Diabetes & Pituitary - MedEd lecture Flashcards
Symptoms of Type 1 diabetes + pathophysiology
Polyuria (osmotic diuresis due to hyperglycemia)
Polydipsia
Weight loss (no insulin, therefore no feedback mechanism to tell the body to stop breaking down fat and muscle)
DKA symptoms
Abdo pain
Nausea and vomiting
Tachypnoea - Kussmaul’s breathing
Coma
Signs/presentation of type 2 DM
Picked up on routine investigation/RF being south asian/black/age
Acanthosis nigrans
Infections due to glucose - fungal, cellulits
Fatigue
Polydipsia/polyuria
Normal level for fasting glucose
<5.5
Normal level for random glucose
<11.1
Normal level for glucose after food
<7/.8
Normal HbA1c
<42
Random glucose levels in diabetics
> or equal to 11.1
Fasting glucose levels in diabetics
> or equal to 7
Post prandial glucose levels in unmanaged diabetics
> or equal to 11.1
Mx of type 1 diabetes
Basal bolus
What does basal bolus mean?
Long acting + short acting before meals
Long acting example
Glargine SC
Example of short acting
Lispro / Aspart SC pre meal
Type 2 DM Mx - step 1 (glycemic control)
Diet, exercise, education
Metformin
If HbA1c above 48, give metformin
Type 2 DM Mx - step 2 (glycemic control)
If HbA1c still above 48 with metformin, give another drug e.g. DPP4i,
Or also: piogliatazone, SU, SGLT-2i
Type 2 DM Mx - step 3 (glycemic control)
Add another drug or try insulin
T2DM BP Mx
Depending on age (below or above 55yrs)
ACEi/ARB
+ CCB/Thiazide Diuretics
ACEi/ARB + CCB + Diuretics
or if afrocarribean, CCB then +ACEi/ARB/Diuretics then all three
Step 4 of BP Mx in T2DM
If potassium is less than 4.5, add spiro
If more than 4.5, BB
Lipid management in T2DM if low risk vs high risk
Atorvastatin 20mg if 10 year cardiovascular risk is >10% on QRD
80mg if IHD/Cerebrovascular D/peripheral artery disease
If high Qrisk score/evidence of CVD what else do you need to give besides atorvastatin?
Antiplatelet - aspirin 75mg
Acute complications of DM
Hypoglycemia
Diabetic ketoacidosis (DKA)
Hyperosmolar hyperglycemic state (HHS)
Long term complications of DM
Microvascular
- Diabetic retinopathy
- Diabetic nephropathy
- Diabetic neuropathy
Macrovascular
- IHD
- Cerebrovascular disease
- Peripheral vascular disease
Causes of hypoglycemia in diabetics
Missed meals Alcohol SU (sulphonylureas)/SGLT-2i Unaccustomed exercise Inappropriate insulin
Hypoglycemia symptoms + BM level
Palpitations Tremor Sweating Pallor Anxiety Drowsiness Confusion Altered behaviour Seizures Coma AND Low sugar <3.6
Treatment for hypos + why it works
If conscious - oral glucose and complex carbs
If unconscious,
1mg GLUCAGON IM AKA PARENTERAL (tells liver to convert glycogen into glucose)
If that fails, IV dextrose (10-20% glucose)
Note: if you give any more glucose, it would damage the tissues.
DKA triad
Hyperglycemia
Ketonaemia
Metabolic acidosis (due to acidity of ketones)
Explain the pathophysiology of DKA - what causes it? What metabolic changes happen?
Stress hormones and insulin deficiency cause hyperglcemia.
This in turn causes osmotic diuresis, leading to dehydration.
Reduced flow to kidneys means that hydrogen ions aren’t excreted out well, therefore you get metabolic acidosis.
The pt ends up vomiting in order to deal with the metabolic acidosis, which leads to even more dehydration.
Note: ketonemia also massively contributes towards the metabolic acidosis, causing KUSSMAUL’s BREATHING and VOMITING.
ALSO, as there is no insulin, there is nothing to tell the body to take in potassium, therefore TOTAL BODY POTASSIUM remains LOW, though in the blood it varies.
Compare HHS and DKA
HHS - caused by hyperglycemia but not ketonemia as pt has some insulin therefore suppressing ketone production
HHS - no abdo pain but other symptoms of DKA like collapse, confusion, vomiting, nausea, kussmaul breathing
HHS - normal ketones <3mmol/L and normal pH, but plasma glucose above 30
DKA - ketones above 3mmol/L, pH below 7.3, plasma glucose above 11
Causes of DKA/HHS
Infection
Illness
Non-adherence to diabetes meds
May be initial presentation of diabetes
Mx of DKA/HHS
IV fluids + potassium chloride if below 5.5
THEN IV insulin, only if potassium is above 3.5
If sugar below 14, give dextrose
Treat underlying cause
Stages and features of diabetic retinopathy / maculopathy
Background: blot and dot haemorrhages/hard exudates (paint first)
Pre-proliferative: background + cotton wool spots (add cotton)
Proliferative: non-proliferative + new vessels on disk (neovascularisation) (add strawberry laces)
Maculopathy: hard exudates (i.e., background retinopathy) happens to be near macula
Management of diabetic retinopathy
Background - improve sugar control
Pre-proliferative and proliferative - pan-retinal photocoagulation
Maculopathy - grid photocoagulation
