Diabetes and its treatment Flashcards
What is type 1 diabetes
Insulin deficiency
What is type 2 diabetes
Impaired B-cell function and/or loss of insulin sensitivity (insulin resistance)
Symptoms of diabetes
Glucosuria (glucose in urine)
Polyuria, thirst (increased volume and frequency of urine)
Fatigue and malaise
Blurred vision
Infections (e.g. candidiasis)
Extra symptoms of type 1
Weight loss
Ketoacidosis (N&V, acetone breath)
extra symptoms of type 2
Complications (secondary)
altered mental state
What are normal glucose levels (fasting and random)
Fasting- <7.0mmol/L
Random <11.1mmol.L
How is diabetes diagnosed
If patient is presenting with signs/symptoms and levels of plasma glucose are as below, then positive diagnosis:
- Fasting>7mmol/L
- Random>11.1mmol/L
- Plasma glucose concentration >11.1mmol/L 2h after 75g glucose in an oral glucose tolerance test
- HbA1c> 48mmol/mol
What does the HbA1c test show
Shows glycated haemoglobin
-Indicator of glycemic control during the previous 2-3 months
IF a person is asymptomatic, how is diabetes diagnosed
Two abnormal test results are needed (preferably using same test)
What are the test results like when there is impaired glucose tolerance
Fasting<7
random or OGTT>7.8<11.1 mol/L (still under the normal range but on the higher end)
What are the test results like when someone has impaired fasting glycaemia
Fasting>6.1<7mmol/L
What is the HbA1c like for someone who is pre-diabetic
42-47 (do annual screening /give lifestyle advice)
What is ketogenesis
Synthesis of ketone bodies by the liver from fatty acid breakdown products
What are the ketone bodies produced during ketogenesis
Acetoacetate which turns into B-hydroxybutyrate and acetone
(normally a small amount in blood)
When is there increased ketogenesis
In starvation and in diabetes mellitus so there is an excess of ketones
What does an excess of ketones do
cause metabolic acidosis (decrease in blood pH)
What inhibits and stimilates hepatic ketogenesis
Inhibited by insulin
Stimulated by glucagon
What are the different types of insulins and when would you use them
-Short acting (before meals) i.e. analogues
Intermediate-acting (isophane)
Long-acting (insulin zinc suspension and analogues)
Biphasic (pre-mixed) - mix of short and intermediate acting insulins
–> Use them depending on the patient. They are made to suit life-style of patients
What is the basal/bolus treatment programme
Long acting insulin (Basal) given which lasts for 24h and short acting insulin is given prior to every meal (Bolus)
What are the twice daily injections programme
Short and intermediate acting insulin injections
Where are insulin injections given
outer thighs
Lower abdomen
Upper outer arms
Buttocks
Why are patients asked to rotate injection sites of insulin
To avoid lipodystrophy (which is lipoatrophy and lipohypertrophy) in some sites
What are insulin pumps and what do they do (and who can use them)
Type 1 only
Continuous subcutaneous insulin infusion
-Continuous basal dose, with patient activated bolus doses at meal times
When are insulin injections given
(short acting soluble insulin for urgent treatment)
For fine control in serious illness
IN diabetic ketoacidosis
In surgery- peri-operative
Secondary causes of diabetes
Endocrine- Cushing’s, acromegaly, pheochromocytoma (excess adrenaline)
Pancreatic disease- chronic pancreatitis, surgery, CF, tumour
Genetic disorders- Down’s syndrome, Prader-Willi
Drug induced- steroids, beta blockers, diuretics
What is the first step in the treatment of diabetes
Diet/ lifestyle interventions trialled for 3 months
What is the second step in treatment of diabetes and what are the cautions
Metformin (first in line but caution in renal impairment)
or
Sulphonylurea or DDP-4 inhibitor or pioglitazone or SGLT-2 inhibitor
What is the third step in treatment of diabetes
Dual therapy
What is the fourth step in treatment of diabetes and what do you do if this dousing work
Triple therapy
-Start insulin- then intensify insulin regime or add drugs
action of metformin
Decrease gluconeogenesis and increase glucose utilisation
Action of sulphonylureas and prandial glucose regulators
Stimulate insulin secretion
-Via blockade of islet B cell ATP sensitive K+ channel
Mode of action of pioglitazone
PPAR y (gamma) agonists which boost the action of insulin
What is the incretin release like in type 2 diabetes
Slower than a ‘normal’ patient
Mode of action of GLP-1
Incretin mimetics
Mode of action of DDP-4
Block enzyme that degrades incretins
What do both DDP-4 and GLP-1 mimetic do (they are drugs used in incretin based therapy)
Promote insulin release reduce glucagon secretion reduce gastric emptying Promote satiety Reduce hepatic glucose production
What is the sodium glucose co-transporter 2 inhibitor drug (SGLT-2)
Side effects?
Inhibits renal glucose reabsorption by inhibits SGLT2 in renal PCT. Increases urinary glucose excretion and decreases blood glucose
Urinary tract infections
POlyuria
Dehydration
