP-4i/ pioglitazone/ SU
- SGLT-2
- Aim for 6.5%
- Aim for 7% on SU

If >7.5%= dual therapy
- DPP4i + Pioglitazone
- DPP-4i + SU
- Pio + SU

Second intensification= insulin based treatment

Vascular disease prevention

Smoking cessation

Target BP for <140/80

Consder statin + aspirin

Nephropathy prevention/ management

For albuminuria
- ACE-i / ARB

Hypoglycaemia
- Symptoms

Autonomic
- Sweating
- Palpitations, dizziness
- Tremor

Neuroglycopenic
- Confusion
- Drowsiness
- Blurred vision
- Seizure
- Coma

Hyopogylcaemia
- Treatment

Orally
- Sugar, fast acting (20g glucose tablet, pure fruit juice)
- Followed by long acting starch

IV
- 150ml 10% Glucose IV

No IV access
- 1mg Glucagon IM

Hypoglycaemia is defined as…

Blood glucose <4mmol/L

When should IM glucagon should not be used?

History of severe liver disease

Starved patients

Biochemical features of HHS

Blood glucose >30mmol/L Ketonaemia <3mmol/L pH >7.3, serum bicarbonate >15mmol/L Serum osmolality >320mosmol/L - Hypernatraemia - derranged K

Presentation of HHS

Hypovolaemia - Dry mucous membranes - Reduced skin turgor - Drowsiness/ reduced GCS Hypotension Reduced urinary output, AKI Hypothermia

Complications of HHS

VTE- MI, stroke Death

Investigations for HHS

Venous blood gas Serum osmolality Fluid balance chart (urinary catheter) U+Es LFTs, clotting CRP Urine/ blood culture ECG CXR

Initial management of HHS

1. Slow infusion of IV fluids - 500ml- 1L of saline over 1 hour - 2-3L positive in 6 hours. 2. IV fixed rate insulin if ketones >1 3. Prophylactic LMWH 4. IV antibiotics is infection suspected 5. Cardiac monitoring

Follow-up management of HHS

Avoid hypoglycaemia - Maintain blood glucose between 10-15, start IV glucose if <14 Avoid rapid decrease in serum osmolality - 3-5mosmol/kg/hr - Reduce saline infusion rate if quicker, increase if Na+ rises or osmolality increases - start s/c insulin once stabilised.

Aims of management in DKA

Decrease blood ketones by at least 0.5mmol/L/ hr Increase bicarbonate by >3mmol/L/hr Reduce glucose by >3mmol/L/hr Normalise K+ levels

DKA is defined as resolved when...

Ketones <0.3mmol/L pH >7.3

DKA is characterised by what 3 features

Ketones >3mmol/L Blood glucose >11mol/L Metabolic acidosis (pH <7.3, bicarbonate <15mmol/L)

Risk factors for DKA

Poorly managed DM / poor compliance to medication Acute illness- infection, ACS, stroke Surgery Dehydration Alcohol Stress

Presentation of DKA

Abdominal pain Nausea, vomiting Kaussmal breathing Dehydration: reduced skin turgor, dry mucous membranes Ketone breath

Initial management of DKA

1. IV fluids - fluid bolus 500mL over 15-20mins 2. Fixed-rate rapid IV insulin - 50units in 50mls of saline - 0.1units/kg/hr 3. Correct K+ - If hypokalaemic= 40mmol KCl in 1L NaCl over 4 hours. 4. Treat underlying cause (i.e. antibiotics) 5. Start IV 10% dextrose when CBG <12mmol/L

Management after DKA has resolved

1. Variable rate insulin 2. Restart s/c long-acting insulin when eating and drinking - Overlap with IV insulin, at least 4 hours before stopping