DM an introduction Flashcards
what are the presenting features of diabetes
polyuria and polydipsia (thirst) weight loss and fatigue puritis vulvae and balanitis hunger blurred vision
describe the difference in characteristics of diabetes
check photos
what are the 4 classifications of diabetes
latent autoimmune diabetes in adults (LADA) type 1
maturity onset DM of he young (MODY) type 2
gestational diabetes
secondary - paretic destruction, acromegaly, cushings
what 3 clinical features are a sign of type 1 diabetes and must be treated with immediate insulin
weight loss
moderate or large urinary ketones (read at 15 seconds)
high urinary glucose (read at 30 seconds)
what are the aims of treatment of diabetes
relief of symptoms
prevention of ketoacidosis
prevention of complications both micro/macrovascular
what are the microvascular complications of DM
retinopathy (regular eye testing)
neuropathy (regular foot examination)
nephropathy (urine test for micro albumin and blood test for kidney functions - U and E)
why is it important to avoid nephropathy
poor prognosis
CV mortality creating increases
end stage renal failure
tend to develop retinopathy and neuropathy as well
what is the aim during treatment of type 1 diabetes and what do you use
restore physiology of the beta cell
insulin treatment - twice daily short/medium acting insulin - basal bolus
judge CHO intake
awareness of exercise affect on blood glucose
what is hypoglycaemia caused by in type 1 diabetes
high insulin levels
how many people with type 1 diabetes experience hypoglycaemia coma
30%
what are the symptoms and signs of hypoglycaemia
autonomic - nausea, tremor, sweating, tachycardia, anxiety
neuroglycopenic - confusion, drowsiness, lethargy, slurred speech
what is dilemma of type 1 diabetes in terms of glucose targets
setting higher glucose targets reduce risk of hypo but increase risks of diabetic complications
setting lower targets reduce risk of complication but increase risk of hypoglycaemia
why do some people not track blood glucose
risk of hypoglycaemia too difficult risk of weight gain interfere with life stye lack of knowledge
what are the main risk factors of type 2 DM
obesity and lack of physical exercise
what happens to the liver and muscle/adipose tissue in type 2 DM
liver has increased hepatic glucose production
M and AT - decrease insulin dependant glucose uptake by adipose tissue and muscle
what are the two main physiological characteristic behind type 2 DM
B cell dysfunction and insulin resistance
what are the complications of type 2 diabetes
blindness
increase in CV mortality and stroke
lower extremity amputations
end stage renal failure
what are the macrovascular complications of type 2 DM
MI, stroke, peripheral vascular disease
what is the life expectancy shortened by in type 2 DM
about 10 years
what is the treatment of type 2 diabetes
weight loss and exercise
medication to control BP, blood glucose and lipids
what are some of the complications of type 2 diabetes which we need to prevent
hypertension overweight hyperlipidaemia hyperglycaemia thrombosis potential nephropathy
describe the mode of action of thiazolidinediones (resiglitazone/Pioglitazone)
decrease insulin resistance in adipose tissue, skeletal muscle and liver
beneficial effect on B cell function
agonists at nucelar receptor peroxisome proliferator activated receptor gama (PPAAR-y)
describe the mode of action of biguanides (such as metformin)
suppresses hepatic glucose output and enhance glucose sensitivity and stimulate insulin mediated glucose disposal
they do not stimulate insulin secretion
describe the mode of action of sulphonylureas and meglitininides
such as glicalzide and glimepiride
both blower fasting blood glucose concentrations by stimulating insulin secretion from the pancreas
describe the mode of action of alpha-glucosidase inhibitors such as acarbose
delay digestion and absorption of carbs in the GIT - inhibit this enzyme responsible for metabolism of complex carbs into absorbable monosaccharides
describe the mode of action of glucagon like peptide 1 GLP analogues
mimic GLP1 a GIT hormone that increases insulin secretion from the pancreas and inhibits glucagon release
describe the mode of action of dipeptidyl peptidase 4 DPP-4 inhibitors
block DPP4 which would otherwise inactive GLP
what are the clinical consequences of hypoglyceamia
cardiac arrthmyias and neurological implications which lead to brain damage
inflammation, increased risk of thrombosis and endothelial cell dysfunction which leads to vascular death
