DM Flashcards
What fasting glucose definition of DM?
Fasting glucose >7
What are presenting features of DM?
- Thirst
- Polyuria
- Weight loss & fatigue
- Hunger
- Pruritus and balantis (candidiasis)
- Blurred vision (altered acuity due to uptake of glucose/water into lens)
Which HLA is T1DM associated with>
HLA DR 3 and 4
What causes T1DM/
Autoimmune destruction of B pancreatic cells
What do urinary ketones indicate?
Insulin at any age
T1
What causes T2DM?
Decreased secretion of and increased resistance to insuline
How can you tell prognosis in T2DM?
Impaired FG
Impaired GTT
What are other causes of Diabetes?
Steroids Thiazides Pancreatitis Trauma Cushings CF Acromegaly Hyperthyroidism Pregnancy
Explain the disease process behind DKA
Hyperglycaemia causing ketones which escape into urine and osmotic diuresis= fall in blood volume.
Ketones also cause anorexia and vomit
Therefore dehydration and vomit and hyperglycaemia leading to acidosis > CV collapse > death
What are the 3 main things in DKA?
Hyperglycaemia
Ketones
Acidosis
What causes DKA?
Illness
Medication errors
New diagnosis
What are clinical features of DKA?
Polyuria and polydipsia Nausea and vomit Weight loss Weakness Abdominal pain Drowsiness/confusion Hyperventilation Dehydration Hypotension Tachycardia Coma Kussmaul's Resps
What happens to K+ in DKA?
Initially high then falls fast with vomiting
How is DKA managed?
Rehydrate (3L in 3 hours)
Insulin
Replace K+
Treat cause
What are complications of DKA?
Cerebral oedema ARDS Thromboembolism Aspiration Pneumonia Death
What is management of T1DM?
Insulin
Usually BD short/med acting and a basal bolus after meals
What are symptoms of diabetic retinopathy?
Ischemia and occlusion . proliferation- laser therapy only treatment- risk of tunnel vision, loss of night vision
How do you manage stroke risk in diabetes?
Aspirin
How is peripheral neuropathy in diabetes managed?
Tricyclics SSRIs Gabapentin Opioids Lignocaine
What are symptoms of autonomic neuropathy in DM?
Postural hypotension Arrhythmia (silent MI) Urine retention Erectile dysfunction Gastroparesis- constipation, diarrhoea
What are symptoms of diabetic nephropathy?
Proteinuria (hallmark sign)
Main cause of ESRF
How is DM nephropathy managed?
BP control- ACEi/ARB and spironolactone
Glycaemic control
Cholesterol control (statin)
How is T2DM managed without medication?
Lifestyle advice- diet, weight loss
excercise, BP target 140/90
What are HbA1C treatment thresholds?
42-48- lifestyle advice
48+ metformin
58+ metformin plus another
Resistant at 58+ add third
