Diabetes classification, diagnosis and management Flashcards
At what age does type 1 diabetes mellitus present?
It usually has adolescent onset however it can occur at any age
What is the cause of type 1 diabetes mellitus?
Autoimmune attack of the insulin secreting beta cells of the pancreas. This means that patients are insulin dependent.
What is latent autoimmune diabetes of adults (LADA)?
It is slower progression autoimmune destruction of pancreatic beta cells resulting in a form of type 1 DM that progresses to insulin dependence later in life.
At what age does type 2 DM present and what population has higher prevelence of it?
It usually presents over 40 but is starting to present younger and younger, it has higher prevelence in asians, men and the elderly.
What is the cause of type 2 diabetes mellitus?
Increased insulin resistance and decreased insulin secretion
What is maturity onset diabetes of the young?
Rare autosomal dominant form of type 2 diabetes that affects young people
What are the pancreatic causes of diabetes mellitus?
Pancreatic surgery (more than 90% removed)
Pancreatic cancer
Pancreatic destruction (haemochromatosis, cycstic fibrosis)
Trauma
What drugs can cause DM?
Steroids, anti-HIV drugs, newer anti-psychotics
What are the criteria for metabolic syndrome?
Central obesity (BMI over 30) Two of: BP over 130/85 triglycerides over 1.7mmol/L fasting glucose >5.6mmol/L or type 2 DM
What are the three WHO diagnostic criteria for DM?
- Symptoms of hyperglycaemia (polydipsia, polyuria, weight loss, visual blurring, genital thrush, lethargy)
- Raised venous glucose on two seperate occasions (fasting >7mmol/L and random >11.1mmol/L) Or oral glucose tolerance test >11.1mmol/L
- Hba1c >48mmol/mol
How do the presentations of type 1 and type 2 DM typically differ?
Type 1 typically present with polydipsia, polyuria, weight loss and lethargy
Type 2 are typically asymptomatic and are picked up following complications e.g. MI
What is the first stage of type 2 diabetes control?
Diet, weight control and exercise
What is the first line medication for type 2 DM?
Metformin standard release
What is the cut of Hba1c beyond which second line treatments should be tried?
58mmol/mol which is around 7%
What are the types of oral hypoglycaemic agents for treating type 2 DM?
Biguanides e.g. metformin DPP4 inhibitors glitazone Sulphonureas SGLTIs GLP1 agonists
How does metformin work?
Metformin increases insulin sensitivity, it is weight neutral and has side effects of nausea and diahorrea
Lactic acidosis with renal failure
How do DPP4 inhibitors work?
E.g. sitagliptin - they work by inhibiting an enzyme that destroys the hormone incretin
How does pioglitazone work?
It increases insulin sensitvity it has the side effects of hypoglycaemia, fractures, fluid retention, deranged LFTs and increased weight
How does sulphonurea work?
e.g. gliclazide, It works by increasing insulin secretion, it has the side effects of hypoglycaemia and it causes increased weight
How does SGLTI work?
e.g. empagliflozin, They reduce glucose reabsorption in the kidneys
How do GLP analogues work?
e.g. exenatide, They mimic incretin which augument insulin release (increases release from pancreas, slows gastric emptying so slower peak in glucose) it also reduces appetite
It is used for obese patients
For type 1 DM what are the 4 main types of insulins?
Ultra-fast acting (novorapid) - inject at the start of each meal or just after
Isophane insulin -cheap but very old and unpredictable peak
Pre-mixed insulins - NovoMix - (30% short acting 70% long acting)
Long acting human insulin analogues (insulin glargine) e.g. lantus - typically used at bedtime - no peak so good for night hypoglycaemia
What is a biphasic insulin regime?
Novomix is given twice daily premixed insulins - for people with regular lifestyles
What is a QDS insulin regime?
4 injections daily (3 short acting, one long acting)
3 ultra fast before meals and one long acting at night (lantus)
For flexible lifestyles
What is DAFNE?
Dose adjusted for normal eating - training in how to adjust dosing improves gycaemic control
What is the proper procedure for measuring a patients blood glucose?
Both of you wash hands
Gloves and apron
Sterilise finger using skin wipe
Finger should be milked to trap blood and the a sterile lancet is used on the lateral side of the finger
First drop is wiped away and second drop should be touched with the strip
Make sure not to touch finger
Any abnormal results should be repeated and then strip and lancet should be put in sharps bin
What colour are ketones and glucose test strips?
Ketones are green and glucose are blue
How would you explain to a patient how to do home glucose monitoring?
- Ensure that the patient has a good supply of lancets and glucose test strips, a glucose test meter, and a sharps bin
- Tell them to start by washing their hands
- Insert the test strip to turn the meter on and prepare a new lancet
- Choose which finger to prick, the sides of the end segment of the finger are best, advise to avoid the pad or close to the nail, and advise against using the index finger or thumb. Advise to rotate fingers, and use a different finger each time you test
- Hold the test strip against the blood until the meter bleeps
- Dispose of the lancet and test strip in the sharps bin
- Record the reading in a diary
What is the dose of metformin, when would you increase it? What drugs do you add if this isnt working?
initial dose is 500mg daily that can be titrated up to a dose of max 2g a day if the target of 48mmol/mol is not met
If 58mmol/mol is reached then can start a second agent for example sitagliptin, add a third agent if still above 58mmol/L
What is the dietary advice to give to type 2 diabetics?
Encourage high fibre, low glycaemic index food carbs such as Toast and pasta
Try to reduce saturated fats
Aim for weight loss of 5-10% if overweight
Why do you get polydipsia and polyuria with diabetes?
, high glucose content causes water to be dragged out of the body as the excess glucose is being excreted in the urine
What is the difference between MODY 1/3 and MODY 2?
1/3 respond well to oral hypoglycaemics and mody 2 does not
