Diabetes Revision Flashcards
What is the ideal blood glucose conc?
4.4 - 6.1 mmol/l
Is insulin an anabolic or catabolic hormone?
Anabolic
Insulin reduces blood sugar levels in what 2 ways?
1) Causes cells in body to ABSORB glucose from blood and use it as FUEL
2) Causes muscle & liver cells to ABSORB glucose from blood and STORE it as GLYCOGEN
Is glucagon a catabolic or anabolic hormone?
Catabolic
Glucagon INCREASES blood sugar levels in what 2 ways?
1) glycogenolysis –> tells liver to break down stored glycogen into glucose
2) gluconeogenesis –> tells liver to convert proteins & fats into glucose
Example of fluid resuscitation in DKA management:
1st hour –> 1L of 0.9% saline
For the remaining time –> 0.9% sodium chloride 1L with potassium chloride
When there is doubt about whether a patient has type 1 or type 2 diabetes, what 2 investigations can be done?
1) Serum C-peptide
2) Autoantibodies
What are the 3 types of autoantibodies in T1D?
1) Anti-islet cell antibodies
2) Anti-GAD antibodies
3) Anti-insulin antibodies
How often is HbA1c monitored in T1D?
Every 3 to 6 months
What does HbA1c measure?
Glycated haemoglobin –> how much glucose is attached to the haemoglobin molecule
What is a closed loop system in T1D management? What is it a combination of?
AKA an artificial pancreas
1) continuous glucose monitor
2) an insulin pump
What are the macrovascular complications of diabetes?
1) Coronary artery disease
2) Peripheral ischaemia –> poor skin healing and foot ulcers
3) Stroke
4) HTN
What are the microvascular complications in diabetes?
1) Peripheral neuropathy
2) Retinopathy
3) Nephropathy (particularly glomerulosclerosis)
What is the main kidney disease seen in diabetes?
Glomerulosclerosis
Infection-related complications of T1D & T2D?
1) UTIs
2) Pneumonia
3) SSTIs, particuarly in the feet
4) Fungal infections, particularly oral and vaginal candidiasis
Pathophysiology of T1D vs T2D?
T1DM –> autoimmune destruction of beta cells of pancreas
T2DM –> resistance to insulin due to repeated exposure
What HbA1c indicates pre-diabetes?
42-47
What HbA1c level indicates diabetes?
≥48
To confirm a diagnosis of T2D, when is the HbA1c repeated?
Repeated after 1 month to confirm the diagnosis (unless there are symptoms or signs of complications).
What is the HbA1c target for new type 2 diabetics?
48 mmol/mol
What is the HbA1c target for patients requiring MORE THAN 1 antidiabetic medication?
53 mmol/mol
Give stepwise medical management of T2D
1st line –> metformin
2nd line –> dual therapy: add sulfonylurea, pioglitazone, DPP-4 inhibitor or SGLT-2 inhibitor
3rd line –> triple therapy (with metformin and two of the second line drugs) or insulin therapy