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Year3 Endo Conditions > Diabetes Type 1 and Type 2 > Flashcards

Diabetes Type 1 and Type 2 Flashcards

1
Q

What causes type 1 diabetes?

A

autoimmune destruction of pancreatic beta cells

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2
Q

How common is T1 or T2?

A

5-10% of all patients with diabetes

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3
Q

What ethnicity is usually affected by T1 diabetes?

A

White europeans

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4
Q

What are RF for T1 diabetes?

A
  1. Genes: HLA DR3/4

2. Other autoimmune conditions

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5
Q

What happens in T2 diabetes?

A

Decrease insulin production and increased insulin resistance

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6
Q

What are RF for T2 diabetes?

A
  1. Overweight
  2. Ethnic groups
  3. FHx T2
  4. Hx gestational diabetes
  5. PCOS
  6. Hypertension
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7
Q

What are the signs and symptoms of T1 diabetes?

A
  1. Hyperglycaemia: Random plasma glucose ≥11.1 mmol/L (≥200 mg/dL)
  2. Polyuria
  3. Polydipsia
  4. Weight loss
  5. Fatigue
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8
Q

What are the signs and symptoms of T2 diabetes?

A
  1. Candida infections
  2. UTIs
  3. Polydipsia
  4. Polyuria
  5. Fatigue
  6. Blurred vision
  7. Acathosis nigricans
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9
Q

What are possible differential diagnosis of T1 diabetes?

A
  1. Monogenic diabetes
  2. Neonatal diabetes
  3. Latent autoimmune diabetes in adults
  4. Type 2 Diabetes
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10
Q

What are possible differential diagnosis for T2 diabetes?

A
  1. Non-diabetic hyperglycaemia (pre-diabetes)
  2. DM Type 1
  3. LADA
    Monogenic diabetes
  4. Ketosis-prone diabetes
  5. Diabetes, gestational
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11
Q

What investigations do you do for T1 diabetes?

A
  1. Random plasma glucose
  2. Fasting plasma glucose
  3. 2-hour plasma glucose
  4. HbA1c
  5. Clinical Diagnosis (adult)
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12
Q

What is random plasma glucose with someone with T1 diabetes?

A

≥11.1 mmol/L (≥200 mg/dL)

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13
Q

What is the fasting plasma glucose for someone with T1 diabetes?

A

≥7.0 mmol/L (≥126 mg/dL)

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14
Q

What is the 2-hr plasma glucose in T1 diabetes?

A

≥11.1 mmol/L (≥200 mg/dL)

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15
Q

What is the HbA1c in T1 Diabetes?

A

≥6.5% (≥48 mmol/mol)

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16
Q

What investigations do you do for T2 diabetes?

A
  1. Fasting plasma glucose
  2. HbA1c
  3. 2-hour post-load glucose after 75g oral glucose
  4. Random plasma glucose
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17
Q

What is plasma fasting glucose in T2 diabetes?

A

≥7.0 mmol/L (≥126 mg/dL)

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18
Q

What is HbA1c like in T2 diabetes?

A

: ≥48 mmol/mol (≥6.5%)

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19
Q

What is 2-hour post-load glucose after 75g oral glucose like in T2 diabetes?

A

≥11.1 mmol/L (≥200 mg/dL)

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20
Q

What is random plasma glucose in T2 diabetes?

A

≥11.1 mmol/L (≥200 mg/dL)

21
Q

What is management for T1 diabetes?

A
  • 1st line: basal-bolus insulin e.g. insulin detemir and insulin lispro
  • Adjunct: pre-meal insulin correction dose + metformin (500mg) 1x or 2x daily
22
Q

What is management for T2 diabetes?

A
  • 1st line: lifestyle changes
  • Control BP, Lipid management
  • Then metformin, then usually SGLT-1, insulin
23
Q

What are possible complication of T1 diabetes?

A
  1. DKA
  2. Hypoglycaemia
  3. Retinopathy
  4. Diabetic kidney disease
  5. peripheral or autonomic neuropathy
  6. cardiovascular disease
  7. depression
  8. eating disorders
24
Q

What are possible complications of T2 diabetes?

A
  1. Diabetic kidney disease
  2. Impaired vision
  3. Cardiovascular disease
  4. Stroke
  5. Depression
  6. DKA
25
Q

How is life expectancy changed in T2 diabetes?

A

type 2 diabetes is diagnosed at age 40, men lose an average of 5.8 years of life, and women lose an average of 6.8 years of life

26
Q

How common is diabetic retinopathy in T2 diabetes?

A

12% to 19% of people with type 2 diabetes have some diabetic retinopathy already at the time of diagnosis

27
Q

What is the patho of T1?

A

pancreatic islet beta cells destroyed: autoimmune

28
Q

What does the absolute insulin deficiency in T1 lead to?

A

lipolysis and ketogenesis

29
Q

What is T1 associated with?

A

HLA DR3/4

30
Q

What is T2 associated with?

A

obesity, HTN, inactivity and disturbed lipid

31
Q

What is patho of T2 diabetes?

A
  1. Reduced peripheral sensitivity to insulin

2. Reduced insulin production (over time)

32
Q

What is 2hr post prandial glucose for T1?

A

> 11.1

33
Q

What is prediabetes fasting glucose, HbA1c and 2hr post prandial glucose?

A
  1. Fasting glucose: 5.5-6.9
  2. 2hr post-pandial glucose: 7.8-11
  3. Hba1c: 42-47 (6-6.4)
34
Q

How do you confirm diagnosis of T1 and T2 ?

A
  1. Symptoms + 1 of above tests

2. Asymptomatic + 2 different tests, on 2 different days

35
Q

How do you distinguish between T1 and T2 diabetes?

A
  1. Urine dip for glucose & ketones (common in T1 but not T2)
  2. Specific antibodies are useful to distinguish between T1 and T2 but not necessary for T1 diagnosis
  3. Anti-GAD (80%) and Islet cell antibodies (ICA) (70-80%)
36
Q

When should you not used HbA1c?

A
  • ALL children and young people
  • patients of any age suspected of having Type 1 diabetes
  • patients with symptoms of diabetes for less than 2 months
  • patients at high risk who are acutely ill (e.g. those requiring hospital admission)
  • patients taking medication that may cause rapid glucose rise e.g. steroids, antipsychotics
  • patients with acute pancreatic damage, including pancreatic surgery
  • in pregnancy
  • presence of genetic, haematologic and illness-related factors that influence HbA1c and its measurement
37
Q

What is basal bolus?

A

long acting + short acting (before meals)

38
Q

What is long acting basal bolus?

A

insulin glargine (subcutaneous injection OD)

39
Q

What is short acting basal bolus?

A

insulin lispro or aspart (subcut pre meal)

40
Q

How is insulin treatment monitored?

A

day-to-day using capillary glucose, and over time using HbA1c (3 months)

41
Q

What lifestyle modifications are used in T2?

A

Diet, exercise, education

42
Q

What medications are used for glycaemic control in T2?

A
  1. Step 1: Metformin if HbA1c >48 despite lifestyle advice
  2. Step 2: Add another drug (DPP4i, pioglitazone, SU, SGLT-2i)
  3. Step 3: Add further drug or try insulin based treatment
43
Q

What is the lipid management in T2 diabetes?

A
  1. Atorvastatin 20mg OD if 10-year cardiovascular event ≥ 10%
  2. Atorvastatin 80mg OD if IHD/CVD/peripheral artery disease
44
Q

What is the BP management for T2 diabetes?

A
  1. Step 1: ACEi OR ARB (ARB preferred for black African patients)
  2. Step 2: Add CCB or thiazide
  3. Step 3: ACEi/ARB + CCB + thiazide
    - Check potassium, consult specialist
  4. Step 4: If K<4.5 add spironolactone, if K>4.5 add b-blocker
45
Q

What is antiplatelet therapy for T2 diabetes?

A

Aspirin 75mg for patients with IHD/CVD/peripheral artery disease

46
Q

How is BP mangement different in diabetes from normal BP management?

A

BP management in all type II diabetics begins with ACEi/ARB rather than CCB (even if the patient is black or over the age of 55)

47
Q

What do you do if HbA1c>58 despite metformin and lifestyle?

A
  1. Metformin + DPP-4i e.g., sitagliptin (-gliptin) or
  2. Metformin + Pioglitazone or
  3. Metformin + A sulfonylurea e.g., gliclazide or
  4. Metformin + An SGLT-2i e.g., dapaglifozin (-gliflozin)
48
Q

What do you do if HbA1c>58 despite metformin and lifestyle and further measures?

A
  1. Metformin + DPP-4i + sulfonylurea
  2. Metformin + pioglitazone + sulfonylurea
  3. metformin, pioglitazonea or an SU, and an SGLT-2i
  4. Insulin based treatment
49
Q

Are ACEi or A2RBs used?

A

In black African and Afro-Caribbean patients, A2RBs are preferred over ACE inhibitors.

Year3 Endo Conditions (33 decks)

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