Diabetes Mellitis + DKA, HHS, Hypos Flashcards
Compare the patho of Type I vs Type II Diabetes
Type I: Autoimmune destruction of the insulin-producing β cells of the islets of Langerhans in the pancreas
Type II: Relative deficiency of insulin due to an excess of adipose tissue ‘insulin resistance’
How does Type I diabetes present
- Polyuria
- Polydipsia
- Weight loss
- May present with DKA: abdo pain, vomiting, ↓consciousness
How does Type II diabetes present
- Often picked up incidentally on routine blood tests
- Polydipsia
- Polyuria
What causes polyuria and polydipsia in a diabetes?
Water being ‘dragged’ out of the body due to the osmotic effects of excess blood glucose being excreted in the urine (glycosuria).
List 5 ways to check blood glucose
- Capillary blood glucose - finger-prick glucose monitor
- One-off blood glucose, fasting or non-fasting
- HbA1c
- Glucose tolerance test
- Flash Glucose Monitoring (e.g. FreeStyle Libre)
What does HbA1c tell us?
Measures the amount of glycosylated haemoglobin and represents the average blood glucose over the past 2-3 months
Explain the glucose tolerance test
A fasting blood glucose is taken after which a 75g glucose load is taken
After 2 hours a second blood glucose reading is then taken
What is the WHO criteria for diagnosing type II diabetes?
If patient is symptomatic:
- fasting glucose ≥ 7.0 mmol/l
- random glucose ≥ 11.1 mmol/l (or after OGTT)
If patient is asymptomatic: above criteria must be demonstrated on two separate occasions
Answer the following:
HbA1c ≥ ______% (48 mmol/mol) is diagnostic of diabetes mellitus
But an HbA1c less than this does not exclude diabetes
6.5
3 Principals of Diabetes management
- drug therapy to normalise blood glucose levels
- monitoring for and treating any complications related to diabetes
- modifying any other risk factors for other conditions such as CVD
Management of Type I diabetes
- Subcutaneous insulin regimes
- Monitoring dietary carbohydrate intake
- Monitoring blood sugar levels on waking, at each meal and before bed
- Monitoring for and managing complications, both short and long term
List 2 S/Es of Insulin
- Hypoglycaemia
- Lipodystrophy
- Weight gain
What are the 2 main insulin therapies?
- Basal Bolus Regimes
- Insulin Pump
Explain the Basal Bolus Regime?
Basal → long acting insulin, typically in the evening, gives a constant background insulin throughout the day
Bolus → short acting insulin, usually 3 times a day before meals. Also injected according to the number of carbohydrates consumed during snacks
List 2 examples of Rapid-acting Insulin?
How long do these take to start working and how long do these last?
eg. Novorapid, Humalog, Apidra
Start working after around 10 minutes and last around 4 hours
List 2 examples of Short-acting Insulins?
How long do these take to start working and how long do these last?
eg. Actrapid, Humulin S, Insuman Rapid
Start working in around 30 minutes and last around 8 hours
List 2 examples of Intermediate-acting Insulin?
How long do these take to start working and how long do these last?
eg. Insulatard, Humulin I, Insuman Basal
Start working in around 1 hour and last around 16 hours
List 2 examples of Long-acting Insulins?
How long do these take to start working and how long do these last?
eg. Lantus, Levemir, Degludec (lasts over 40 hours)
Starts working in around 1 hour and lasts around 24 hours
What are Combination Insulins?
List 2 examples
Contain a rapid acting and an intermediate acting insulin.
In brackets is the proportion of rapid to intermediate acting insulin
eg.
- Humalog 25 (25:75)
- Humalog 50 (50:50)
- Novomix 30 (30:70)
What is an Insulin Pump?
What are the 2 types?
Small devices that continuously infuse insulin at different rates to control blood sugar levels
Types:
- Tethered pump
- Patch pump
What is needed to qualify for an insulin pump funded by the NHS?
Child needs to be over 12 and have difficulty controlling their HbA1c
List 3 advantages and 3 disadvantages of an insulin pump over a basal-bolus regime?
Advantages:
- Better blood sugar control
- More flexibility with eating
- Less injections
Disadvantages
- Difficulties learning to use the pump
- Having it attached at all times
- Blockages in the infusion set
- Small risk of infection
Medical management of Type II Diabetes?
In order of stepping up
- Initial drug treatment → Metformin
- Dual therapy → Metformin + pioglitazone or DPP‑4 inhibitor or sulphonylurea
- Triple therapy → using above medications OR insulin therapy
- metformin + sulfonylurea + GLP1 memetic
Medical management of Type II diabetes if Metformin is not tolerated?
In order of stepping up
- Gliptin or Sulfonylurea or Pioglitazone
- (Gliptin + Pioglitazone) or (Gliptin + Sulfonylurea) or (Pioglitazone + Sulfonylurea)
- Insulin
List 4 drug classes use to treat Type II Diabetes
- Biguanides
- Sulfonylureas
- SGLT-2 inhibitors
- DPP-4 inhibitors
- Thiazolidinediones
- GLP-1 analogues
- Intestinal Alpha-Glucosidase Inhibitors
Example of a Biguanide
Mechanism of action?
Eg. Metformin (first line)
MoA: Increases peripheral insulin sensitivity, decreases hepatic gluconeogenesis
Side effects of Metformin?
Contraindications?
S/E: diarrhoea, abdo pain, lactic acidosis
Contraindications: eGFR < 30 ml/min
Example of a Sulfonylureas
Mechanism of Action?
S/E
Eg. Gliclazide
MoA: Stimulate pancreatic beta cells to secrete insulin
S/E: Hypoglycaemia, weight gain, hyponatraemia