Diabetes Flashcards
what is normal BG levels?
3.5 - 8 mmol/L
what is T1DM?
autoimmune destruction of the pancreatic B cells. Occurs in genetically susceptible individuals/triggered by an environmental antigen.
Features of T1DM? what causes these?
thirst - due to electrolyte losses
polyuria - osmotic diuresis with high glucose
weight loss - fluid depleted
DKA
what is the diagnostic criteria for DM?
fasting glucose >7
random glucose >11.0
How do you manage T1DM?
EDUCATE - foot care/healthy weight/stop smoking
DIET - low in sugar/high in starchy carbs/low fat
BG MONITORING
INSULIN - long acting morning and night and short acting before food
what are some complications of insulin treatment?
hypoglycaemia, lipohypertrophy, local allergic reaction, insulin resistance, weight gain
what are the features of hypoglycaemia?
symptoms <3.0mmol/L glucose
hunger, sweating, pallor, tachycardia, unconscious, fit
Mx for hypoglycaemia?
glucogel, IV dextrose
what is T2DM?
polygenic disorder, linked with central obesity. B cell mass is reduced by 50% and there is peripheral insulin resistance
features of chronic T2DM presentation?
reduced energy, visual problems, recurrent candida infections
what is the treatment pathway for a patient with T2DM?
- Dietary/lifestyle advice
- Metformin (biguanide)
- Metformin + Sulfonyluria
- Add in insulin therapy (increasing doses)
how does Metformin work? what are the side effects?
Reduces glucose production by the liver & sensitises tissues to insulin
SE = anorexia and diarrhoea
name a sulfonylurea, how do they work and SE?
Glibenclamide - they increase insulin secretion
SE = hypoglycaemia
what is DKA?
uncontrolled catabolism and insulin deficiency. Absent insulin causes increased hepatic gluconeogenesis and osmotic diureses by the kidneys –> dehydration
- peripheral lipolysis –> increased circulating free fatty acids –> liver –> ketosis –> metabolic acidosis
features of DKA?
profound dehydration and vomiting
eyes sunken/reduced tissue turgor/dry tongue/low BP
kussmauls resp
abdo pain
what are Ix findings for DKA?
BG > 11 blood ketones > 3 acidosis < 7.3 urine stix - glycosuria/ketonuria UE - raised creatinine
How do you manage DKA?
- 0.9% NaCL 500mL over 15 mins to rehydrate
- Insulin + fluids (including potassium)
- once BG has gone down - give fluids + K + dextrose and start an insulin regime
what are the features of hyperosomolar hyperglycaemic state?
uncontrolled DM
hyperglycaemia, hyperosmolality, no ketones
dehydration, osmotic diuresis
what are the macrovascular complications of diabetes? how do you manage this?
major risk factor for atherosclerosis, increased risk of stroke/IHD/hyperlipidaemia
Mx: control BP/stop smoking/statin
name some microvascular complications of diabetes?
retinopathy, neuropathy, nephropathy
what are the two types of diabetic retinopathy?
proliferative
non-proliferative
name some features of diabetic eye disease on fundoscopy?
dot and blot haemorrhages
new leaking vessels
exudates
cotton wool spots
how can you manage diabetic retinopathy?
laser photocoagulation of new vessels
stop smoking
good glycaemic control
how does diabetes damage the kidneys?
glomerular disease
ischaemic lesions
ascending UTIs
what are the signs of diabetic neuropathy
symmetrical sensory neuropathy
loss of vibration and pain first
“walking on cotton wool”
what are the complications of diabetic neuropathy?
unrecognised trauma
ulcers
neuropathic arthropathy (Charcot’s joint)
some findings O/E of vascular disease
thin skin absent hair bluish discolouration reduced skin temp absent pulses
