Diabetes and complications Flashcards
diabetes mellitus
chronic, progressive disease.
hyperglycaemia
absolute or relative insulin deficiency (insulin resistance)
risk of microvascular and microvascular complications
diagnosis of diabetes
hba1c >48mmol/L
fasting plasma glucose >7
2hr OGTT 75g >11
random plasma glucose >11.1
how do we classify diabetes
- type 1
type 1: beta cell destruction leading to absolute insulin deficiency. childhood/failure of insulin secretion. at risk of DKA
how do we classify diabetes
- type 2
progressive insulin secretory defect (B cell dysfunction) usually associated with insulin resistance. middle aged/elderly. weight gain and obesity.
other specific types of diabetes
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
gestational diabetes mellitus
any degree of glucose intolerance developing during pregnancy that is not clearly other forms of diabetes (t1dm/t2dm)
tends to disappear after pregnancy
evidence of insulin secretory failure
low levels of plasma insulin
plasma or urine c-peptide
indicators of type 1
child/youg adult
weight loss
osmotic symptoms
type 1 diabetes antibodies
type 2 diabetes indicators
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
complications of diabetes
acute / chronic
acute: hypoglycaemia and hyperglycaemia (DKA, HHS)
chronic: microvascular and microvascular. diabetic foot
microvascular disease complications
diabetic retinopathy
diabetic nephropathy
diabetic peripheral neuropathy
microvascular disease complications
MI
stroke
peripheral artery disease
risk factors for diabetes
glucose
BP
lipids
smoking
mechanism of glucose causing complications
see slides
diabetic foot ulceration
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
Charcot neuro arthropathy
?
aims of treatment
control symptoms restore QOL prevent acute diabetic emergencies delay and prevent chronic complications strong emphasis on self care evidence-based therapies
treatment of type 1 diabetes
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
treatment of type 1 diabetes
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
type 2 diabetes treatment
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
acute complications of diabetes
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
DKA pathway
check this
K+ replacement
IV fluids
