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Phase 2 (again) > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Types of Diabetes Mellitus

A
  1. Type 1
  2. Type 2
  3. MODY - maturity onset diabetes of the young
  4. Pancreatic diabetes - pancreatitis, surgery, cancer
  5. Endocrine diabetes - acromegaly, Cushing’s
  6. Malnutrition related diabetes
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2
Q

Define Diabetes Mellitus

A

A disease in which the body is unable to produce/respond to insulin normally, resulting in abnormal carbohydrate metabolism and increased blood glucose

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3
Q

Type 1 pathology

A

Autoimmune disease in which beta cells are destroyed resulting in cessation of insulin production. Glucose can’t be transported into cells -> high blood glucose

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4
Q

Type 2 pathology

A

Peripheral insulin resistance -> more insulin produced to have same effect (beta cell hyperplasia), normoglycaemia -> amylin secretion by beta cells -> beta cell hypoplasia and hypotrophy -> decreased insulin production -> high blood glucose

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5
Q

RF T2DM (10)

A
  1. > 40yrs
  2. Men
  3. South Asian, Black-Caribbean, Black-African (>25y)
  4. Obesity
  5. Hypercholesterolaemia
  6. Sedentary lifestyle
  7. Family history
  8. HTN
  9. Smoking & alcohol
  10. PCOS (polycystic ovary syndrome)
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6
Q

Diagnosis of T2DM

A
  1. Symptoms and 1 abnormal blood glucose test (fasting>7mmol/L, random >11.1mmol/L)
  2. 2 abnormal blood glucose tests (as above, oral glucose tolerance test 2h >11.1mmol/L)
  3. Abnormal HbA1c
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7
Q

HbA1c level ranges

A

Normal <42mmol/mol
Pre-diabetic 42-47mmol/mol
Diabetic >48mmol/mol

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8
Q

When to avoid HbA1c

A
  1. Pregnancy
  2. Type 1
  3. Children
  4. Haemoglobinopathies
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9
Q

Symptoms of hyperglycaemia

A
  1. Polydipsia
  2. Polyphagia
  3. Glycosuria
  4. Polyuria
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10
Q

Explain symptoms of hyperglycaemia

A

High blood glucose damages nephrons, causing glycosuria. High osmolarity of filtrate draws in water - polyuria. Dehydration from polyuria causes polydipsia. Cells starved of glucose causes hunger and weight loss due to lipo and proteolysis.

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11
Q

Diagnosis of T1DM

A
  1. Fasting glucose (8h w/o food) >7mmol/L
  2. Random glucose >11.1mmol/L
  3. Hyperglycaemic symptoms with 1 or more of
    • Ketoacidosis
    • Rapid weight loss
    • Onset <5y/o
    • BMI<25
    • FHx of autoimmune disease
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12
Q

RF T1DM (2)

A
  1. HLA-DR3, HLA-DR4 gene (FHx autoimmune disease)

2. PMH of autoimmune disease

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13
Q

T1DM treatment

A

Insulin

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14
Q

T2DM management

A
  1. Lifestyle and diet modification (low sat fat, sugar, high starch-carb)
  2. Monotherapy - metformin
  3. Dual therapy (if HbA1c >58mmol/mol)
    • Metformin + DDP4 inhibitor
    • Metformin + pioglitazone
    • Metformin + sulphonylurea (SU)
    • Metformin + SGLT-2i
  4. Triple therapy (if HbA1c >58mmol/mol)
    • Metformin + DDP4 inhibitor + SU
    • Metformin + pioglitazone + SU
    • Metformin + SU/pioglitazone + SGLT-2i
    • Insulin based therapy
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15
Q

Metformin

A

Biguanide. Increases insulin sensitivity and helps with weight
SE: nausea, diarrhoea (try modified release), abdominal pain
Avoid if eGFR <36mL/min - risk of lactic acidosis

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16
Q

DPP4-inhibitors

A

E.g Sitagliptin

Block DDP4 action - enzyme that destroys incretin

17
Q

Pioglitazone

A

Increases insulin sensitivity
SE: hypoglycaemia, fractures, fluid retention, increase LFT
CI: CCF, osteoporosis, increasing weight/oedema

18
Q

Sulphonyurea

A

Increase insulin secretion

SE: hypoglycaemia

19
Q

SGLT-2i

A

Selective sodium-glucose co-transporter 2 inhibitor.

Blocks reabsorption of glucose in the kidneys and promotes secretion of excess glucose in urine

20
Q

Annual diabetic review (9)

A
  1. HbA1C test
  2. BP
  3. BMI
  4. Plasma lipids
  5. Visual acuity and retina state
  6. Urine test for proteinuria, microalbuminuria
  7. Renal function blood test - creatinine
  8. Check condition of feet, pulses, neurology
  9. Review of CV RF
21
Q

Define hypoglycaemia

A

Plasma glucose <3mmol/L

22
Q

Causes of hypoglycaemia (diabetic) (4)

A
  • Insulin or SU treatment
  • Increased activity
  • Missed meal
  • Accidental/non-accidental overdose
23
Q

Symptoms of hypoglycaemia

A

Autonomic: sweating, anxiety, hunger, tremor, palpitations, dizziness, tachycardia
Neuroglycopenic: confusion, drowsiness, visual trouble, seizures, coma

24
Q

Complications of diabetes (8)

A
  1. Vascular disease
  2. Nephropathy
  3. Diabetic retinopathy
  4. Cataracts - senile or snowflake
  5. Rubeosis iridis (new vessels on iris - lead to glaucoma)
  6. Metabolic complications
  7. Diabetic feet
  8. Neuropathy
25
Q

Treatment of hypoglycaemia (3)

A
  1. 15-20g quick-acting carbohydrate snack and recheck blood glucose after 10-15mins
  2. If conscious but uncooperative, squirt glucose gel in gums and teeth
  3. Glucose IVI or glucagon 1mg/IVI
26
Q

3 key features of Diabetic Ketoacidosis (DKA)

A
  1. Hyperglycaemia
  2. Raised plasma ketones
  3. Metabolic acidosis
27
Q

Pathogenesis of DKA

A
  1. Insufficient insulin -> unrestrained gluconeogenesis in the liver
  2. Dehydration due to osmotic diuresis in the kidneys as a result of hyperglycaemia
    3, Peripheral lipolysis -> lots of FFAs in the blood -> converted into ketones in the liver -> metabolic acidosis
28
Q

Clinical features of DKA (7)

A
  1. Dehydration (reduced tissue turgor pressure -> skin takes longer to snap back into place)
  2. Vomiting and abdominal pain (electrolyte disturbance)
  3. Sunken eyes and dry tongue
  4. Low BP
  5. Kussmaul’s breathing (deep and rapid - respiratory compensation)
  6. Fruity breath (ketones)
  7. Low body temp
29
Q

DKA investigations

A
  1. Blood glucose >11mmol/L
  2. Ketonaemia - finger prick sample measuring b-hydroxybutyrate
  3. Acidaemia - pH < 7.35
  4. Urine dipstick - glycosuria and ketouria
  5. U&E - creatinine and urea high, serum potassium high (low insulin allows to shift out cells), low total body potassium (osmotic diuresis)
30
Q

Management of DKA

A
  1. Fluid replacement - NaCl 0.9%
  2. IV glucose - 6 units/hour
  3. Electrolytes
31
Q

Symptoms of diabetic neuropathy (8)

A
  1. Numbness or reduced ability to feel temp/pain in fingers and toes, glove and stocking distribution
  2. Tingling/burning sensation
  3. Sharp pains or cramps
  4. Hypersensitivity
  5. Muscle weakness
  6. Hyporeflexia - particularly in ankle
  7. Loss of balance and coordination
  8. Foot issues - ulcers, infection, amputation
32
Q

Symptoms of diabetic retinopathy (6)

A
  1. Spots or floaters in vision
  2. Blurred vision
  3. Fluctuating vision
  4. Impaired colour vision
  5. Dark or empty areas in vision
  6. Vision loss
33
Q

Investigations for diabetic retinopathy

A

Fundoscopy - cotton wool spots and flare haemorrhages

34
Q

Pathophysiology of diabetic nephropathy (3)

A
  1. Glomerular disease
  2. Ischaemic renal lesions
  3. Ascending UTIs

Phase 2 (again) (24 decks)

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