Diabetes mellitus Flashcards
Type 1 diabetes
Insulin-dependent
beta cells of the pancreas which produce insulin are completely destroyed.
Type 2 diabetes
beta cells produce too little insulin too late.
tissue responses to insulin may also be decreased (insulin resistant)- especially in overweight people.
What cells can be detected at time of type 1 diabetes diagnosis?
Islet cell antibodies
3 classic symptoms of diabetes
Polydipsia (extreme thirst)
Polyuria (extreme urine output)
Feeling tired/lethargic
Other symptoms: general itching, fluctuating vision, weight loss (type 1
Tests used to diagnose DM
Blood glucose
glycosylated haemoglobin (HbA1c)
presence of glucose in urine (not diagnostic- further investigation required)
When is a diagnosis of diabetes made?
fasting venous plasma glucose >/= 7 mmol/L and/or
random venous plasma glucose >/= to 11.1mmol/L
How is an oral glucose tolerance test carried out for borderline cases?
1) Patient fasted overnight (except water)
2) Fasted blood sample is collected
3) 75g anhydrous glucose is given orally as a sugary drink (1.75g/kg in children)
4) A second blood sample is taken after 2hrs.
5) Diabetes is confirmed if fasting plasma glucose >/= 7 mmol/L and/or 2hr post glucose load is >/= 11. 1mmol/L (difference in criteria for gestational diabetes
Fasting blood glucose levels in DM
≥7 mmol/L
2 hr post glucose load glucose level in DM
≥ 11.1mmol/L
Fasting glucose level with impared glucose tolerance
Same as DM- ≥7mmol/L
2hr post glucose load glucoe levels for impared glucose tolerance
≥7.8 mmol/L
Fasting glucose levels for impaired fasting glycaemia
≥6.1 and <7 mmol/L
2 hour post glucose load glucose levels in impaired fasting glycaemia
<7.8 mmol/L
Fasting glucose levels gestational diabetes
≥5.6mmol/L
2hrs after glucose load glucose levels in gestational diabetes
≥7.8mmol/L
Glycated haemoglobin (HbA1C) test
mainly used for monitoring blood sugar control in patients with diabetes
HbA1c of 48mmol/mol (6. 5%) = recommended cut off point for diagnosing diabetes.
A value less than this doesnt exclude diabetes
Not suitable for type 1
Acute (metabolic) complications for type 1 diabetes
Ketoacidosis- lack of insulin causes harmful substances called ketones to build up in the blood
Acute metabolic complications for type 2 diabetes
Non-ketotic hyperosmolar hyperglycaemic state- blood has too much salt, glucose and other substances
Hypoglycaemia
level <4mmol/L ‘four is the floor’
Long term complications DM
Microvascular (affecting small blood vessels
Retinopathy (damage to retina)
Neuropathy (nerve damage)
Nephropathy (kidney damage)
How can diet control manage DM?
all pts diagnosed should receive help from the dietician.
Alcohol does not cause hyperglycaemia but may result in hypoglycaemia in pts treated w insulin if taken without sufficient carbohydrates so pts should limit alcohol.
Moderate consumption may be protective for T2
1st line for type 1 diabetes
Insulin treatment- multiple daily injection basal-bolus insulin regimes. (Twice daily insulin detemir).
Side effects of insulin treatment
Hypoglycaemia, weight gain and lipodystrophy at site of injection
How is insulin prepped?
Titrated to individual need.
Achieves best glycaemic effect without causing substantial hypoglycaemia
Somogyi effect
Hyperglycaemia seen in the morning in insulin-treated pts- can be rebound hyperglycaemia, occuring due to counter-regulatory hormone release. This is due to hypoglycaemia in sleep/morning time-> evening dose of insulin required to be decreased.
Examples of rapid-acting insulin analogues
Insulin lispro, insulin aspart and insulin glutisine
Second line for type 1 diabetes if first line insulin determir is not tolerated, or twice daily not acceptable to the patient
Once daily insulin glargine
or once daily insulin degludec if nocturnal hypoglycaemia is a concern.
Once daily may also be offered for pts who need injection administration assistance.
What is not recommended for adults with newly diagnosed type 1 diabetes?
Non-basal-bolus insulin regimens (e.g. twice-daily mixed [biphasic], basal-only, or bolus-only regimens)
First line treatment for type 2 diabetes
dietary and lifestyle changes
Biguanides: Metformin
Side effects for metformin
Gastrointestinal disturbances
Weight loss (useful in overweight patients)
Lactic acidosis
Decreased Vitamin B12 absorption
no hypoglycaemia- no effect on insulin secretion
MOA of metformin
Increases glucose uptake by peripheral tissues
Reduces hepatic gluconeogenesis
Reduces appetite
Monitoring of DM
Blood glucose measurement
Glycosylated/glycated HbA1C test
Urine glucose measurement
Urine ketones measurement
What to address with type 2 patients
Hypertension, obesity and hyperlipidaemia control
Diabetes is a risk factor for heart attack, stroke, decreased blood circulation leading to gangrene
