Diabetes Flashcards
what is the general resting fasting blood glucose
4-7mmol/L
true/false - blood glucose tends to decrease with age
false - it increases
cutoff for diabetes - fasting plasma glucose
> 7mmol/L
cutoff for diabetes - 2hr plasma glucose tolerance tesrt
> 11.1mol/L
cutoff for diabetes - HbA1c
> 48mmol/mol
predibetes cutoff for fasting plasma glucose
6.1-6.9mol/L
prediabetes cutoff for 2hr glucose tolerance test
7.8-11.0mol/L
prediabetes cutoff for HbA1c
42-47mmol/mol
cutoff normal glucose fasting tolerance
<6.0mol/L
cutoff normal glucose 2hr tolerance test
<7.7mol/L
cutoff normal HbA1c
<41mmol/mol
what is C peptide a measure of and when may it be useful
measures endogenous insulin production as a byproduct of insulin production
measures intrinsic insulin production as s/c or IV insulin do not have C peptide
pancreatic disease leading to diabetes
CF haemachromatosis pancreatic cancer alcohol/chronic pancreatitis acute pancreatitis
what positive blood test must type 1 diabetics have
pancreatic autoantibodies
presentation of diabetes
asymptomatic polyuria high blood glucose blurred vision genital thrush fatigue weight loss lost vision diabetic ketoacidosis HHS
microvascular complications hyperglycaemia
retiniopathy
nephropathy
neuropathy
macrovascular complications of hyperglycaemia
MI/ACS
stroke
peripheral vascular disease
dislipidaemia may help contribute to hypertension
what is HbA1c and why is it of value
glycated Hb, absorbed into RBC and binds to Hb and due to 3/4 month lifespan on erythrocyte it estimates diabetic activity over 3/4 months
when is HbA1c not of good use
haemolytic anaemia
pregnancy
recent blood loss
target for HbA1c
48-58mmol/mol
48 for new diabetics or if possible
53 for all diabetics
58 for those on triple therapy/insulin or if others unachievable
what HbA1c target is high and considered a risk for DKA
> 75mmol/mol
at what random glucose would ketones need measured for risk of DKA
> 15mol/L
what other treatments may be used in addition to diabetes management to prevent cardiovascular complications
antiplatelet therapy
antihypertensives
cholesterol control (statins)
what % weight loss may result in remission for diabetes 2
10/15%
what dietary modifications should be made for type 2DM
reduce fat intake
increase fruit modestly and veg aggressively
reduce salt
safe alcohol consumption
normal unrefined carbs but less refined carbs
exercise therapy
what HbA1c target is used for the elderly with dementia
there isnt, treat symptomatically in line with end of care
what one action is key to global t2dm prevention
weight reduction
describe diabetes incidence and prevalence in scotland
indicence is stable for 5 years but prevalence is increasing - likely due to increased lifespan
barriers for preventing diabetes
health inequality
evaluating if the programme works
obesogenic environment
identifying those at high risk and engaging them
overcoming identifying those at high risk of T2D
screen for impaired glucose tolerance and others
overcoming health inequality for those at risk of T2DM
no easy fix at all
overcoming obesogenic environment?
sugar tax
political agenda, supported by food industry and healthcare professionals
evaluating if the healthcare programme is working
high quality data collection
DIRECT clinical trial used what method to try and induce diabetes remission
complete diet replacement at 830kcal for 12-20 wks
stepped 400kcal meal introduction every 2-3 weeks and stepping up exercise
findings of DIRECT clinical trial?
almost 1/2 came off diabetes meds for >2m and had HbA1c<48mmol/mol
80% of those who lost >10kg remained in remission for >12 months
non modifiable risk factors for type 2 diabetes
family history
ethnicity
age
modifiable risk factors for type 2 diabetes
sedentary lifestyle
energy dense diet
overweight/obese
how much sustained weight loss is recommended in overweight/obese people
> 5%
nutrition - what should be reduced in type 2 diabetes
energy dense foods and drinks
fast foods
alcohol
sedentary behaviour
nutrition - what should be encouraged in type 2 diabetes
lower energy foods/drinks
moderate/vigorous activity
self weighing
describe carb counting in type 1 diabetes
identifying foods containing carbohydrate and counting content
calculating insulin dose to cover carbohydrates eaten
causes of hypoglycaemia is type 1 diabetes
missed/delayed meal alcohol too much insulin increased physical activity not enough carbohydrate in meal
why does alcohol cause hypoglycaemia in type 1 diabetes
inhibits gluconeogenesis and enhances effects of insulin
reducing risk of hypoglycaemia in type 1 diabetes
carry emergency supply of CHO
check blood glucose regularly
dont consume alcohol on empty stomach
how much physical activity should an adult have a week
150 mins moderate/75 mins vigorous activity a week with 2 days strength training
how much physical activity should a child 5-18 have per day
1 hour
how much physical activity should a child <5 have a day
180 mins of being active
describe the peak incidence of type 1 diabetes
10-15 but can occur from 6m to 70-80s
true/false - T1DM is more common in Caribbean populations
false - it is more common in white
what % of diabetics are type 1
around 10%
true/false - most of those with diabetes are in wealthy countries and 1/3 are undiagnosed
false - most are in middle/low income countries and 1/2 are undiagnosed
what factors have influence over health inequalities
socioeconomic status education rural LGBT gender ethnicity cultural factors
what is the fat storage threshold
insulin resistance occurs when fat can no longer be stored in s/c fat and spills over FFA to viscera
describe how FFA spilling over to viscera causes insulin resistance
fat in muscle, liver, pancreas causes pooer glucose reception so poorer insulin release
in functional beta cells they produce more insulin to counter this
in genetic disposition, there are vulnerable beta cells to cannot cope with higher blood glucose
what other conditions other than diabetes is insulin resistance associated with
polycystic ovarian syndrome
hypertension
hyperlipidaemia
hyperglycaemia - even in absent diabetes
microvascular complications of diabetes
neuropathy
nephropathy
retinopathy
macrovascular complications of diabetes
cardiovascular disease
peripheral vascular disease
cerebrovascular disease
solutions to fingerprick glucose monitoring
continuous glucose monitoring
flash glucose monitoring
what are possible disadvantages of continuous glucose monitoring
cost
pt doesnt like having it attached
20 min delay in reading as measures interstitial glucose
what are the units used in flash glucose monitoring
mg/dl
lifestyle activities needing attention for living with diabetes
diet previous/upcoming activities exercise taking insulin 15 mins before meals blood glucose monitoring hypoglycaemai appointments blood pressure/ cholesterol management work pregnancy
what is diabetes distress
affective state from constant worry and adherence with diet, exercise, blood glucose monitoring, lifestyle adjustment
how many patients with diabetes experience poor mental wellbeing/emotional distress
40-50%
only roughly 1/3 patients are asked about their wellbeing
complication of hypoglycaemia in early onset type 1 diabetes?
neurological deficit and impaired cognitive function
chronic hyperglycaemia in type 2 diabetes can lead to what psychological factors?
poorer mental and physical health
less motivation
poorer relationships
worse learning and memory
why is it important to identify emotional distress in diabetics
if not, it can lead to poorer glucose control, increased admission, greater mortality and complications due to downward spiral
how can doctors reduce psychosocial aspects of diabetes
educate the patient
listen to their perspective and refer if needed
tailor the treatment to the patients confidence, goals and support them
when should you especially ask a patient about how they feel having diabetes
after missing goals, diagnosis and onset of complications
what is type 1 diabetes
state of absolute insulin deficiency
environmental stimulus in genetically susceptible individual leads to aa pancreatic beta cell destruction
what % of those with T1DM are diagnosed before 20
85%
what % of diabetic type 1 genes are HLA II related and what specific genes does this relate to
50%
HLA-DR3-DQ2
HLA DR4-DQ8
environmental factors affecting type 1 diabetes?
seasonality timing of birth genes - 5% HLA +ve viral infection maternal factors weight gain vitamin D
what immune cell mediates the beta cell destruction in T1DM
lymphocytes
antibodies used in diagnosing T1DM
GAD65Ab IA-2Ab IAA ZnT8Ab if anti-GAD, IA-2 and ZnT8 are +ve then T1DM can be diagnosed
what T1DM Ab is most useful in older patient diagnosis
Anti-GAD(65Ab)
maternal risk factors for developing T1DM
infection age ABO mismatch stress birth order
autoimmune trigger factors for developing T1DM
viral infection
vitamin d deficiency
dietary factors
environmental factors
accelerating factors for developing T1DM
puberty diet/weight infection stress insulin resistance
true/false - C peptide should be taken at T1DM diagnosis
false - it should be taken after months/years to check intrinsic insulin function
what is LADA
late onset T1DM misdiagnosed as type 2
what is idiopathic T1DM
permanent insulinopenia and prone to DKA but no evidence of beta cell autoimmunity
african, asian with strong inheritance pattern and not HLA assd
clinical presentation demographic for T1DM
pre school and peri puberty small peak mid 30s lean acute onset severe symptoms severe weight loss ketonuria ± metabolic acidosis
symptoms of T1DM
thirst polyuria thrush weakness weight loss fatigue blurred vision infection
what should be done to manage a new T1DM pt
basal bolus insulin education - DAFNE BERTIE dietician contact carb count to insulin bolus blood glucose + ketone monitor annual HbA1c, renal, lipid, weight, BP, foot risk, retinal
safety issues in insulin prescription
wrong dose
wrong type
insulin omission
name 2 soluble insulin preparations, onset time, peak and duration
actrapid, humulin S
30-60 mins
2-4hr
5-8 hrs
name 2 insulin analogues, onset time, peak and duration
humalog, novorapid
15 mins
60-90 mins
4-5hrs
why are insulin analogues preferred over soluble insulin
faster acting and less chance of hypoglycaemia
name 2 basal dose insulin analogues, dosage time, how long they last
lantus, levemir
long acting with little peak activity
taken once or twice daily
name 2 basal insulin preparations, how long they last
insulatard, humulin I
peak 4-6hrs
long acting
