Diabetes Mellitus Flashcards
describe the two main types of diabetes mellitus
type 1:
- inability to produce insulin due to destruction (autoimmune or idiopathic) of pancreatic B cells
- juvenile onset
type 2:
- gradual insulin resistance/insensitivity AND/OR B cells fail to secrete enough insulin
- usually adult onset, related to obesity
describe 3 other common types of diabetes mellitus
MODY (maturity onset diabetes of the young)
- inherited form of type 2; strong family history of DM
LADA (latent autoimmune diabetes of adulthood)
- variant of type 1 that occurs post puberty w/ more gradual onset
gestational diabetes
- not uncommon in pregnancy
which type of DM is most prevalent
T2D
what is the main characteristic of DM and what are some other presentations of DM
key characteristic = hyperglycaemia
- polyuria
- polydipsia
- nocturia
- glycosuria
- fatigue
- blurred vision
- signs of macro/micro vascular disease e.g. retinopathy, nephropathy, stroke, MI
- numb/tingling hands and feet
- weight loss (T1D)/weight gain (T2D)
- infections, delayed healing
- ↑appetite
- acetone breath (T1D)
what are some of the complications of DM
- hypoglycaemia (from insulin treatment)
- -> treat w/ sugary drink or IV dextrose in severe cases
- chronic hyperglycaemia
- -> CVD
- -> nephropathy
- -> retinopathy
- diabetic ketoacidosis
- -> life threatening; severe hyperglycaemia, acidosis, dehydration, K+ imbalance
- -> give insulin, fluids and manage K+ imbalance
what are some investigations that can be done in suspected DM
- fasting plasma glucose: >7mmol/L (126mg/dL)
- random plasma glucose: >11mmol/L (200mg/dL) (+symptoms)
- HbA1c: >48mmol/mol (6.5%)
- glucose tolerance test (for borderline): impaired in DM
- urine dip for glucose
outline what different levels of HbA1c indicate
- <42mmol/mol (6%) = normal
- 42-47mmol/mol (6-6.4%) = pre-diabetes
- > 48mmol/mol (6.5%) = diabetes
what is the normal range for fasting plasma glucose
usually 3.4-6.2mmol/L
from other sources:
- <6.9mmol/L
- <7.8mmol/L at 2hrs after 75g oral glucose load (glucose tolerance test)
at what level of blood glucose would you expect to see glucose in urine, and why
- blood glucose >10mmol/L
- renal capacity for reabsorption is exceeded
how does ketoacidosis occur from diabetes
- ↓insulin
- switch to fat metabolism
- B-oxidation of FFAs
- ketones (present in urine)
what are the first and second line drug treatments for T2D
first line = metformin
second line = GLP-1 RA or SGLT2i (if established or ↑risk of CVD)
what are the options of medical treatment for diabetes
- biguanides (metformin)
- sulfonylureas
- incretins
- -> glucagon like peptide-1 analogue (GLP-1 RA)
- -> dipeptidylpeptidase IV inhibitors (DPP4i)
- sodium-glucose co-transport 2 inhibitors (SGLT2i)
- thiazolidonediones
- meglitinides
- aGlucosidase inhibitors
- insulin therapy
outline the management of DM
- subcutaneous insulin
- -> background long acting once daily
- -> short acting before meals
- monitoring
- -> dietary carbs
- -> blood glucose; morning/night/at meals
- -> HbA1c 3-6 monthly
- lifestyle changes may be sufficient for T2D but if not use oral medication
