Diabetes and Treatment Flashcards
what is fasting blood glucose?
4.0-5.9 mmol/L
what is fasting blood glucose?
4.0-5.9 mmol/L
what is the blood glucose level after a meal ?
what is the difference between type 1 and type 2 diabetes ?
in type 1 diabetes insulin is not produced in sufficient amounts
in type 2 diabetes the cells do not respond to insulin
what are the symptoms of type 1 diabetes ?
frequent urination, excessive thirst, extreme hunger, dramatic weight loss, irritability, weakness and fatigue, nausea and vomiting
what are the symptoms of type 2 diabetes ?
increased thirst, frequent or night time urination, blurry vision, unusual fatigue, dark skin around neck or armpits (acanthosis nigricans)
how is diabetes diagnosed ?
- diabetes symptoms and random plasma glucose >11.1 mol/L OR fasting plasma glucose > 7 mmol/L OR 2 hour oral glucose tolerance test > 11.1 mmol/L
- no diabetes symptoms - any 2 positive tests
- HbA1c > 48 mmol/mol
what are the major risk factors for microvascular complications in patients with diabetes ?
hypertension, hypercholesterolaemia, smoking, obesity
what is the blood glucose level after a meal ?
what is the difference between type 1 and type 2 diabetes ?
in type 1 diabetes insulin is not produced in sufficient amounts
in type 2 diabetes the cells do not respond to insulin
what are the symptoms of type 1 diabetes ?
frequent urination, excessive thirst, extreme hunger, dramatic weight loss, irritability, weakness and fatigue, nausea and vomiting
what are the symptoms of type 2 diabetes ?
increased thirst, frequent or night time urination, blurry vision, unusual fatigue, dark skin around neck or armpits (acanthosis nigricans)
how is diabetes diagnosed ?
- diabetes symptoms and random plasma glucose >11.1 mol/L OR fasting plasma glucose > 7 mmol/L OR 2 hour oral glucose tolerance test > 11.1 mmol/L
- no diabetes symptoms - any 2 positive tests
- HbA1c > 48 mmol/mol
what are the major risk factors for microvascular complications in patients with diabetes ?
hypertension, hypercholesterolaemia, smoking, obesity
what are the major complications form diabetes ?
wounds which won’t heal leading to amputation, heart disease, stroke, kidney failure, retinopathy leading to blindness
what therapy is given for type 1 diabetes ?
injectable insulin via pen or pump devices
what therapy is given for type 2 diabetes ?
oral - metformin, sulphonylureas, glitazones, DPP4 inhibitor, SGLT2 inhibitor
injectable - GLP-1 agonist, insulin via pen devices
what is the first line treatment for type 2 diabetes ?
metformin
what are the advantages of metformin ?
prevents cardiovascular complications, does not cause hypoglycaemia, aids weight loss
what are the side effects of metformin ?
GI changes - diarrhoea, vomiting, loss of appetite,
lactic acidosis, B12 deficiency
what is the dosage and timing of metformin ?
max 2g per day with or after meals
in what event should diabetes controlling drugs be stopped ?
if eGFR
what is the action of sulphonylureas ?
stimulate pancreatic beta cells to produce insulin
what are the side effects of sulphonylureas ?
hypoglycaemia, weight gain
what is the dosage and timing for sulphonylureas ?
max 160mg twice daily before meals
what is the action of glitazones ?
improve insulin resistance
what are the side effects of glitazones ?
fluid retention, haematuria (bladder cancer), increased risk of bone fracture, weight gain, hepatotoxicity
what is the dosage and timing for sulphonylureas ?
45 mg once daily taken any time
what are the advantages of incretin hormones (GLP) ?
reduce appetite and promote satiety, delay gastric emptying, reduce hepatic gluconeogenesis, stimulates release of insulin only in the presence of glucose
which enzyme is GLP inactivated by ?
DPP4
what is the action of SGLT2 inhibitors ?
removal of glucose and its associated calories via the kidney
what are the side effects of SGLT2 inhibitors ?
increased frequency of UTI, increased frequency of thrush, modest diuretic effect
what is the definition of hypoglycaemia?
any episode of low blood glucose i.e.
who is at risk of hypoglycaemia ?
individuals taking insulin or sulphonylureas
what are the symptoms of hypoglycaemia ?
autonomic - due to inactivation of autonomic nervous system, sweating, tremor, anxiety, palpitations
neuroglycopaenic - due to reduced glucose delivery to the brain, poor concentration, odd behaviour, dizziness, blurred vision
coma, death
what are the treatment options for hypoglycaemia ?
- dextrose, fruit juice, coke etc.
- hypostop, honey on inside of cheeks
- IM glucagon, IV glucose
what are the consequecnes of hypoglycaemia ?
falls, prolonged QT interval leading to arrythmia and death, repeat hypoglycaemia leading to cognitive impairment and unawareness, driving consequences
how does hypoglycaemia affect driving a car or motorcycle ?
must have awareness, no more than 1 hypo needing third party assistance in last 12 months, appropriate blood glucose monitoring
how does hypoglycaemia affect driving a lorry or bus ?
must have awareness, no hypo needing assistance in last 12 months, appropriate blood glucose monitoring, 3 monthly blood glucose readings
what type of diabetes does diabetic ketoacidosis (DKA) occur in ?
type 1
what are the criteria for diagnosis of DKA ?
all three of:
capillary blood glucose > 11 mol/L,
capillary ketones > 3 mmol/L,
venous pH
what are the precipitating factors for DKA ?
infection, new diagnosis, non compliance
what is the pathophysiology of DKA ?
acute insulin deficiency, lipolysis leading to formation of fatty acids, fatty acid metabolism leads to ketone formation, ketoacidosis, nausea and vomiting, respiratory compensation
how is DKA managed ?
fluid resuscitation, insulin infusion, screen and treat underlying infection, DVT prophylaxis
