Diabetes and Treatment Flashcards by Grace Eaton

what is fasting blood glucose?

4.0-5.9 mmol/L

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what is fasting blood glucose?

4.0-5.9 mmol/L

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what is the blood glucose level after a meal ?

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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

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what are the symptoms of type 1 diabetes ?

frequent urination, 
excessive thirst, 
extreme hunger, 
dramatic weight loss, 
irritability,
weakness and fatigue,
nausea and vomiting

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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)

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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

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what are the major risk factors for microvascular complications in patients with diabetes ?

hypertension, hypercholesterolaemia, smoking, obesity

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what is the blood glucose level after a meal ?

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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

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what are the symptoms of type 1 diabetes ?

frequent urination, 
excessive thirst, 
extreme hunger, 
dramatic weight loss, 
irritability,
weakness and fatigue,
nausea and vomiting

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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)

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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

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what are the major risk factors for microvascular complications in patients with diabetes ?

hypertension, hypercholesterolaemia, smoking, obesity

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what are the major complications form diabetes ?

wounds which won’t heal leading to amputation, heart disease, stroke, kidney failure, retinopathy leading to blindness

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what therapy is given for type 1 diabetes ?

injectable insulin via pen or pump devices

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what therapy is given for type 2 diabetes ?

oral - metformin, sulphonylureas, glitazones, DPP4 inhibitor, SGLT2 inhibitor
injectable - GLP-1 agonist, insulin via pen devices

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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 ?

1. dextrose, fruit juice, coke etc. 2. hypostop, honey on inside of cheeks 3. 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