Endocrinology - T2DM Flashcards
Risk factors for T2DM
Older
Ethnicity
Family history
Obesity
Sedentary lifestyles
High carbohydrate (particularly refined carbohydrate) diet
HHS presentation symptoms
Often preceding infection e.g. UTI/Chest infection and dehydration
Symptoms:
- Increased thirst
- Urinary frequency
- Nausea and vomiting
- Drowsiness/confusion
- Coma
Treatment of HHS
- Fluid resuscitation
- Electrolyte replacement and close monitoring (monitoring especially for sodium and potassium)
- Treat cause of HHS e.g. antibiotics
- May need insulin to help bring down the glucose levels if fluid resuscitation stops doing this
HHS presentation symptoms
Often preceding infection e.g. UTI/Chest infection and dehydration
Symptoms:
- Drowsiness/confusion
- Increased thirst
- Urinary frequency
- Nausea and vomiting
- Coma
Investigations in suspected HHS
Bedside - ECG, Urine dip/MC+S. Urine ketones, Sputum culture (if cough)
Bloods:
- Blood glucose
- Serum ketones
- VBG
- Serum osmolality
- U+Es
- FBC
- CRP
- Blood cultures - if infection
- Troponin - if chest pain
Imaging
- Consider CXR - if suspect pneumonia as cause
Investigations in suspected HHS
Bedside - ECG, Urine dip/MC+S, Sputum culture (if cough)
Bloods:
- Blood glucose
- Serum ketones
- HbA1c
- VBG
- Serum osmolality
- U+Es
- FBC
- CRP
- Blood cultures - if infection
- Troponin - if chest pain
Imaging
- Consider CXR - if suspect pneumonia as cause
HHS differentials
DKA
Lactic acidosis
Alcoholic ketoacidosis
Overdose e.g. of paracetamol, aspirin?
Describing T2DM diagnosis in lay terms
A protein called insulin in the blood is needed to let the sugar into the cells from the blood
But the cells become resistant to insulin and therefore the sugar cant enter the cells and the blood sugar becomes high
Treatment options for T2 diabetes
Lifestyle modifications and risk factor modification:
- Low sugar/carbohydrate, high fibre diet (also low satfat)
- Lots of vegetables and oily fish
- Exercise/weight loss/maintain healthy weight (initial target 5-10%)
- Stop smoking
- Reduce alcohol intake
- Optimise HTN, Hyperlipidaemia and CV disease management
Medical management:
- 1st line - metformin
- 2nd line - Add sulphonylurea, Pioglitazone, DPP4 or SGLT2 inhibitor
- 3rd line - triple therapy (metformin and two of above) or metformin and insulin
How is T2DM diagnosis made?
One of these:
HbA1c - > 48 mmol/mol
Random glucose >11 mmol/L
Fasting glucose >7
OGTT 2h result >11
Treatment targets
HbA1c
- Measure every 3-6 months until stable on medication
- Otherwise every 6m
HbA1c targets:
- 48mmol/L if on non-hypoglycaemics or lifestyle treatment
- 53 if on hypoglycaemic drugs
When to advise routine capillary blood glucose monitoring in T2DM
If on insulin
If evidence of hypoglycaemic episodes
If on hypogycaemics and driving or operating machinery
Pregnant or planning to get pregnant
