Diabetes Mellitus Flashcards
Think of a definition for DM?
Persistent hyperglycaemia due to insulin deficiency (type 1) or insensitivity (type 2).
Insulin physiology:
- What cells produce insulin?
- Where are these cells found?
Beta-cells
Pancreatic inlets - islet of Langerhans
Presentation:
Which type tends to have a more insidious and subtle onset? - Daddy
What complication does Type 1 DM present with?
What complication does Type 2 DM present with?
Type 2
DKA
MI
Symptoms:
Why do they get polydipsia and polyuria?
Why do they get polyuria?
Why do they get polyphagia?
These make up the 3P’s.
With glycosuria, your kidneys may not take enough blood sugar out of your urine before it passes out of your body.
(1) Increased blood glucose levels.
(2) When blood glucose levels get high, your kidneys produce more urine in an effort to remove the extra glucose from your body.
(3) Meanwhile, because your body is losing fluids, your brain tells you to drink more in order to replace them.
Normally, your kidneys absorb blood sugar back into your blood vessels from any liquid that passes through them.
The body can’t convert the food you eat into energy. This lack of energy causes an increase in hunger.
Symptoms:
Why do they get weight loss?
What swells in the eye causing temporary blurring of vision?
Why do they get genital thrush?
In people with diabetes, insufficient insulin prevents the body from getting glucose from the blood into the body’s cells to use as energy.
When this occurs, the body starts burning fat and muscle for energy, causing a reduction in overall body weight.
The lens swells due to raised blood sugars
High glucose in urine gives the yeast the perfect environment to grow in leading to thrush
Symptoms:
Why do they muscle cramps?
Why do they get tiredness?
An imbalance or deficiency of any of these minerals can lead to the excitability of nerve and muscle tissue and result in excessive muscle contractions or cramps
A high sugar diet results in the loss of minerals such as magnesium, potassium, and calcium in the urine.
With diabetes, fatigue is caused by a number of factors, including:
- High blood sugar levels, either from a lack of the insulin or from insulin resistance, can affect the body’s ability to get glucose from the blood into cells to meet our energy needs.
Signs:
Most signs are rare at presentation except neuropathy!!
Neuro:
- Give 2 reasons why they get peripheral neuropathy? - Why do they get postural hypotension?
- Diabetes can cause dorsal column disease affecting balance. What test can be done to look for this?
(1) Over time, uncontrolled high blood sugar damages nerves and interfere with their ability to send signals, leading to diabetic neuropathy.
(2) High blood sugar also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
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Diabetes can also damage the nerves supplying your blood vessels, which in turn can lead to a drop in blood pressure upon standing up or any other sudden movements where your blood vessels may find it hard to adjust.- dysautonomia
Romberg’s test - lack of proprioception when eyes are closed:
Dorsal column - fine touch, vibration, proprioception
Signs:
Eyes:
- Why do they get xanthelasma?
- What happens leading to sight loss?
- DM cause mononeuritis multiplex which leads to paralysis of the muscles within or surrounding the eye. What is the technical name for this?
Mouth:
- Why do they get oral candidiasis? - 3
Legs:
- Why do they ulcers when they cut themselves?
- LOOK UP Necrobiosis lipoidica
Why are they more susceptible to infections?
What is lipoatrophy and why is it associated with insulin use?
Due to risk factors - high level of lipids in blood - obesity
Retinopathy
Ophthalmoplegia
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High glucose in saliva
Poor resistance to infection
Dry mouth (low saliva levels) can contribute to oral thrush.
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Narrowed arteries can also reduce blood flow to the feet amongst some people with diabetes and this can impair the foot’s ability to heal properly.
When the foot cannot heal, a foot ulcer can develop.
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As high blood sugar levels can weaken the patient’s immune system defences.
In addition, some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the body’s vulnerability to infection.
Localized loss of fat tissue.
As a result of subcutaneous injections of insulin
Diagnosis:
Fasting glucose:
- How many hours do they fast for?
- Over what conc is it classed as hyperglycaemic? - mmol/L
Random glucose:
- Over what conc is it classed as hyperglycaemic? - mmol/L
OGTT:
- What does it stand for?
- Describe the 3 steps?
- Over what conc is it classed as hyperglycaemic? - mmol/L
HbA1c:
- What does measure?
- Over what conc is it classed as hyperglycaemic? - mmol/mol
7/11 by beyonce - to remember which way round it is
8 hrs or overnight
> # 7 mmol/L11.1 mmol/L - same as OGTT
Oral glucose tolerance test
(1) Fast overnight
(2) Measure glucose 1 hr before glucose drink
(3) Measure glucose 2 hrs after
> # 11.1 mmol/LAverage blood glucose (sugar) levels for the last two to three months.
> 48 mmol/mol
Management - Drugs:
Type 1:
- What needs to be initiated straight away?
- Where does this need to happen?
Type 2:
- What 2 things can be started?
Why do they need a flu vaccine?
ACEi/ARB are started to control BP. Under what BP target is used for:
- Type 1
- Type 2
Statins:
- Over what age is this prescribed for type 1?
- For type 2, they have prescribed statins if they get >10% on the ____ algorithm. Fill the blank.
<140/90 - same as person w/o diabetes
Same-day referral to hospital diabetes team to initiate insulin
Oral hypoglycaemic agents Insulin ---- They have a weakened immune system \+ they are likely to have complications from the flu ====== <135/85
> 40 yrs old
QRISK algorithm
Management - HbA1C monitoring:
What is the aim?
How often is it checked if they are well controlled?
What if they aren’t;t well controlled?
48 mmol/mol
6 months
3 months
Management - Annual review:
How is CVD risk checked? - 2
Renal:
- What 2 things are checked for kidney disease?
- What is microalbuminuria an early sign of?
What is done to look for retinopathy?
What clinical exams are done for neuropathy? - 4
What should you also ask men about that they might find quite embarrassing?
BP, lipids
U+E
Urine albumin
Diabetic nephropathy
Retinal photography - look up
Motor exams
Sensory exams
Eyes exam
Feet check - ulcers
Erectile dysfunction
Complications:
Microvascular:
(1) Neuropathy - what is the distribution of the neuropathy described as? How does the neuropathy feel? - 3
(2) Retinopathy - 2 presentations?
(3) Nephropathy - what is it?
Glove and stockings distribution
Numbness
Tingle - pins and needles
Pain
Diplopia - due to ophthalmoplegia
Blurring
Damage to the kidneys
Complications:
Macrovascular - 3 diseases that DM results in
Others:
- What 2 things contribute to the development of a diabetic foot?
Complications in:
- Type 1 - 2
- Type 2
Why do you have to be cautious about DKA’s on those with SGLT2 inhibitors?
MI
Cerebrovascular events
PVD
Vasculopathy Neuropathy ==== DKA Hypoglycaemia
Hyperosmolar hyperglycaemic state (HHS)
It can cause a DKA with normal or moderately raised glucose!!!
Diabetic Neuropathy (Autonomic)
What is the effect on the following:
- BP
- Brain
- Vagal neuropathy
- GI - 2
- Urine
- Sexual
- Gustatory
Postural BP drop
Reduced cerebrovascular autoregulation
Loss of resp sinus tachycardia
Gastroparesis and diarrhoea
Urinary retention
Erectile dysfunction
Gustatory sweating
