Diabetes Type 1 and Type 2 Flashcards
What causes type 1 diabetes?
autoimmune destruction of pancreatic beta cells
How common is T1 or T2?
5-10% of all patients with diabetes
What ethnicity is usually affected by T1 diabetes?
White europeans
What are RF for T1 diabetes?
- Genes: HLA DR3/4
2. Other autoimmune conditions
What happens in T2 diabetes?
Decrease insulin production and increased insulin resistance
What are RF for T2 diabetes?
- Overweight
- Ethnic groups
- FHx T2
- Hx gestational diabetes
- PCOS
- Hypertension
What are the signs and symptoms of T1 diabetes?
- Hyperglycaemia: Random plasma glucose ≥11.1 mmol/L (≥200 mg/dL)
- Polyuria
- Polydipsia
- Weight loss
- Fatigue
What are the signs and symptoms of T2 diabetes?
- Candida infections
- UTIs
- Polydipsia
- Polyuria
- Fatigue
- Blurred vision
- Acathosis nigricans
What are possible differential diagnosis of T1 diabetes?
- Monogenic diabetes
- Neonatal diabetes
- Latent autoimmune diabetes in adults
- Type 2 Diabetes
What are possible differential diagnosis for T2 diabetes?
- Non-diabetic hyperglycaemia (pre-diabetes)
- DM Type 1
- LADA
Monogenic diabetes - Ketosis-prone diabetes
- Diabetes, gestational
What investigations do you do for T1 diabetes?
- Random plasma glucose
- Fasting plasma glucose
- 2-hour plasma glucose
- HbA1c
- Clinical Diagnosis (adult)
What is random plasma glucose with someone with T1 diabetes?
≥11.1 mmol/L (≥200 mg/dL)
What is the fasting plasma glucose for someone with T1 diabetes?
≥7.0 mmol/L (≥126 mg/dL)
What is the 2-hr plasma glucose in T1 diabetes?
≥11.1 mmol/L (≥200 mg/dL)
What is the HbA1c in T1 Diabetes?
≥6.5% (≥48 mmol/mol)
What investigations do you do for T2 diabetes?
- Fasting plasma glucose
- HbA1c
- 2-hour post-load glucose after 75g oral glucose
- Random plasma glucose
What is plasma fasting glucose in T2 diabetes?
≥7.0 mmol/L (≥126 mg/dL)
What is HbA1c like in T2 diabetes?
: ≥48 mmol/mol (≥6.5%)
What is 2-hour post-load glucose after 75g oral glucose like in T2 diabetes?
≥11.1 mmol/L (≥200 mg/dL)
What is random plasma glucose in T2 diabetes?
≥11.1 mmol/L (≥200 mg/dL)
What is management for T1 diabetes?
- 1st line: basal-bolus insulin e.g. insulin detemir and insulin lispro
- Adjunct: pre-meal insulin correction dose + metformin (500mg) 1x or 2x daily
What is management for T2 diabetes?
- 1st line: lifestyle changes
- Control BP, Lipid management
- Then metformin, then usually SGLT-1, insulin
What are possible complication of T1 diabetes?
- DKA
- Hypoglycaemia
- Retinopathy
- Diabetic kidney disease
- peripheral or autonomic neuropathy
- cardiovascular disease
- depression
- eating disorders
What are possible complications of T2 diabetes?
- Diabetic kidney disease
- Impaired vision
- Cardiovascular disease
- Stroke
- Depression
- DKA
How is life expectancy changed in T2 diabetes?
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
How common is diabetic retinopathy in T2 diabetes?
12% to 19% of people with type 2 diabetes have some diabetic retinopathy already at the time of diagnosis
What is the patho of T1?
pancreatic islet beta cells destroyed: autoimmune
What does the absolute insulin deficiency in T1 lead to?
lipolysis and ketogenesis
What is T1 associated with?
HLA DR3/4
What is T2 associated with?
obesity, HTN, inactivity and disturbed lipid
What is patho of T2 diabetes?
- Reduced peripheral sensitivity to insulin
2. Reduced insulin production (over time)
What is 2hr post prandial glucose for T1?
> 11.1
What is prediabetes fasting glucose, HbA1c and 2hr post prandial glucose?
- Fasting glucose: 5.5-6.9
- 2hr post-pandial glucose: 7.8-11
- Hba1c: 42-47 (6-6.4)
How do you confirm diagnosis of T1 and T2 ?
- Symptoms + 1 of above tests
2. Asymptomatic + 2 different tests, on 2 different days
How do you distinguish between T1 and T2 diabetes?
- Urine dip for glucose & ketones (common in T1 but not T2)
- Specific antibodies are useful to distinguish between T1 and T2 but not necessary for T1 diagnosis
- Anti-GAD (80%) and Islet cell antibodies (ICA) (70-80%)
When should you not used HbA1c?
- 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
What is basal bolus?
long acting + short acting (before meals)
What is long acting basal bolus?
insulin glargine (subcutaneous injection OD)
What is short acting basal bolus?
insulin lispro or aspart (subcut pre meal)
How is insulin treatment monitored?
day-to-day using capillary glucose, and over time using HbA1c (3 months)
What lifestyle modifications are used in T2?
Diet, exercise, education
What medications are used for glycaemic control in T2?
- Step 1: Metformin if HbA1c >48 despite lifestyle advice
- Step 2: Add another drug (DPP4i, pioglitazone, SU, SGLT-2i)
- Step 3: Add further drug or try insulin based treatment
What is the lipid management in T2 diabetes?
- Atorvastatin 20mg OD if 10-year cardiovascular event ≥ 10%
- Atorvastatin 80mg OD if IHD/CVD/peripheral artery disease
What is the BP management for T2 diabetes?
- Step 1: ACEi OR ARB (ARB preferred for black African patients)
- Step 2: Add CCB or thiazide
- Step 3: ACEi/ARB + CCB + thiazide
- Check potassium, consult specialist - Step 4: If K<4.5 add spironolactone, if K>4.5 add b-blocker
What is antiplatelet therapy for T2 diabetes?
Aspirin 75mg for patients with IHD/CVD/peripheral artery disease
How is BP mangement different in diabetes from normal BP management?
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)
What do you do if HbA1c>58 despite metformin and lifestyle?
- Metformin + DPP-4i e.g., sitagliptin (-gliptin) or
- Metformin + Pioglitazone or
- Metformin + A sulfonylurea e.g., gliclazide or
- Metformin + An SGLT-2i e.g., dapaglifozin (-gliflozin)
What do you do if HbA1c>58 despite metformin and lifestyle and further measures?
- Metformin + DPP-4i + sulfonylurea
- Metformin + pioglitazone + sulfonylurea
- metformin, pioglitazonea or an SU, and an SGLT-2i
- Insulin based treatment
Are ACEi or A2RBs used?
In black African and Afro-Caribbean patients, A2RBs are preferred over ACE inhibitors.
