Diabetes Mellitus Flashcards
How much of NHS’s total budget is spent on managing patients with DM?
8%
Define Diabetes Mellitus
Chronic conditions characterised by abnormally raised levels of blood glucose
How many types of DM are there and what are they?
7: T1DM T2DM Prediabetes Gestational Diabetes Maturity onset diabetes of the young (MODY) Latent autoimmune diabetes of adults (LADA) Other types
Define T1DM
Autoimmune disorder where the pancreatic insulin-producing beta cells of the islet of Langerhans are destroyed by T-cells. Thus resulting in absolute deficiency of insulin resulting in raised glucose levels.
What can poorly controlled T1DM lead to?
Diabetic Ketoacidosis, resulting in significant morbidity and mortality. Presents as nausea and vomiting, abdo pain, Kussmaul’s breathing, disorientation, confusion.
What are the main focuses of diabetes management?
Reducing incidence of MACROVASCULAR (ischaemic heart disease, stroke) and MICROVASCULAR (eye, nerve and kidney damage) complications
Define T2DM
Most common cause of diabetes. It is the relative deficiency of insulin due to an excess of adipose tissue ie. there is not enough insulin to go around all the excess fatty tissue, leading to raised blood glucose
Define Prediabetes
Term used for pts who don’t yet meet the criteria for a formal diagnosis of T2DM to be made, but are likely to develop the condition over the next few years, if no lifestyle interventions are taken.
Define Gestational Diabetes
Raised blood glucose levels during pregnancy. It is important to detect this, as if left untreated, it may lead to adverse outcomes for the mother and baby
Define MODY
Maturity onset diabetes of the young (MODY) = a group of inherited genetic disorders affecting the production of insulin. Results in younger patients developing symptoms similar to those with T2DM, ie. symptomatic hyperglycaemia with progression to more severe complications such as DKA.
Define LADA
LADA = Latent autoimmune diabetes of adults. Small group of pts develop autoimmune related diabetes later in life and they’re often misdiagnosed as having T2DM
What are less common types of DM?
Any pathological process which damages the insulin-producing cells of the pancreas may cause diabetes to develop. EG. chronic pancreatitis and haemochromatosis. Drugs may also cause raised glucose levels eg. glucocorticoids which commonly result in raised blood glucose levels.
Why do diabetes pts present with polydipsia and polyuria?
Polyuria and polydipsia are due to water being ‘dragged’ out of the body due to osmotic effects of excess blood glucose being excreted in the urine (glycosuria)
What are the 4 main investigations of blood glucose?
- Bedside finger prick blood glucose monitor
- One-off blood glucose - either fasting or non-fasting
- HbA1c measures the amount of glycosylated haemoglobin and represents the average blood glucose over the past 2-3mths.
- a glucose tolerance test - a fasting blood glucose is taken after which a 75g glucose load is taken. After 2hrs, a second blood glucose reading is then taken.
What are WHO’s diagnostic criteria?
Symptomatic patient:
- fasting glucose ≥ 7mmol/l
- random glucose ≥ 11.1mmol/l (or after 75g oral glucose tolerance test (OGTT))
In asymptomatic patients, the above criteria must be demonstrated on 2 separate occasions
WHO’s guidance on DM diagnosis using HbA1c
- ≥ 6.5% (48mmol/mol) = DM
- < 6.5% does not exclude DM (ie it is not as sensitive at fasting samples for detecting diabetes)
- in asymptomatic pts, test must be repeated to confirm diagnosis
misleading HbA1c results can be caused by increased red cell turnover.
HbA1c and fasting glucose values for prediabetes
HbA1c = 42-47mmol/mol (6-6.4%)
Fasting glucose = 6.1-6.9mmol/l
When is insulin used?
For T1DM and sometimes in poorly controlled T2DM
How is insulin administed?
SC
What are the main side effects of INSULIN?
HYPOglycaemia
Weight gain
Lipodystrophy
How is T1DM managed?
SC insulin - either analogue, human sequence of porcine
either short, immediate or long-acting
What 6 drugs can be used in management of T2DM?
Metformin Sulfonylureas Thiazolidinediones DPP-4 inhibitors (-gliptins) SGLT-2 inhibitors (-glifozins) GLP-1 agonists (-tides)
What is the first-line medication for T2DM management?
Metformin
When is metformin contraindicated?
In pts with an eGFR of < 30ml/min