Diabetes Flashcards
What is definition of T1DM?
Autoimmune beta cell destruction causing hyperglycaemia and insulin deficiency, defined as random plasma glucose >11mmol/L
What is the definition of T2DM?
Characterised by hyperglycaemia due to insulin resistance (body unable to respond to normal levels of insulin) and insulin deficiency (pancreas unable to secrete enough insulin), defined as random plasma glucose >11mmol/L or HbA1c >48mmol/L
What are the long term complications of hyperglycaemia?
Macrovascular complications include coronary artery disease, peripheral arterial disease and stroke
Microvascular complications include diabetic nephropathy, neuropathy and retinopathy
Infection related include UTI, pneumonia, fungal infections e.g. oral candidiasis.
Risk factors for T2DM?
Modifiable: obesity, inactive lifestyle, high carb diet
Non-modifiable: FHx, older age, ethnicity e.g. Asian, Black, Chinese
Presentation of T2DM individual?
Polyuria, polydipsia, blurred vision, recurrent infections e.g. UTI or fungal infections on skin, weight loss, acanthosis nigricans, hypertensive,
Presentation of T1DM individual?
Polyuria, polydipsia, weight loss, recurrent infections e.g. UTI or skin infections, present with DKA nausea, vomiting, abdominal pain,
RF for T1DM?
FH-first degree relative
Age of onset is childhood
Genetic: HLA association
Tests for T1DM/T2DM?
HbA1c glycated Hb (average level of glucose in the previous 3 months) >48mmol/mol
Random plasma glucose (taken anytime) >11mmol/L on 1 occasion if symptomatic or 2 occasions if asymptomatic
Fasting plasma glucose (no food or drink) >7mmol/L on 1 occasion if symptomatic or 2 occasions if asymptomatic
OGTT (2 hours after intake of glucose) >11mmol/L
What is the random plasma glucose level for T1DM/T2DM?
Random plasma glucose >11mmol/L
Normal target would be 4-7mmol/L
Mx for T1DM?
Conservative
- Healthy balanced diet
- Smoking cessation
- Regular exercise
- Reduced alcohol
- refer to education programme DAFNE
- refer to specialist team for individual care plan
Medical
- NICE target is 48mmol/L HbA1c (measure every 3months)
- Insulin therapy: rapid/short acting (quick onset of action/short duration) given 30 minutes before meal
- Insulin therapy: intermediate/long acting (slow onset of action/long duration) given once a day
Mx for T2DM
Conservative
- Healthy balanced diet: vegetables, low carb, high fibre
- Smoking cessation
- Control risk factors e.g. hypertension, hyperlipidaemia, CVD
- Regular exercise
- Reduced alcohol
Medical
-NICE target is 48mmol/L HbA1c (measure every 3months)
- 1st line low dose Metformin, then Increase Metformin dose
- 2nd line add: sulfonylurea (gliclazide), thiazolidinedione (pioglitazone), DPP-4 inhibitor (sitagliptin) or SGLT-2 inhibitor (empagliflozin).
What is the action of metformin?
Drug class called biguanide. Lowers blood glucose by increases insulin sensitivity
What are the common side effects of Metformin?
Abdominal pain, diarrhoea
Disadvantages of pioglitazone?
Weight gain, fluid retention.
Examples of insulin injection?
Rapid acting, 30 mins before meal, novorapid, weight gain,
Long acting, once a day, levemir, weight gain, self injecting.
