Primary Care-DIABETES Flashcards
What is the pathophysiology of type 1 diabetes?
-Autoimmune destruction of Beta cells in Islets of Langerhans of pancreas
-leading to lack of production of insulin
-Glucose cannot be taken up from blood or
converted to glycogen for storage
patient:
Insulin is a hormone produced by the body to allow the sugar in your blood to enter cells and be used for energy. If you imagen it like insulin is the key to the cells doors, allowing the sugar to enter. In type 1 diabetes this key isn’t produced and so the cell doors cant be opened, glucose cant enter and there is a build up of sugar in the blood
What is the pathophysiology of type 2 diabetes?
- Beta cells remain intact but may secrete less insulin
- Other cells also become insensitive to insulin (insulin resistance)
patient explanation: the key doesn’t quite fit the lock
What genes are responsible for type 1 diabetes?
HLA-DR3
HLA-DR4
How does type 1 diabetes present?
Rapid onset of clinical triad over days/weeks
- Polyuria
- Polydipsia
- Weight loss
What are some long-term complications of diabetes?
Retinopathy Neuropathy Nephropathy Erectile dysfunction Vascular disease - main cause of death
How does diabetic ketoacidosis present?
Nausea + vomiting
Severe confusion
Dehydrated - dry mucus membranes and reduced skin turgor
Ketotic breath
Cusmor breathing - deep sighing breaths to try breathe off CO2
Generalised GCS
What would you see in DKA bloods?
In DKA you would see:
- high creatinine,
- sodium, potassium and phosphate eleveted or normal
- low bicarb
- high glucose
- ketones
- low pH
What is the criteria for diagnosis of diabetes?
One abnormal reading if they have symptoms:
HbA1c > 48mmol/L (neg cannot rule out)
Fasting blood glucose >7mmol/l
Random blood glucose >11.1mmol/l
If asymptomatic: 2readings on 2 separate days either fasting >7mmol/l OR Hba1c
What is the gold standard test for diabetes?
Glucose tolerance test
Ask patient to fast overnight, then give 75g of glucose. Check plasma glucose after 2 HOURS
• ≥11.1mmol/L = diabetic
• ≥7.8 and <11.1mmol/L = impaired glucose tolerance
• <7.8mmol/L = non-diabetic
What is the pharmacological management of T2DM?
STEP 1 IF 48+
Metformin 500mg BD after food (can titrate up to 2g/day if not <48)
STEP 2 DUAL THERAPY IF 58+ (new aim of <53) Metformin PLUS (glicazide 40mg OD, sitagliptin, pioglitazone, empagiflozin (SGLT-2i)
STEP 3 if 58+ Insulin or TRIPLE THERAPY -metformin+stigaliptin+glicazide -metformin+pioglitazone+glicazide -metformin+(pioglitazone or glicazide) +empagiflovin
OR GLP -1 injections if BMI>35
What class of drug is metformin in? How does metformin work?
Biguanides
- Reduces rate of gluconeogenesis
- Increases insulin sensitivity to increase uptake of glucose by cells but doesn’t affect insulin output
What are some side effects of metformin?
- GI upset (reduce appetite, Nausea, diarrhoea and abdo pain)-reduce these by taking with food
- Weight loss
When is metformin contraindicated?
- Renal dysfunction (STOP if egfr <30 or creat >150)
- Stop if tissue hypoxia or before GA or contrast containing iodine (withhold for 48 hours)
How do glitazones work?
example of a glitazone?
- Increase insulin production and sensitivity to insulin
- pioglitazone
What are side effects of glitazones?
When are they contraindicated?
- Fluid-retention - increased risk of HF
- Fractures
- Weight gain
C/I in cardiovascular disease or osteoporosis/bladder cancer
Must stop if there is weight gain or oedema
What does acarbose do?
Decreases breakdown of starch to sugar
What are the side effects of acarbose?
Severe flatulence
Abdominal distention
Diarrhoea
What is the diagnostic criteria for DKA?
D -Diagnosis of diabetes or BG >11mmol/L
K -Ketones (blood ketone >3mmol/L or urine ++)
A -Acidosis on ABG (<7.3 or bicarb <15)
note: patients on SGLT2 inhibition’s (flozin) may be euglycemic