Diabetes Flashcards
Define Diabetes mellitus
chronic abnormally high blood glucose levels
what are the 5 types of DM?
-type 1
-type 2
-MODY
-LADA
-gestational
(-prediabetes)
Define type 1 diabetes.
- chronic tendency to an abnormally high blood glucose due to decreased production of insulin
- this is due to an autoimmune destruction of beta islet cells in the pancreas
- presents in early life/early adulthood
- usually gen unwell +/- DKA
Define type 2 diabetes.
- tendency to abnormally high blood glucose due to reduced sensitivity of cells to insulin therefore leading to a decreased uptake of glucose
- relative deficiency in insulin due to increased adipose tissue
- HbA1C >48mmol
define prediabetes.
- not met requirements for T2DM diagnosis yet but at risk of developing it in the next few year
- monitor closely + lifestyle advice
- HbA1C 42-47
define gestational diabetes.
increased blood glucose in pregnancy
may have consequences for mother and baby
Define MODY
mature onset diabetes of the young
- T2DM onset less than 25 y.o.
- Autosomal dominant inheritance
Define LADA
latent autoimmune diabetes in adults
older age onset of T1DM
Typical features of T1DM?
- polyuria/nocturia
- polydipsia
- weight loss
- fatigue
- DKA
Diagnostic criteria of T1DM?
> 7, >11, >48
fasting, random, average
with Sx need 1 value
w/o Sx need 2 values
Tx principles for diabetes.
- manage blood glucose levels
- monitor for complications
- modify other risk factors
What are the complications for DM?
micro:
- retinopathy
- nephropathy
- peripheral neuropathy
Macro:
- Stroke
- MI
- renal artery stenosis
- PVD
MOA of metformin?
- increase insulin sensitivity
- decrease gluconeogenesis
When is metformin contraindicated?
-eGFR <30
Moa of :
- gliptins (DPP-4 inhibitors)
- sulfonylureas
- pioglitazone
- flozins (SGLT-2 inhibitors)
- tides (GLP-1 agonists)
- GLiptINs - inhibit GLucagon secretion
- sulfonyluREAS - stimulate pancREAS to secrete Insulin
- pioglitAzone - Apidogensis + fatty acid uptake
- flOzins (SGLT-2 inhibitors) - inhibits reabsOrption of glucose in the kidney
- tides (GLP-1 agonists) - inhibits glucagon production
What is the the HbA1C target for a T2DM on medication?
53mmol
When do you start metformin for T2DM? When do you add a second medication?
- HbA1C >48mmol
- THEN add another at >58mmol
Fasting advice to muslim’s whom have DM.
Eat meal containing long-acting carbs before sunrise
Give them a BM monitor to allow them to check, particularly if they feel
unwell
Metformin – take 1/3 dose before sunrise and 2/3 after
Switch one-daily sulfonylureas to after sunset
No adjustment needed for patients taking pioglitazone
Define DKA.
Glucose >11 mmol/L or known T1DM
pH < 7.3
Bicarbonate < 15mmol/L (acidic)
Ketones >3 mmol/L or urinary ketones ++ on dipstick
Anion gap >10
How do you treat DKA?
- fluid resus
- 0.1 units/kg/hr FRII + 10% dex when BM<15
- correct hyopkalaemia
What is a complication of fluid resus in DKA that needs to be monitored for?
- cerebral oedema from IVI too quick
- headache, irritability, visual disturbances, focal neuro
What is a hyperosmolar hyperglycaemic state?
HHS - very high increased blood glucose (>40mmol) in a patient with T2DM
What are the diagnostic criteria for HHS?
- dehydration
- hyperosmolality (increased concentration of solutes due to decrease in volume)
- hyperglycaemia >30mmol (pH<7.3, low bicarb + NO KETONES)
What are the causes of HHS?
- illness - MI, stroke, infection, endocrine disturbance
- medication induced
- DM related - first presentation, poor control
