diabetes real Flashcards
symptoms of diabetes
• Polyuria • Polydipsia • Blurred vision • Loss of sensation • Poor wound healing • More specific to T1 o Ketosis/ketonuria o Polyuria, polydipsia, weight loss, younger age o Rapid onset o Family history of autoimmune disease
diagnosis of diabetes
HbA1c
• Glycosylated hemoglobin is formed by the binding of glucose to hemoglobin
• Occurs gradually over the life span of RBC
• Reflects the average BSL over the 3 months
Oralglucose tolerance test
• Test them when they come
• Give them a sugary drink and then test them at 1 hour and 2 hour test
chronic complications of diabetes •
Microvascular Eye disease Retinopathy Macular edema o Neuropathy • Gastrointestinal • sexual dysfunction • Infectious • Cataracts • Glaucoma • Periodontal disease
type 1
• Absolute defiency of insulin caused by pancreatic b cell destruction
Type 2
- Caused by a combination of
- Peripheral resistance to insulin action and inadequate secretory response by pancreatic b cells
- Relative insulin defiency
short vs long acting insulin
o Better control
o More flexible
o More injection
o More risk of hypos
o Fewer injections
o Less risk of hypos
o Less flexible
o Looser control
split mixed regimen
most common Simple and coinvent Lower risk of hypos Decreased flexibility Cannot skip meals
basal bolus regimen
o Typically 4 injections a day
o Three daily injection of short acting
o One long acting at night
Flexibility
Better bsl control
Regular bsl monitoring required
Fails to cover snacks
Higher risk of hypos
Medication therapy
o 1st line Metformin
o 2nd line agents SGLT2 inhibitor, GLP1 agonists or DPP4
o 3rd line is adding sulphonyurea or thiazolidinedione
Metformin
o Reduce hepatic glucose production o Increases peripheral utilization of glucose o Gi adverse effects common o Nausea, vomiting, anorexia, diarrhea o Start at low dose o Lactic acidosis is rare o Usually comes with weight loss o It is renally cleared so cant use it with people with kidney disease o Slow onset may take up to 2 weeks
Incretin hormones
- Associated with weight loss
- DPP-4 inhibitors
- By inhibiting DPP-4 these agents increase concentration of GLP-1 and GIP (the ‘incretin’ hormones)–results in increased glucose-dependent insulin secretion, reduced glucagon
- Oral
GLP -1 agonists
o Exenatide
o Injectable agents that mimic GLP-1
o Nausea and vomiting
Sodium glucose co-transporter 2 SGLT2 inhibitors
o Dapagliflozin, Empagliflozin, Ertuglizin
o Reduces reabsorption of glucose in the kidney
o Eliminating more glucose
o Takes water and sodium with it thus reducing blood pressure and weight
o Shown to reduce CKD
o When used earlier on
o Good cardiovascular benefits for those with cardiovascular disease
Sulfonylureas
o Glipizide
o Gliclazide
o Main effect to increase pancreatic insulin secretion
o Most common
Thiazolidinediones
Pioglitazone
o Increase sensitivity of perioheral tissues to insulin, decrease hepatic glucose output
Acarbose
o Last line option
o Not taken very well by patients
Diabetic ketoacidosis complications and symptoms
Infection
Infarction
o Nausea o Thrist o Ab pain o SOB o Physical findings o Tachycardia o Dehydration o Tachypnoea o Lethargy
management of diabetic ketoacidosis
o Patient should be managed in endocrine unit o Obs Bp Pulse Urine output Capillary blood glucose Electrolytes especially potassium o Correct with fluid loss o Correct hyperglycemia and suppress ketones with insulin o Correct electrolyte disturbances o Resolution of acid base balance o Treatment of concurrent conditions
Type 2 HHS hyperglycemic hyperosmolar state symptoms
o Hyperglycemia and osmotic diuresis occur but lipolysis and ketosis are limited
o Extreme hyperglycemia develops via
o Increased hepatic glucose production
o Decreased peripheral glucose utilization
Generalized weakness leg cramps Focal neurological symptoms Seizures Dehydration Tachycardia Tachypnoea
Management Type 2 HHS hyperglycemic hyperosmolar state
improvement of circulatory volume and tissue perfusion; gradual reduction of serum glucose and plasma osmolarity; correction of electrolyte imbalance; and identification and prompt treatment of precipitating causes
Correct potassium and electrolytes
Start prophylactic doses of low molecular heparin, and consider full anticoagulation if serum osmolarity exceeds 350 mmol/l
Give insulin infusion, and stop oral hypoglycaemic medications
Insulin plays a secondary role in the management of HHS, and fluid therapy should always precede insulin administration
Those involved in diabetes management
- GP
- Pharmacist
- Specialist
- Diabetes educator
- Podiatrist
- Optometrist
- Dietician
Why do oral hypoglycaemics eventually fail on these drugs and require insulin?
- Diabetes being a chronic condition
- Insulin resistance increasing
- Beta cell dysfunction
- Patients will need muitple meds
What are the potential side effects of insulin
- Although weight gain and lipohypertrophy are potential problems with insulin, the most frequent/serious adverse effect is hypoglycaemia
- Rotate site of incision
- Give food before regular eating
- Exercise and diet
- Hypoglycaemic episodes (‘hypos’) may occur with excessive insulin dosage, delayed or insufficient food, or increased physical activity
- Warning symptoms include sweating, hunger, faintness, palpitations, tremor, headache, visual disturbance and altered mood, and usually occur <2.2mmol/L (although can occur at higher BSLs)
- If person is conscious, initial hypoglycaemia treatment should be with oral glucose (or sucrose)
- If the patient is unconscious give glucagon 1 mg subcutaneously, intramuscularly or intravenously
- Carers and colleagues of the at risk person with diabetes should be familiar with the identification of hypoglycaemia and treatment including SC glucagon administration
