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MD2 Foundation > Diabetes Assessment and Management > Flashcards

Diabetes Assessment and Management Flashcards

1
Q

What is diabetes?

A 
Group of metabolic disorders
Characterised by hyperglycaemia
Due to
- Insulin secretion
- Insulin action
- Both
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2
Q

What is chronic hyperglycaemia associated with?

A

Long-term damage

Dysfunction and failure of organs

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3
Q

What is type 1 diabetes?

A

Autoimmune
Idiopathic
Absolute insulin deficiency secondary to pancreatic beta cell destruction

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4
Q

What is type 2 diabetes?

A

Spectrum
Insulin resistance
Varying degrees of insulin secretion

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5
Q

Why are people commonly overweight with type 2 diabetes?

A

They’re commonly hyperinsulinaemic > causes weight gain

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6
Q

What causes gestational diabetes?

A

Pregnancy hormones

Generally have family history of diabetes

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7
Q

What is the outcome in type 1 diabetes without insulin?

A

Death

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8
Q

What is the pathophysiology of type 1 diabetes?

A

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

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9
Q

Which antibodies are tested for in type 1 diabetes?

A

Anti-glutamic acid decarboxylase (GAD) Abs

Anti-islet Abs

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10
Q

How can endogenous insulin production be tested for?

A

C-peptide in blood

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11
Q

What is the duration of the pre-diabetic stage?

A

Very variable

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12
Q

How is the pre-diabetic stage managed?

A

Give something to lower sugar; eg: metformin

Insulin too strong

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13
Q

Why do you get insulin deficiency in type 2 diabetes?

A

Beta cell burnout

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14
Q

What syndrome is type 2 diabetes often part of?

A

Metabolic syndrome

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15
Q

What is the pathophysiology of type 2 diabetes?

A 
Beta cell defects and insulin resistance
Major environmental factor = obesity
Genetics
- Very important
- Polygenic
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16
Q

What is the normal fasting plasma glucose?

A

Less than 6.1 mmol/L

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17
Q

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

A

6.1-6.9 mmol/L

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18
Q

How is diabetes diagnosed?

A

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

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19
Q

When should the tests to diagnose diabetes be repeated?

A

In absence of unequivocal hyperglycaemia with acute metabolic decompensation

20
Q

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

A

No

21
Q

What are the aims of treatment in diabetes?

A

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

22
Q

Why is it important to control blood sugar levels early?

A

Increases fatigue of islet beta cells

23
Q

What are the two categories of chronic complications of diabetes?

A

Microvascular disease

Macrovascular disease

24
Q

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

A

Retinopathy
Nephropathy
Neuropathy

25
Q

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

A

Cardiovascular disease
Peripheral vascular disease
Cerebrovascular disease

26
Q

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

A 
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
27
Q

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

A 
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
28
Q

What is often the presentation of myocardial ischaemia in diabetes?

A

“Silent”

  • Dyspnoea on exertion common symptom
  • Need high degree of clinical suspicion
29
Q

What cerebrovascular diseases are common in diabetes?

A

Transient ischaemic attack
Stroke
Multi-infarct dementia

30
Q

Which areas are prone to ischaemia in peripheral vascular disease?

A

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

31
Q

What are the principals of type 2 diabetes management?

A

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

32
Q

How does exercise help with blood glucose control?

A

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

33
Q

When can hypoglycaemia occur after exercise?

A

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

34
Q

What forms HbA1c?

A

Non-enzymatic glycation of Hb

Elevation of glucose increases percentage of glycated Hb

35
Q

What is the HbA1c level proportional to?

A

Average blood glucose over previous 1-3 months

36
Q

When is HbA1c unreliable?

A

Blood transfusion
Blood loss
Anaemia
Thalassemia

37
Q

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

A

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

38
Q

What complications of diabetes are benefited from intensive glycaemic control?

A

Microvascular

39
Q

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

A

Increased mortality

40
Q

What is the legacy effect?

A

Early glycaemic control reduced cardiovascular disease many years later

41
Q

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

A

Higher HbA1c target

42
Q

What is the current management of type 2 diabetes?

A 
Diet and exercise >
Oral monotherapy >
Oral dual combination >
Oral triple combination >
Oral + insulin >
Insulin
43
Q

What is the first line therapy in type 2 diabetes?

A

Metformin, unless contraindicated/not tolerated

44
Q

When is metformin often commenced?

A

At time of diagnosis in conjunction with diet and exercise

45
Q

What are the advantages of metformin?

A

No weight gain

No major hypoglycaemia

46
Q

What are the side effects of metformin?

A

GI intolerance main

  • Nausea > minimised by using slow-release form
  • Diarrhoea
47
Q

What are the contraindications for metformin?

A

Renal failure

- Risk of lactic acidosis

MD2 Foundation (42 decks)

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