Type 2 Diabetes Mellitus Flashcards
what is the name given to the combination of severe bone and soft tissue infection in patients with diabetes?
fetid foot
what is fetid foot?
extensive, chronic soft tissue and bone infection causing a foul exudate
what is the management of fetid foot?
extensive surgical debridement and/or amputation
what is type 2 diabetes mellitus?
pancreatic beta cells production of insulin becomes insufficient due to insulin resistance
how do you diagnose type 2 diabetes mellitus?
- random blood glucose = 11.1 mmol/l
- fasting plasma glucose = 7 mmol/l
- 2 hour glucose tolerance = 11.1 mmol/l
- HbA1C = 48 mmol/mol (6.5%)
symptomatic + 1 of the above OR asymptomatic + 2 results on different days
what are the complications of T2DM?
- gastroparesis
- autonomic neuropathy
- peripheral arterial disease
- diabetic foot infections
- sexual dysfunction
- cardiac complications
what causes gastroparesis?
nerve damage to the autonomic nervous system, specifically the vagus nerve which is responsible for controlling the gastric muscles
what does damage to the vagus nerve lead to?
- delayed gastric emptying
- offensive egg smelling burps due to baterial overgrowth
- early satiety
- abnormal stomach wall movements
- morning nausea
what is the management of gastroparesis?
- motility agents - metoclopramide or domperidone
- tight glycaemic control
- antibiotics - erythromycin
- botox injections (to relax the gastric outflow obstruction)
- gastric pacemakers = last resort
what is postural hypotension caused by in T2DM?
autonomic nervous system damage
what is postural or orthostatic hypotension?
fall in systolic blood pressure by 20mmHg or more after changing posture, typically from lying to standing
what are the clinical features of an autonomic neuropathy?
- drop in blood pressure on movement - dizziness, falls and LOC
- sitting or standing slowly may help with light headedness
- exacerbated by dehydration (can occur in hyperglycaemia with consequent polyuria)
what is the management of autonomic neuropathy?
- increased dietary salt
- use of salt retaining hormones - i.e. fludorcortisone or midodrine
- raising the head of the bed to retrain the body’s baroreceptors
- wearing elasticated stockings to overcome venous pooling in the peripheries
what is the known macrovascular complication of T2DM?
peripheral arterial disease
how does peripheral arterial disease present?
- foot discolouration
- gangrene
- intermittent claudication
- rest pain
- night pain
- absent peripheral pulses (confirmed on doppler)
what is the management for a diabetic foot infection?
- good glycaemic and blood pressure control
- smoking cessation
- improving the circulation (potentially with angioplasty or bypass surgery)
- debridement of the wound
- use of larvae therapy (maggots)
- antibiotics
what is a complication of diabetic foot infection?
osteomyelitis
how is osteomyelitis diagnosed?
MRI
what are the common causative organisms in diabetic foot infections?
gram +ve organisms
- staph aurea
- enterococcus
what are the common causative organisms in diabetic foot infections?
gram -ve organisms
- pseudomonas aeruginosa
- escherichia coli
- klebsiella species
- proteus species
- anaerobes
what are the causes for sexual dysfunction in T2DM?
- poor glycaemic control
- neuropathy
- microvascular complications
- obesity
- hypertension
- depression
- medication side effects
- alcohol
- cannabis
- hypogonadism
what investigations should be carried out in a T2Dm patient with sexual dysfunction?
- 9am testosterone blood test
- gonadotrophin levels
what is the pathophysiology of cardiac complications in T2DM?
- hyperglycaemia + free fatty acids -> change in blood vessel -> cardiovascular disease
- lining of the blood vessels may become thicker -> impaired blood flow
what is the conservative management of T2DM?
- diet advice
- encouraging regular physical activity
- smoking cessation
- measure HbA1c levels at 3-6 month intervals
what is the medical management of T2DM?
- metformin
- pioglitazine
- DPP-4 inhibitors
- sulphonylureas
- SGLT-2 inhibitors
single therapy -> dual therapy -> triple therapy
what is the recommended insulin therapy?
basal insulin therapy with isophane (NPH) insulin e.g. insulatard
what is the typical pattern of sensory loss in T2DM?
glove and stocking sensory loss
what should T2DM target blood pressure be?
140/90mmHg
what is the first-line management of peripheral diabetic neuropathy?
tricyclic anti-depressants (e.g. amitriptyline)
