Diabetes Flashcards
What is diabetes mellitus?
What is a common symptoms of diabetes mellitus?
Diabetes - group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, action or both
- commonly associated with excessive thirst and production of large amounts of urine
How is diabetes diagnosed?
How can type of diabetes be determined?
- fasting glucose > or = 7mmol/l
- random > or = 11.1mmol/l
- and symptoms OR repeat test
- HbA1c > or = 43mmol/l
Type of diabetes:
- often type 1 is diagnosed on history and presentation e.g. DKA alone
- if in doubt, GAD/IA2 antibodies may help (increasing use)
What is type 1 diabetes?
Type 2?
Other types?
Type 1: pancreatic beta cell destruction, insulin is required for survival, usually characterised by presence of anti-GAD/anti-islet cell antibodies, lymphocytes attacking islet cell
T2DM: associated with obesity and sedentary lifestyle, amyloid (fatty deposits) on islet cell, reduction in production of insulin
Others:
- monogenic (MODY) - inherited gene mutation HNF1 alpha
- secondary causes e.g. drugs, pancreatic pathology
- gestational
List some conditions associated with insulin resistance:
- intra-abdominal obesity
- inactivity
- genetics
- medication
- smoking
- fetal malnutrition
- enothelial disease
- PCOS
How is T2DM treated?
Therapy Ladder in T2DM
- diet and exercise
- oral monotherapy
- oral combination
- injectable and oral therapy
Which drugs can be used for diabetes?
- biguanide (metformin)
- sulphonylurea
- thiazolidinedione
- meglitinide
- alpha-glucosidase inhibitor
- DPP-4 inhibitors
- SGLT2 inhibitors
- GLP1 receptor agonists
- insulin
What are the aims of therapy in diabetes?
What are the complications associated with diabetes?
Aims of treatment:
- prevent hyperglycaemia
- avoid hypoglycaemia
- reduce chronic complications
Complications:
- macrovascular: IHD, stroke
- microvascular: neuropathy, nephropathy, retinopathy
- erectile dysfunction
- psychiatric
List some acute complications of diabetes:
Diabetes and dental disease?
- diabetic ketoacidosis (DKA) - type 1
- hyperglycaemia hyperosmolar syndrome (HHS) - type 2
- overlap with both occurs
Dental aspects of diabetes:
Higher risk of periodontal disease
- high glucose - poor wound healing/increased infection/xerostomia
- small blood vessel change - reduced blood flow
Risk factors:
- poor glucose control
- poor OH
- smoking
- additional drug treatment
- eating disorders common in T1DM
What does sick day rules indicate?
What are the sadman rules?
Sugar - blood glucose can increase when pt is ill
Insulin - never stop insulin or oral medications
Carbohydrate - ensure patient maintains hydration and carbohydrate intake
Ketones - should be medically checked
SADMAN - there are several drugs that should be temporarily stopped in conditions that could lead to complications:
SGLT2 inhibitors, ACE inhibitors, Diuretics, Metformin, ARBs, NSAIDs
Before treatment of a diabteic patient, what should you consider?
Does the pt need to fast?
- NO: treat as usual
- YES: medication may require adjustment
Will pt be able to eat and drink soon after procedure?
- YES: continue prescribed medication
- NO: review medication
Presence/risk of infection?
What are the symptoms of hypoglycaemia?
How is it treated?
Early: sweating, palpitations, hunger
Later signs: confusion, drowsiness, odd behaviour, speech difficulty, lack of coordination, unconsciousness
Sometimes no obvious signs or symptoms
Treatment:
- provide a starchy carbohydrate snack
- consider hospital admission for IV glucose infusion for people treated with oral hypoglycaemic medication
