Diabetes mellitus type 1 and type 2 Flashcards
What is type 1 diabetes
inadequate secretion of insulin due to autoimmune destruction of pancreatic beta cells
What is type 2 diabetes
reduced peripheral sensitivity to insulin which leads to reduced insulin production
What may someone with T1DM present with
typically presents when young
polyuria and polydipsia
weight loss and fatigue
DKA- nausea and vomitting, abdominal pain, kussmaul breathing,sweet smelling breath
What may someone with T2DM present with
> 40
often asymptomatic
on examination - acanthosis nigricans, micro/macrovascular complication
What are risk factors for T2DM
obesity
hypertension
south asian/afro-carribean
family history
What investigations are required for diabetes mellitus
Random glucose >11.1
fasting glucose>7.0
2hr postprandial glucose >11.1
HbA1c >48
Diagnosis made if symptomatic and 1 positive test OR asymptomatic and 2 positive tests on separate occasions
Urine dip for glucose and ketones - common in type 1
Anti GAD and ICA - in type 1
What is the management for T1DM
Insulin
monitored with capillary glucose and HbA1c
Basal-bolus regime -
–long acting ( Insulin glargine ) and short acting ( insulin lispro)
What is management for T2DM
Glycaemic control
– lifestyle changes
–metformin
–SGLT2 inhibitor
– if HbA1c rises to 58 , add DPP-4 inhibitor, pioglitazone or sulfonylurea
- drug you add depends on patient
BP management
ACEi or ARB
Lipid management
Atorvastatin 20mg OD
Atorvastatin 80mg OD if CVD
Antiplatelets if existing CVD
What are SGLT 2 inhibitors, example and any side effects
reversibly inhibit sodium-glucose co-transporter 2 in renal PCT to reduce glucose reabsorption and increase urinary glucose excretion
-gliflozin ( Dapagliflozin)
UTIs
Fourniers gangrene
normoglycaemic ketoacidosis
weight loss
have cardiovascular benefits
What are biguanides , example and side effects
example - metformin
metformin activates AMPK in hepatocyte mitochondria which inhibits ATP production , blocks gluconeogenesis and subsequent glucose output
GI side effects - abdo pain , decreased appetite, diarrhoea, vomiting
What are DPP-4 inhibitors , example amd side effects
-gliptin ( Sitagliptin)
inhibit action of DPP-4 , which is an enzyme that metabolise incretins
incretins help stimulate production of insulin when needed
upper resp tract infections
flu-like symptoms
avoid in patients with pancreatitis
What are sulphonylureas, example and side effects
inhibit ATP sensitive potassium
-lazide ( GLICLAZIDE)
channel on pancreatic beta cell
inhibition causes depolarisation which stimulates calcium influx and hence vesicle exocytosis
weight gain
hypoglycaemia
What are some side effects of pioglitazone
has some associations with bladder cancer
can cause weight gain
What are the HbA1c targets for someone with T2DM
lifestyle management only - 48
lifestyle + metformin = 48
any drug that cause cause hypoglycaemia = 53
