DIABETES Flashcards
how is t2dm diagnosed?
fasting plasma glucose >7
OGTT >11
HbA1c of >48
how is ‘pre-diabetes’ diagnosed?
fasting plasma glucose <7
OGTT between 7.8 - 11
HbA1c of 42-47
what are the risk factors of t2dm?
south asian male gender obesity lack of exercise calorie and alcohol excess
what are the 3 mechanisms by which insulin lowers blood glucose levels?
DECREASES hepatic gluconeogenesis
INCREASE in glucose uptake in adipose tissue and muscle (GLUT4)
what are the symptoms of hyperglycaemia?
polyuria, polydipsia, visual blurring, genital thrush, lethargy, recurrent infections
why do hyperglycaemic patients often feel thirsty?
kidneys attempt to excrete excess glucose from blood. Glucose is a solute, so water follows, causing dehydration
explain the pathophysiology of t2dm…
liver, adipose tissue and muscle INSENSITIVE to actions of insulin
AND / OR
beta cell dysfunction, causing decreased levels of insulin
what dietary interventions should be suggested for an obese patient with t2dm?
low calorie ketogenic diets - high fat, medium protein, low carb (preferred)
low glycaemic index diet - second choice
what are the differentials if a patient presents with polyuria?
diabetes
hypercalaemia
diabetes insipidus
what is the difference between diabetes insipidus and melitus?
insipidus is caused by pituitary pathologies, causing increased water excretion due to ADH disfunction
no glucose in urine of pt with insipidus!!
what are the main symptoms of hypercalcaemia?
TATT polyuria OR anuria muscle aches urinary stones headaches depression arhythmias (although uncommon)
you have been asked to discuss the implications of a t2dm diagnosis with a patient. How would you go about this?
- explain t2dm in lay terms
- lifestyle advice
- dietary change
- potential long term complications
- medical management
- management of cardiovascular risk
what are the names of 3 educational programmes that address t2dm?
XPERT
DESMOND
DAFNE
which tests make up the annual diabetes review workup?
lipid profile HbA1c urine albumin creatinine ratio eGFR diabetic foot exam fundoscopy
explain the algorithm for t2dm pharmacological management…
- lifestyle
- metformin
- metformin + ddp4 / glicazide / sglt2 / thiazolidinedione
- metformin + 2 of above
5a. insulin therapy
5b. metformin + sulfonyl urea + GLP1 agonist
what type of drug is metformin?
biguinide
the ‘gliptins’ belong to which family of hypoglycaemics?
DPP4 inhibitors
what is the mechanism of action of the ‘flozins’?
SGLT2 inhibition
what is the function of GLP1?
released by the intestine in response to food, it has 4 effects;
- increases insulin secretion
- decreases hepatic gluconeogenesis
- delays gastric emptying
- increases satiety
the ‘azides’ belong it which family of hypoglycaemia drug?
sulfonylureas
which is the only hypoglycaemic drug to cause hypos?
sulfonylureas e.g. glicazide
the ‘tides’ are belong to which family of hypoglycaemics?
GLP1 analgoues
pioglitazone is an example of which class of hypoglycaemic drug?
thiazolidineiones
what is mature onset diabetes of the young (MODY)?
a type of t2dm
rare, autosomal dominant
affects young people
