Diabetes Mellitus Flashcards
T1DM presentation
polyuria
polydipsia
wt loss
DKA
T1DM genetics?
HLA-D3 and –D4
T1DM antibodies?
anti-islet,
anti-GAD
T2DM presentation?
polyuria
polydipsia
complications
Genetics of T2DM?
concordance in 80%
Risk factors for T2DM
obesity,
reduced exercise
calorie and alcohol excess
Diagnosis of diabetes if symptomatic
One reading of:
Fasting glucose > 7
or random > 11.1
Diagnosis of diabetes if asymptomatic
Two readings of:
Raised plasma glucose
or OGTT > 11.1 mM
OGTT: Normal people fasting glucose level?
<6.1
OGTT: Normal people 2hrs post 75g sugar glucose level?
<7.8
OGTT: diabetes fasting glucose level?
>/= 7
OGTT: diabetes 2hrs post 75g sugar glucose level?
>/= 11.1
Drugs causing DM?
Steroids
Anti-HIV
Atypical neuroletics
Thiazides
Metabolic Syndrome features
Central obesity + 2 of:
- ↑ Triglycerides
- ↓ HDL
- HTN
- Hyperglycaemia: DM, IGT, IFG
Metabolic syndrome risk
Increased risk of MI
Principles of monitoring of diabetes?
Monitor 4Cs every 6mo/year
- glycaemic Control
- Complications
- Competency (injection)
- Coping (psychosocial)
Diet modifications for diabetes?
↓ total calorie intake
↓ refined CHO, ↑ complex CHO
↑ soluble fibre
↓ fat (esp saturated)
↓Na
Statins in pts with DM?
if >40yrs regardless of lipids
Aspirin in pts with DM?
if >50yrs
or <50 with other CVD RFs
Oral hypoglycaemics?
- Biguanide
- Sulfonylurea
Biguanide example
Metformin
Solfonylurea example and dose?
gliclazide MR 30mg with breakfast
Side effects of metformin?
- nausea
- diarrhoea
- abdo pain
- lactic acidosis
CIs to metfromin?
- GFR < 30
- tissue hypoxia (sepsis, MI)
SE of gliclazide?
- hypoglycaemia
- wt gain
1st line treatment of T2DM?
Oral hypoglycaemics
+ insulin
2nd line treatment of T2DM
Biguanide
+ Sulfonylurea
+ DPP-4 inhibitor / Thiazolidinedione
When to use 2nd line mx of DM
If insulin unacceptable
3rd line treatment of T2DM?
Biguanide
+ Sulfonylurea
+ GLP-1 agonist
When to use 3rd line mx of DM
If insulin unacceptable or BMI>35
DPP-4 inhibitor example
Linagliptin
DPP-4 inhibitor mechanism of action
Inhibits incretin breakdown
Increases insulin production
Inhibits glucagon release
Thiazolidinedione example
Pioglitazone
Thiazolidinedione mechanism of action
Lowers insulin resistance
GLP-1 agonist example
Exenatide
GLP-1 agonist mechanism of action
Glucagon Like Peptide 1
Incretin analogue
Benefit of GLP-1 agonist
Weight loss
Common insulin regimes?
- BD biphasic regime
- basal-bolus regime
- OD long-acting before bed
BD biphasic insulin regime?
BD insulin mixture
30min before breakfast and dinner
(for regular lifestyle eg elderly)
Basal-bolus regime?
- Bedtime long-acting + short acting before each meal
- T1DM allowing flexible lifestyle
OD Long-Acting Before Bed
Initial regime when switching from tablets in T2DM
Short acting insulin example
Actrapid
Long acting insulin example
insulatard
SGLT-2 inhibitor example
Dapaglifozin
SGLT-2 inhibitor mechanism of action
Reduce glucose absoption in kidney
Insulin requirements during illness?
- Insulin requirements increase (even if low food intake)
- (liver always making glucose even when not eating)
Side effects of insulin therapy?
- hypoglycaemia
- lipohypertrophy
- wt gain in T2DM (give metformin to reduce wt)
Lipohypertrophy definition
Lump in skin from fat accumulation
At site of multiple insulin injections
Diabetes complications?
- Hyperglycaemia: DKA, HHS
- Hypoglycaemia
- Infection
- Macrovascular
- Microvascular
Macrovascular complications of diabetes?
MI
Stroke
Peripheral vascular disease
Ulcers
Feature of MI in DM
May be silent due to autonomic neuropathy
Features of ischaemic diabetic feet
- critical toes
- pulseless
- painful ulcers
Features of neuropathic diabetic feet
- loss of sensation
- deformity
- painless ulcers
Deformities seen in neuropathic diabetic feet
Charcot’s joints
Pes cavus
Claw toes
Abx of diabetic foot infection?
benpen + fluclox ± metronidazole
Nephropathy pathophysiology in DM?
Hyperglycaemia → nephron loss and glomerulosclerosis
Feature of nephropathy in DM?
Microalbuminuria
- urine albumin:Cr (ACR) ≥30mg/mM
Eye complications of diabetes?
- Retinopathy and maculopathy
- Cataracts
- Rubeosis iris
- CN palsies
Rubeosis iris definition
new vessels on iris → glaucoma
Ix for diabetic retinopathy?
fluorescein angiography
Background diabetic Retinopathy features?
- Dots: microaneurysms
- Blot haemorrhages
- Hard exudates: yellow lipid patches
Pre-proliferative diabetic Retinopathy features?
- Cotton-wool spots (retinal infarcts)
- Venous beading
- Haemorrhages
Proliferative diabetic Retinopathy features?
- New vessels
- Pre-retinal or vitreous haemorrhage
Stages of diabetic retinopathy
Background
Pre-proliferative
Proliferative
Diabetic Maculopathy features?
- ↓ acuity may be only sign
- Hard exudates w/i one disc width of macula
Neuropathy pathophysiology?
Metabolic glycosylation,
Reactive Oxygen Species (ROS),
Ischaemia: loss of vasa nervorum
Diabetic neuropathy signs and symptoms?
Symmetrical
Glove and stocking loss
Absent ankle jerks
Numbness, tingling, pain
Treatment of Diabetic neuropathy?
- Paracetamol
- Amitriptylin, Gabapentin, SSRI
- Capsaicin cream
- Baclofen
Diabetic Autonomic neuropathy
- Postural hypotension
- Gastroparesis
- Diarrhoea
- Urinary retention
- Erectile dysfunction
Sx of gastroparesis
Early satiety
GORD
Bloating
Rx of Postural hypotension?
fludrocortisone
Dose of metformin?
500mg after evening meal
Increasing to 2g max.
