Diabetes and complications

Question 1

diabetes mellitus

Answer 1

chronic, progressive disease.
hyperglycaemia
absolute or relative insulin deficiency (insulin resistance)
risk of microvascular and microvascular complications

Question 2

diagnosis of diabetes

Answer 2

hba1c >48mmol/L

fasting plasma glucose >7

2hr OGTT 75g >11

random plasma glucose >11.1

Question 3

how do we classify diabetes

- type 1

Answer 3

type 1: beta cell destruction leading to absolute insulin deficiency. childhood/failure of insulin secretion. at risk of DKA

Question 4

how do we classify diabetes

- type 2

Answer 4

progressive insulin secretory defect (B cell dysfunction) usually associated with insulin resistance. middle aged/elderly. weight gain and obesity.

Question 5

other specific types of diabetes

Answer 5

genetic defects- beta cell function, MODY, insulin action

disease of exocrine pancreas (structural problem with the pancreas e.g chronic pancreatitis, pancreatic cancer) “type 3 diabetes”

drug or chemical induced e.g. steroids

Question 6

gestational diabetes mellitus

Answer 6

any degree of glucose intolerance developing during pregnancy that is not clearly other forms of diabetes (t1dm/t2dm)

tends to disappear after pregnancy

Question 7

evidence of insulin secretory failure

Answer 7

low levels of plasma insulin

plasma or urine c-peptide

Question 8

indicators of type 1

Answer 8

child/youg adult
weight loss
osmotic symptoms
type 1 diabetes antibodies

Question 9

type 2 diabetes indicators

Answer 9

adult
overweight/obese
fhx
osmotic symptoms

GAD, IA2, ZnT8 antibody negative
absence of urine or plasma ketones
abundant plasma urine
plasma or urine c-peptide

Question 10

complications of diabetes

Answer 10

acute / chronic
acute: hypoglycaemia and hyperglycaemia (DKA, HHS)

chronic: microvascular and microvascular. diabetic foot

Question 11

microvascular disease complications

Answer 11

diabetic retinopathy
diabetic nephropathy
diabetic peripheral neuropathy

Question 12

microvascular disease complications

Answer 12

MI
stroke
peripheral artery disease

Question 13

risk factors for diabetes

Answer 13

glucose
BP
lipids
smoking

Question 14

mechanism of glucose causing complications

Answer 14

see slides

Question 15

diabetic foot ulceration

Answer 15

neuropathy and ischaemic with secondary infections

50% of pure neuropathic develop from haemorrhage within callus= trauma and cracking of dry skin, less sweating, punched out

10-30% are ischaemic= pressure= tissue necrosis= looked ragged edged on margins of feet

neuropathic oedema= increasing skin pressure

prevention focused on limiting occurrence of complications then protecting at risk foot with close observations

Question 16

Charcot neuro arthropathy

Answer 16

?

Question 17

aims of treatment

Answer 17

control symptoms
restore QOL
prevent acute diabetic emergencies
delay and prevent chronic complications
strong emphasis on self care
evidence-based therapies

Question 18

treatment of type 1 diabetes

Answer 18

subcutaneous insulin injections
continuous subcut insulin infusions

pancreas transplant strategies
whole pancreas
islet cell transplants

treatment of other risk factors for vascular disease- BP, lipids, smoking cessation

Question 19

treatment of type 1 diabetes

Answer 19

subcutaneous insulin injections
continuous subcut insulin infusions

pancreas transplant strategies
whole pancreas
islet cell transplants

treatment of other risk factors for vascular disease- BP, lipids, smoking cessation

Question 20

type 2 diabetes treatment

Answer 20

prevention of T2DM for 42-48mmol
lifestyle intervention

metformin
sulfonylureas
pioglitazone (contraindicated in HF, osteoporosis and bladder cancer)
glp-1-analogues (up and coming)
DPP4 inhibitors
SGLT2 inhibitors
insulin
obesity treatment including bariatric surgery

Question 21

acute complications of diabetes

Answer 21

DKA
hypoglycaemia
foot disease- infection, vascular supply, pressure
macrovascular disease
microvascular disease (laser retinopathy, ACE inhibitors for renal disease)

fixed rate insulin infusion
0.1 units per kg
IV fluids and potassium

Question 22

DKA pathway

Answer 22

check this

K+ replacement
IV fluids