Diabetes complications Flashcards
Effects of acute insulin deficiency (type 1)
Polyuria Thirst Weight loss Blurred vision Tiredness
Effects of chronic insulin deficiency
Hyperglycaemia Infections Microvascular complications (retinopathy, nephropathy, neuropathy) Hyperlipidaemia Macrovascular complications
Microvascular mechanism
Hyperglycaemia leads to formation of advanced glycation end-product (AGE)
Increased cytokines and adhesion molecules
Increased sorbitol and decreased myoninositol
Activation of protein kinase C
Results in change in blood flow, coagulation and vascular cell growth
Diabetic retinopathy
Most common cause of blindness in people aged 30-69
20% of type 2 patients have retinopathy at diagnosis
Diabetic nephropathy
Microabluminuria leading to proteinuria
Glomerular death, increased serum creatinine and low glomerular filtration rate
Results in renal failure
Diabetic neuropathy
Ulceration neuropathy
Loss of sensation in feet
Impaired healing
15% of diabetics develop foot ulcers and 5-15% of these need amputations
Capillary glucose testing
Finger prick glucose monitoring
Main monitoring method
Performed multiple times a day
Low cost
CGM
Continuous glucose monitoring
Sensors monitor interstitial glucose
Wirelessly transmits to insulin pump
Expensive
Flash glucose monitoring
Monitors interstitial glucose
Sensor worn on arm for up to 14 days
Shows current glucose and variation
Less expensive than CGM
HbA1C test
Glycosylation of haemoglobin beta chain HbA1 to form HbA1c
If more glucose is present, more haemoglobin is glycosylated
Can be automated
Insulin treatment
Reduce symptoms of hyperglycaemia
Restore glucose homeostasis
Prevent complications
Too much insulin may cause hypoglycaemia
Type 1 insulin treatment regimens
Most patients on “basal-bolus” regimes
Long acting insulin analogue and prandial rapid acting insulin (adjusted according to meal contents)
Rapid acting insulin can be administered by programmable pump
Insulin pump therapy
Used for type 1 diabetes Varies insulin administration at different times of day Insulin dose boosted at meal times Can be integrated with CGM MiniMed 508
Treating insulin resistance
Weight loss
Troglitazone may decrease risk