Diabetes Flashcards
Diagnostic criteria for DKA
Hyperglycaemia (blood glucose >11)
Acidosis (pH <7.3)
Ketosis (blood ketones > 3mmol/l)
Insulin therapy and potassium
Insulin drives potassium into cells
Serum potassium can be high or normal without insulin - kidneys work to balance this (overall potassium low)
Insulin treatment can cause hypokalaemia, can lead to fatal arrythmias
Presentation of DKA
Hyperglycaemia Dehydration Ketosis Metabolic acidosis (with a low bicarbonate) Potassium imbalance
Management of DKA
FIGPICK
F - Fluids - resuscitation
I - Insulin - Actrapid
G - Glucose - monitor (dextrose infusion if falls below certain level
P - Potassium - monitor
I - Infection - treat potential underlying figures
C - Chart - fluid balance
K - Ketones - monitor
Dangers of not cycling injection sites
Lipodystrophy
Subcat fat hardens, insulin not properly absorbed
Symptoms of hypoglycaemia
Tremor Sweating Irritability Dizziness Pallor
Treatment of hypoglycaemia
IM glucagon
IV dextrose
Macrovascular Complications of diabetes
Coronary artery disease is a major cause of death in diabetics
Peripheral ischaemia causes poor healing, ulcers and “diabetic foot”
Stroke
Hypertension
Microvascular Complications of diabetes
Peripheral neuropathy
Retinopathy
Kidney disease, particularly glomerulosclerosis
Infection Related Complications
Urinary Tract Infections
Pneumonia
Skin and soft tissue infections, particularly in the feet
Fungal infections, particularly oral and vaginal candidiasis
Risk Factors in T2DM
Non-Modifiable
Older age
Ethnicity (Black, Chinese, South Asian)
Family history
Modifiable
Obesity
Sedentary lifestyles
High carbohydrate (particularly refined carbohydrate) diet
Glucose levels in pre-diabetes
HbA1c – 42-47 mmol/mol
Impaired fasting glucose – fasting glucose 6.1 – 6.9 mmol/l
Impaired glucose tolerance – plasma glucose at 2 hours 7.8 – 11.1 mmol/l on an OGTT
Diagnosis of T2DM
HbA1c > 48 mmol/mol
Random Glucose > 11 mmol/l
Fasting Glucose > 7 mmol/l
OGTT 2 hour result > 11 mmol/l
Management of T2DM
Dietary Modification
Optimise Other Risk Factors
Monitoring for Complications
What does metformin do?
Increases sensitivity to insulin
Decreases liver production of glucose
Second line treatment of T2DM
Sulfonylurea
Pioglitazone
DPP-4 inhibitor
SGLT-2 inhibitor
Side effects of metformin?
Diarrhoea and abdominal pain. This is dose dependent and reducing the dose often resolves the symptoms
Lactic acidosis
Does NOT typically cause hypoglycaemia
What is Pioglitazone?
Thiazolidinedione
Increases insulin sensitivity and decreases liver production of glucose
Side effects of Pioglitazone
Weight gain Fluid retention Anaemia Heart failure Extended use may increase the risk of bladder cancer Does NOT typically cause hypoglycaemia
Most common sulfonylurea
Gliclazide
Stimulate insulin release from the pancreas
Side effects of sulfonyluria
Weight gain
Hypoglycaemia
Increased risk of cardiovascular disease and myocardial infarction when used as monotherapy
What is the function of incretins?
Increase insulin secretions
Inhibit glucagon production
Slow absorption by the GI tract
Main incretin - GLP-1
Incretins inhibited by DPP-4
Most common DPP-4 inhibitor
Sitagliptin
Inhibits DPP-4 enzyme and therefore increases GLP-1 activity
SIde effects of sitagliptin
GI tract upset
Symptoms of upper respiratory tract infection
Pancreatitis
Examples of SGLT-2 inhibitors
Empagliflozin
Canagliflozin
Dapagliflozin
How do SGLT-2 inhibitors work
Block the SGLT-2 glucose reuptake channels in the proximal tubules
Side effects of SGLT-2 inhibitors
Glucoseuria (glucose in the urine)
Increased rate of urinary tract infections
Weight loss
Diabetic ketoacidosis, notably with only moderately raised glucose. This is a rare complication
Lower limb amputation appears to be more common in patients on canagliflozin. It is not clear if this applies to other SGLT-2 inhibitors
Rapid Acting Insulins
Start working after around 10 minutes and last around 4 hours
Novorapid
Humalog
Apidra
Short-acting Insulins
Start working in around 30 minutes and last around 8 hours
Actrapid
Humulin S
Insuman Rapid
Intermediate-acting Insulins
Start working in around 1 hour and last around 16 hours
Insulatard
Humulin I
Insuman Basal
Long-acting Insulins
Start working in around 1 hour and lasts around 24 hours
Lantus
Levemir
Degludec (lasts over 40 hours)
What do combination insulins contain?
Rapid acting and Intermediate acting insulin
