diabeties Flashcards
what are the 3 main signs of diabetes?
polyuria
polydipsia
polyphagia
how can type 1 diabetes be managed?
set up individual care plan for the person by the diabetes specialist team and review plan annually
education for patient and family
if appropriate encourage children/young people and their family/carers to get influenza vaccinations and immunisation against pneumococcal infections
encourage children/young people to wear/carry a diabetes ID card or MedicAlert bracelet to identify them with type 1
manage lifestyle issues
suggest support groups e.g Diabetes UK support groups
can get
- insulin injections
- an insulin pump
need to check blood glucose levels several times a day
can also get an islet cell transplant to prevent hypoglycaemia
what are some common symptoms of diabetes?
polyuria
nocturnuria
polydipsia
tiredness
weight loss
itching and thrush
poor wound healing
blurred vision
how is type 2 diabetes managed?
set up individual care plan
educate, provide contact details for diabetes team
suggest diabetes support groups e.g diabetes UK helpline
initially, through improved diet and exercise
may have to use insulin or tablets e.g metformin
may need weight loss surgery
what blood glucose level is considered hypoglycaemic?
below 4 mmol/l
what can cause hypoglycaemia in a diabetic?
missing or delaying a meal or snack
not having enough carbohydrate at your last meal
doing a lot of exercise without having extra carbohydrate or without reducing your insulin dose (if you take insulin)
taking more insulin (or certain diabetes medication) than you needed
drinking alcohol on an empty stomach.
what are some signs of hypoglycaemia?
feeling shaky feeling disorientated sweating being anxious or irritable going pale palpitations and a fast pulse lips feeling tingly blurred vision being hungry feeling tearful tiredness having a headache lack of concentration.
why is it common to get thrush/genital itching?
urine contains glucose
this creates an environment for bacteria to thrive
(similar to poor wound healing as blood contains glucose)
what is the diagnostic criteria for diabetes?
- diabetes symptoms
plus
- a random venous plasma glucose concentration ≥ 11.1 mmol/l
or
- a fasting plasma glucose concentration ≥ 7.0 mmol/l (whole blood ≥ 6.1 mmol/l)
or
- two hour plasma glucose concentration ≥ 11.1 mmol/l two hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT).
Within no symptoms, diagnosis shouldn’t be based on a single glucose determination but requires confirmatory plasma venous determination. Do another glucose test on another day to confirm.
what is the normal blood glucose range?
Between 4.0 to 5.4 mmol/L
what is the diagnostic criteria for gestational diabetes?
a fasting plasma glucose level of 5.6mmol/l or above
or
a 2-hour plasma glucose level of 7.8mmol/l or above.
What HbA1c suggests diabetes?
An HbA1c of 48mmol/mol is recommended as the cut off point for diagnosing diabetes.
A value of less than 48mmol/mol does not exclude diabetes diagnosed using glucose tests.
finger prick test shouldn’t be used, instead do a laboratory venous HbA1c.
In patients without symptoms of diabetes the laboratory venous HbA1c should be repeated. If the second sample is <48mmol/mol the person should be treated as at high risk of diabetes and the test should be repeated in 6 months or sooner if symptoms develop.
when is HbA1c not appropriate for diagnosis of diabetes?
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
what are the treatment targets for adults with type 1?
Support adults with type 1 diabetes to aim for a target HbA1c level of 48 mmol/mol or lower, to minimize the risk of long-term vascular complications. (measure every 3-6 months)
advise routine self monitoring of blood glucose in adults with type 1 (fasting 5-7mmol after waking, 4-7 before meals at other times and 5-9 after eating for at least 90 mins)
what are the complications of type 1 diabetes?
Microvascular complications =
nephropathy, retinopathy, and neuropathy (including chronic painful diabetic neuropathy and autonomic neuropathy).
Macrovascular complications = cardiovascular disease (CVD, e.g MI), cerebrovascular disease (e.g stroke and TIA), and peripheral arterial disease (e.g intermittent claudication).
Metabolic complications = diabetic ketoacidosis (DKA) and dyslipidaemia.
increased risk of other autoimmune conditions, most commonly thyroids disease
psychological complications e.g anxiety
reduced QoL
Skin complications
infections
reduced life expectancy
what anti diabetic drugs are recommended for adults with type 2 diabetes?
- offer metformin initially
- if contraindicated/not tolerated, suggest a gliptin,
Pioglitazone, A sulfonylurea or a SGLT-2i. - if metformin alone is ineffective, can consider dual therapy with any of the options listed above.
- can consider triple therapy if this is still ineffective
- still ineffective, can consider metformin, sulfonylurea and GLP-1 mimentic
what reference range is pre diabetes?
Reference Range - HbA1c of 42-47mmol/mol (6.0-6.4%) classified as “prediabetes” indicating high risk of
diabetes
retest annually or if they get symptoms
48+ = diabetes
what is DESMOND and DAFNE?
DAFNE =Dose Adjustment for Normal Eating. programme of education for those on insulin, usually type 1 diabetics, and how to manage it around their diet and lifestyle
DESMOND = is the acronym for Diabetes Education and Self Management for Ongoing and Newly Diagnosed. A way to learn more about Type 2 diabetes and to help manage diabetes-related changes. Also a good way to meet people with diabetes too.
what is DKA?
Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes and, much less commonly, of type 2 diabetes. DKA happens when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body.
glucose cant enter cells so body starts breaking down fat as fuel, this creates ketones = DKA.
what are the symptoms of DKA?
needing to pee more than usual
feeling very thirsty
being sick
tummy pain
breath that smells fruity (like pear drop sweets, or nail varnish)
deep or fast breathing
feeling very tired or sleepy
confusion
passing out
