DM: Diabetes Mellitus Flashcards

1
Q

What are the symptoms and signs of DM?

A

Increased thirst

Increased urination

Dry mouth

Fatigue

Weight loss - despite normal appetite (can be increased)

Blurred vision (chronic)

Tingling limbs (chronic)

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2
Q

How is DM diagnosed?

A

Symptomatic

  • Fasting glucose = 7mmol/l
  • Random glucose 11.1mmol/l
  • 75g OGTT 2 hour plasma glucose = 11.1mmol (MOST RELIABLE)

Asymptomatic = above must be demonstrated on 2 diff occasions

Underlying haemolytic disease = high turnover of RBC which will affect HbA1c - Therefore OGTT = more reliable

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3
Q

How is DM classified?

A

Type 1

Type 2

Gestational (GDM)

Maturity onset diabetes of the young - autosomal dominant (15-25yrs)
- Don’t require insulin - give sulfonylureas

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4
Q

Outline T1DM

A

Pathophysiology = autoimmune, Ab against bet cells of pancreas, islet-associated Ab (IAA)

Management = insulin (basal-bolus, long + short term)

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5
Q

Outline T2DM

A

Pathophysiology = insulin resistance, insulin def

Risk = older, asian, obesity

Treatment = HbA1c target dependant on anti-DM drug type
- First line = metformin
- Lifestyle = diet control, weight loss, HTN control (ACEi - target 140/80), statin (with 10 yr CVS risk - QRISK2)
‣ GI ( glycaemic index) = low index food
‣ High fibre, low fat, low saturated and trans fat

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6
Q

What is metformin and its SEs?

A

Mechanism = increase insulin sensitivity

SE = GI upset (2 weeks), lactic acidosis

500mg OD

Contraindications - hepatic/renal failure, eGFR <30, alcohol abuse

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7
Q

What are sulfonylureas and there SEs?

A

Mechnaism = insulin secretagogue

SE = hypoglycemic episodes (dizziness, sweating - tell pt to carry food around with them), weight gain

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8
Q

What are thiazolidinediones and there SEs?

A

Mechanism = increases peripheral insulin sensitivity

SE = fluid retention, weight gain, liver impairment, increased risk of fractures

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9
Q

What are Glucagon-like peptide 1 mimetics and there SEs?

A

Inject subcut 60 mins before meal

Mechanism = agonists of the GLP-1 receptor, increasing insulin secretion and inhibiting glucagon release

SE = N+V, risk of pancreatitis, risk of renal impairment, weight loss

Should be used when = insulin would othrwise be started, BMI >30

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10
Q

What are Dipeptidyl peptidase-4 inhibitor and there SEs?

A

Sitagliptin

Mechanism = increase incretin levels (GLP-1 and GIP), which inhibit glucagon release, which in turn increases insulin secretion

SE = GI disturbance, nausea, flatulance, dirrahoea, constipation

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11
Q

What are the complications of DM?

A

Macrovascular
- Accelerated atherosclerosis = MI, stroke, TIA, PVD

Microvascular (advanced glycosylation end products)

  • Painful neuropathy
  • Autonomic neuropathy - gastroparesis, ED
  • Nephropathy
  • Retinopathy and diabetic CNIII palsy (spare pupil)
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12
Q

Outline the pathophysiology of diabetic retinopathy?

A
  • Damage to the endothelium (inappropriate glycosylation)
  • Leakage from weakened vessels = protein exudates forming
  • Microvascular occlusion (‘cotton-wool spots’)
  • Local hypoxia
  • New vessels form (stimulated by VEGF)
  • New vessels aren’t as strong -> more likely to bleed
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