Diabetes Flashcards
Define Diabetes
Diabetes is a metabolic disorder due to an absolute or relative lack of endogenous insulin, characterised by elevated blood glucose levels. Overtime it leads to metabolic and vascular complications.
Tell me about T1DM
Caused by autoimmune destruction of pancreatic B cells which leads to an absolute insulin deficiency.
Usually diagnosed in childhood with patient presenting w/ polyuria, polydipsia, low weight or with DKA.
Can be associated with other Autoimmune conditions
What is DKA?
An acute complication of uncontrolled diabetes ( typically T1DM).
An absolute insulin deficiency and increased glucagon results in no glucose utilisation, the body switches to fat oxidative metabolism to generate ATP with the production of ketone bodies as a by-product.
Ketones bodies accumulate and cause a metabolic acidosis.
The severe hyperglycaemia ( reduced glucose utilisation and increased gluconeogenesis ) causes osmotic diuresis which leads to dehydration. Ketonaemia may also cause vomiting -> further dehydration.
Tell me about T2DM
Occurs due to insulin resistance and B cell dysfunction. Theres a relative insulin deficiency and insufficient glucose uptake. Usually presents later ( though now presenting at younger ages).
Patients present with polyuria, polydipsia, the complications of diabetes
What role does genetics play in diabetes?
T1DM - only 30% concordance in MZs
T2DM - 80% concordance in MZs
What are the complications of Diabetes?
Hyperglycaemia - DKA, HONK Hypoglycaemia Increased risk of infection Poorer wound healing Macrovascular Microvascular
the macrovascular include
- MI, PVD, Cerebrovascular event
Microvascular
- retinopathy, nephropathy and peripheral neuropathy
- > important for patient to engage with regular screening -> fundoscopy, ACR, foot check
Whats significant about the presentation of MI in a diabetic patient?
They may not have chest pain due to autonomic neuropathy
Management of macrovascular complications
Manage the other cardiovascular risk factors
- control BP
- smoking
- Lipids
- HbA1c below 6%
Confirm a diagnosis of DM
- If symptomatic ( polyuria, polydipsia, underweight) and raised venous glucose detected once either fasting ≥7mmol or random ≥11.1mmol
- If asymptomatic with raised venous glucose on 2 separate occasions ( as above ) or a 2hr OGTT value of ≥11.1
What is an OGTT?
Patient fast overnight
given 75g of glucose in 300ml water to drink in the morning
venous plasma glucose measured after 2hrs
value of ≥11.1mmol = diabetes diagnosis
What is included in the conservative management of a patient with diabetes?
MMM
MDT, Monitoring, Modification lifestyle
*MDT - Management of patient with DM should involve GP, endocrinologist, specialist nurses and dieticians and chiropodists.
* Monitor patient ( 4Cs)
- their glycaemic Control
- Complications
- Competency ( with insulin injections, checking injection sites)
- Coping - Depression, occupation, coping at home.
What lifestyle modifications would be recommended for diabetic patients?
!!!SSS
DELAYS
Diet ( cal intak, less refined more complex carbs, more soluble fibre, less sat fat, less salt, avoid excess alcohol )
Exercise
Lipids - statin for primary prevention if over 40yrs
ABP - reduce salt and alcohol intake. keep BP below 130/80
Aspirin
- as 1º CVD prevention if over 50yrs or other risk factors
Yearly / 6 months check ups
Smoking cessation
What is the BP med of choice for diabetics?
ACEinhibitors
because B blockers can mask hypoglycaemic events ( they block sympathetic activity )
and thiazides can increase glucose levels
How would you manage a patient with Diabetes?
engage with MDT .... 1. Lifestyle modification 2. Start metformin 3. Metformin + Sulfonylurea 4 additional therapy regular follow ups
Who is started on metformin
who shouldn’t be given metformin?
someone who’s HbA1c is still higher than target after lifestyle changes
CI in patients with GFR <30,
