Diabetes Assessment and Management Flashcards by Srishti D

What is diabetes?

Group of metabolic disorders
Characterised by hyperglycaemia
Due to
- Insulin secretion
- Insulin action
- Both

How well did you know this?

Not at all

Perfectly

What is chronic hyperglycaemia associated with?

Long-term damage

Dysfunction and failure of organs

How well did you know this?

Not at all

Perfectly

What is type 1 diabetes?

Autoimmune
Idiopathic
Absolute insulin deficiency secondary to pancreatic beta cell destruction

How well did you know this?

Not at all

Perfectly

What is type 2 diabetes?

Spectrum
Insulin resistance
Varying degrees of insulin secretion

How well did you know this?

Not at all

Perfectly

Why are people commonly overweight with type 2 diabetes?

They’re commonly hyperinsulinaemic > causes weight gain

How well did you know this?

Not at all

Perfectly

What causes gestational diabetes?

Pregnancy hormones

Generally have family history of diabetes

How well did you know this?

Not at all

Perfectly

What is the outcome in type 1 diabetes without insulin?

Death

How well did you know this?

Not at all

Perfectly

What is the pathophysiology of type 1 diabetes?

Genetic susceptibility
Environmental event triggers process in susceptible people
Pre-diabetic stage
- Multiple Abs in blood
Diabetes
- Insufficient insuline produced to maintain normal blood glucose
- Most beta cells destroyed

How well did you know this?

Not at all

Perfectly

Which antibodies are tested for in type 1 diabetes?

Anti-glutamic acid decarboxylase (GAD) Abs

Anti-islet Abs

How well did you know this?

Not at all

Perfectly

How can endogenous insulin production be tested for?

C-peptide in blood

How well did you know this?

Not at all

Perfectly

What is the duration of the pre-diabetic stage?

Very variable

How well did you know this?

Not at all

Perfectly

How is the pre-diabetic stage managed?

Give something to lower sugar; eg: metformin

Insulin too strong

How well did you know this?

Not at all

Perfectly

Why do you get insulin deficiency in type 2 diabetes?

Beta cell burnout

How well did you know this?

Not at all

Perfectly

What syndrome is type 2 diabetes often part of?

Metabolic syndrome

How well did you know this?

Not at all

Perfectly

What is the pathophysiology of type 2 diabetes?

Beta cell defects and insulin resistance
Major environmental factor = obesity
Genetics
- Very important
- Polygenic

How well did you know this?

Not at all

Perfectly

What is the normal fasting plasma glucose?

Less than 6.1 mmol/L

How well did you know this?

Not at all

Perfectly

What is the fasting plasma glucose if you have impaired fasting glucose?

6.1-6.9 mmol/L

How well did you know this?

Not at all

Perfectly

How is diabetes diagnosed?

Symptoms + random blood glucose >11.1 mmol/L OR
Fasting plasma glucose >7.0 mmol/L OR
HbA1c > 48 mmol/mol (6.5%)
2 hour value >11.1 mmol/L in oral glucose tolerance test

How well did you know this?

Not at all

Perfectly

When should the tests to diagnose diabetes be repeated?

In absence of unequivocal hyperglycaemia with acute metabolic decompensation

Can you diagnose someone with diabetes with a finger-prick blood glucose test?

What are the aims of treatment in diabetes?

Relieve symptoms
Prevent/delay long-term complications
Assist psychological adjustment and improve quality of life

Why is it important to control blood sugar levels early?

Increases fatigue of islet beta cells

What are the two categories of chronic complications of diabetes?

Microvascular disease

Macrovascular disease

What are the microvascular diseases that occur as a result of diabetes?

Retinopathy
Nephropathy
Neuropathy

What are the macrovascular diseases that occur as a result of diabetes?

Cardiovascular disease Peripheral vascular disease Cerebrovascular disease

What are the risks of microvascular complications of diabetes mainly related to?

``` Degree of glucose control - High HbA1c correlates with complication Duration of diabetes Degree of blood pressure control - Especially nephropathy Control of other cardiovascular risk factors - Lipids - Smoking Genetic susceptibility ```

What other major risk factors for macrovascular complications are more likely due to diabetes?

``` Hypertension - 2x prevalent as general population - Even more common in renal failure Dyslipidaemia - Worse with poor metabolic control - Often present in type 2 diabetes even when glycaemic control good ```

What is often the presentation of myocardial ischaemia in diabetes?

"Silent" - Dyspnoea on exertion common symptom - Need high degree of clinical suspicion

What cerebrovascular diseases are common in diabetes?

Transient ischaemic attack Stroke Multi-infarct dementia

Which areas are prone to ischaemia in peripheral vascular disease?

Great toe Medial surface of 1st metatarsal head Lateral surface of 5th metatarsal head Secondary infection common

What are the principals of type 2 diabetes management?

1st line - Healthy eating/weight loss if overweight - Exercise 2nd line - Oral anti-diabetic agents Self blood glucose monitoring for some patients Regular surveillance for microvascular complications Risk reduction for macrovascular complications - Blood pressure - Lipids - Smoking

How does exercise help with blood glucose control?

Increases glucose uptake into muscle Stimulates release of stress hormones > short-term glucose increase - Variable depending on intensity and duration Longer term, blood glucose levels usually decrease Improved sensitisation of muscle to exercise can last 2-3 days

When can hypoglycaemia occur after exercise?

Up to 24 hours later - if treated with insulin/sulphonylureas

What forms HbA1c?

Non-enzymatic glycation of Hb | Elevation of glucose increases percentage of glycated Hb

What is the HbA1c level proportional to?

Average blood glucose over previous 1-3 months

When is HbA1c unreliable?

Blood transfusion Blood loss Anaemia Thalassemia

What is the gold standard, or goal of control level of HbA1c?

53 mmol/mol (7%) = mean plasma glucose of 9.5 mmol/L

What complications of diabetes are benefited from intensive glycaemic control?

Microvascular

What happens with tight glycaemic control if you already have cardiovascular disease?

Increased mortality

What is the legacy effect?

Early glycaemic control reduced cardiovascular disease many years later

What is the target for HbA1c in older people, or those with multiple medical problems where hypoglycaemia poses a risk?

Higher HbA1c target

What is the current management of type 2 diabetes?

``` Diet and exercise > Oral monotherapy > Oral dual combination > Oral triple combination > Oral + insulin > Insulin ```

What is the first line therapy in type 2 diabetes?

Metformin, unless contraindicated/not tolerated

When is metformin often commenced?

At time of diagnosis in conjunction with diet and exercise

What are the advantages of metformin?

No weight gain | No major hypoglycaemia

What are the side effects of metformin?

GI intolerance main - Nausea > minimised by using slow-release form - Diarrhoea

What are the contraindications for metformin?

Renal failure | - Risk of lactic acidosis