Diabetes - Disease Flashcards
What is the definition of diabetes?
2 * fasting blood glucose of > 7 mmol/L
or
1 * 2-hour post OGTT blood glucose > 11.1
or
HbA1c > 48 mmol/L (6.5%) : values below this don’t exclude DM
What is type II diabetes mellitus?
Insulin resistant DM, often associated with hyperinsulinaemia
What is the most common age of people with TII DM?
> 40 y/o
What is the most common race of people with TII DM?
Asian and blacks
Other genetic factors/ family Hx present in these populations
What is the aetiology of TII DM?
Obesity and metabolic syndrome
Genetic predisposition
How does ketosis differ in TII DM compared to TI DM?
TII resistant to ketosis, whereas TI is ketosis prone
What are some of the typical presentation features of someone with TII DM?
Polyuria
Polydipsia - dehydration due to 2ry osmotic diuresis
Lethargy and tiredness
Weight loss
- catabolic state induced by hyperglucagonaemia
- unopposed by insulin
Blurred vision
- due to osmotic disturbance in eyes
Dermatological signs
- Boils/abcesses
- Pruritis vulvae (2ry to thrush)
Increased infection rate
Macrovascular disease
List some of the macrovascular complications as a result of TII DM
Hypertension
Ischaemic heart disease
Cerebro vascular disease
Peripheral vascular disease
- arterial ulcers = especially on feet
What does the annual review of the diabetic patient consist of?
Manage control
- HbA1c => excellent control: < 48mmol/L (6.5%)
Manage complications
- urine: microalbuminuria, neuropathy => ACE inhibitor
- feet: check sensation, vascular status, ulcers
- eyes: retinopathy, cataracts, acuity testing
Manage vascular risk
- BP: aim for 20% 10yr risk
- consider aspirin if CV risk factors
What are the causes of hypoglycaemia in patient with TII DM?
Drug error i.e. insulin overdose
Not eating but still taking medication
Sepsis
Renal impairment: drugs excreted by kidney
What are the symptoms of hypoglycaemia?
Sympathetic activation
- sweating
- tachycardia
Neuro symptoms
- Malaise and dizziness
- Confusion and innapropriate behaviour (‘act drunk’)
- Coma
How should hypoglycaemia be treated?
Unconscious: 80mls of 20% glucose IV
Conscious: 10–20 g of Glucose PO every 15 mins until normal blood glucose
What is hyperosmolar hyperglycaemic non-ketotic syndrome (HONK)?
Occurs in illness, dehydration, and inability to take diabetic medication which results in severe hyperglycaemia
What is the cause of HONK?
Sepsis / acute illness
Non compliant with anti-diabetic medication
First presentation of DM
What is the typical presentation of HONK?
Polyuria, polydipsia
N & V
Abdo pain - non-specific
Tachypnoea due to hypercapnia
Neuro symptoms: malaise, confusion, coma
Rapid weight loss
