T1DM, T2DM & Me Flashcards
what is T1DM
autoimmune destruction of the pancreas
beta cells are destroyed so less insulin is made
less insulin means cells can’t take up glucose and the body thinks it is starving so the liver produces more glucose resulting in hyperglycaemia
what can cause T1DM
genetics + unknown trigger acromegaly cushing's autoimmune disease pheochromocytoma
what are symptoms of T1DM
thirst - polydipsia
tiredness
toilet - polyuria
thinner - weight loss
what are clinical signs of T1DM
polyuria
hyperglycaemia
glucosuria
sweet breath if in ketosis
what tests could you do for T1DM
finger prick blood glucose test in clinic - if >11.1 send for same day investigations
fasting blood glucose >7 indicates diabetes
oral glucose tolerance test > 11.1
HbA1c represents past 2-3 months, below 6% glycated is normal
how could you manage T1DM
patient education - STEP
2 weeks leave to understand management
inform about sick day rules
insulin regimes
what is the twice daily insulin regime
rapid acting + intermediate acting insulin before breakfast and dinner
what is the 3x daily insulin regime
rapid + intermediate before breakfast
rapid before tea
intermediate before bed
what is the 4x daily insulin regime
short acting before breakfast lunch and dinner
intermediate before bed
long acting at a fixed time daily
what is diabetic ketoacidosis
high levels of ketone acids in the blood
how does diabetic ketoacidosis happen
no insulin = no glucose getting into the cells
body converts FFAs into ketone bodies in the liver as an alternate energy source
the ketone bodies cannot be taken up by the brain without insulin
ketones build up in the blood causing metabolic acidosis
how does DKA present
sweet breath from acetone (breakdown product of ketones that escapes in lungs) nausea vomiting breathing abnormalities drowsiness coma death
what investigations could you do in ketoacidosis
urine dipstick for glucose and ketones
arterial blood gas
ECG
how would you treat ketoacidosis
IV saline to rehydrate
IV insulin
IV potassium
monitor closely - NEWS, GCS, blood glucose
what is T2DM
tissues loose their sensitivity to insulin - could be because there is less receptors or some are damaged
more insulin is required to have the same effect
the beta cells have an increased demand so undergo hyperplasia but then burn themselves out and become atrophied so less insulin is produced resulting in hyperglycaemia
what are risk factors for T2DM
genetics obesity poor diet/lifestyle 60+ alcohol asian
how does T2DM present
often asymptomatic until there are complications tiredness thirst weight loss polyuria blurred vision thrush or other low grade infections
what investigations could you do for T2DM
blood glucose
random glucose
oral glucose tolerance test
urine dipstick
what are complications of diabetes mellitus
vascular disease - peripheral, coronary and cerebral retinopathy nephropathy neuropathy diabetic ulcers
what is a hypoglycaemic attack
when blood sugars get dangerously low
4 is the floor but less than 3mmol/l is common threshold
what causes a hypo
taking too much insulin in T1DM compared to glucose consumed
missed meals or overactivity in T1DM
what can cause a hypo in non-diabetics
EXPLAIN exogenous drugs pituitary insufficiency liver failure addison's disease islet cell tumours non-pancreatic tumours
how does a hypoglycaemic attack present
sweating anxiety hunger tremor palpitations dizzy confusion drowsy visual disturbances coma seizures can be misdiagnosed as alcohol overdose
how do you manage a hypo
15-20g quick acting carbohydrate snack - 200ml orange juice and check BG 15-20 mins later, repeat snack up to three times
glucose gel between teeth and gums if conscious but not cooperative
IV glucose if unconscious - 10% at 200ml/hour
can also give glucagon - won’t work if patient is malnourished
once glucose is over 4mmol/l give long acting carbohydrate - toast
how do you treat T2DM
lifestyle advice - diet, exercise alcohol etc
screen for complications
start with metformin
if HbA1c is still 58 or above add on DDP4 inhibitor or pioglitazone or Sulphonylureas or SGLT-2 inhibitor
if its still above 58 add on SU (SGLT-2i for metformin + SU)
if that doesn’t work consider
insulin based therapy
triple therapy - metformin, SU and GLP1 mimetic
what are HbA1c targets
48mmol/l for new T2DM
53 for patients who use more than just metformin
