- check eyes - fundoscopy - check feet - bloods - U+Es, lipid profile, HbA1c - BP - Qrisk - BMI

Type 2 Diabetes Mellitus Flashcards by Anmol Landa

Pathophysiology

Insulin resistance due to sustained hyperglycaemia

How well did you know this?

Not at all

Perfectly

Symptoms

Polyuria
Polydipsia
Weight loss

Nocturia
Fatigue

How well did you know this?

Not at all

Perfectly

Investigations if symptomatic

Measure BMI
Random capillary glucose test > 11
Urine dipstick - glucose

How well did you know this?

Not at all

Perfectly

Which channel does glucose enter muscles and adipose with

GLUT 4

How well did you know this?

Not at all

Perfectly

Risk factors for T2DM

Obesity
FHx
South East Asian

How well did you know this?

Not at all

Perfectly

Investigations if asymptomatic

3 investigation at 2 separate intervals

random blood glucose > 11
fasting blood glucose > 7
HbA1c > 48mmol

How well did you know this?

Not at all

Perfectly

Microvascular complications

Retinopathy - blindness
Neuropathy - peripheral vascular disease and foot ulcer
Nephropathy - chronic kidney disease

Due to hyperglycaemia causing production of sorbitol and advanced glycation end products and oxidative stress which results in endothelial damage

How well did you know this?

Not at all

Perfectly

Macrovascular complications

Atherosclerosis formation leaving to CVD
Increased risk of: 
- MI 
- HF
- Stroke 
- peripheral arterial disease

How well did you know this?

Not at all

Perfectly

Atherosclerosis formation

Endothelial damage
Accumulation of oxidised lipids
Foam cells accumulate
Smooth muscle proliferation and collagen - fibrous cap

How well did you know this?

Not at all

Perfectly

Diabetic screening

check eyes - fundoscopy
check feet
bloods - U+Es, lipid profile, HbA1c
BP
Qrisk
BMI

How well did you know this?

Not at all

Perfectly

Hyperosmolar hyperglycaemia state pathophysiology

Hyperglycaemia > 30mmol causes osmolarity in blood plasma to increase

How well did you know this?

Not at all

Perfectly

Symptoms of HHS

Confusion
Drowsiness
Dehydration - loss of skin turgor and sunken eyelids

How well did you know this?

Not at all

Perfectly

Signs of HHS

Reduced GCS
Hypotension
Capillary blood glucose increases > 35mm

NO KETONES ON ACIDOSIS

How well did you know this?

Not at all

Perfectly

Investigations of HHS

Obs A-E - BP, VBG
CBG
Bloods - U+Es
Fundoscopy

How well did you know this?

Not at all

Perfectly

Management of HHS

Fluids - 0.9% saline
Insulin - FRIII
2-3 hours later - K+
Prophylactic LMWH

How well did you know this?

Not at all

Perfectly

Reasons for HHS

Poor diabetes control
High glucose load
Medication - thiazide like diuretic

Already on metformin drug to add in obese pt

DPP5 inhibitor - sitagliptin

- non weight gaining

Diabetes education programmes

Type 2 newly diagnosed - DESMOND

Type 1 - DAFNE - dose adjustment for normal eating

Diabetic medication

Lifestyle modification
Metformin - biguanide
Gliptin
Gliclazide - Sulfonylurea
Glitazone -thiazolidinediones
Gliflozin - SGLT2 inhibitor
Exenatide - GLP -1 analogue

Side effects of diabetic medication

Metformin

GI upset
diarrhoea
N + V
lactic acidosis
stop if eGFR below 39

Sulfonylurea

weight gain
hypoglycaemia

DPPV inhibitor

GI upset
small risk of pancreatitis
CANT BE USED IN PREGNANCY

thiazolidinediones
- weight gain

SGLT2 inhibitor

UTI
hyponatraemia
polyuria
polydipsia

Exenatide

GI upset
GORD
stop of eGFR below 30

Which medication interacts with diabetic medication

Thiazide like diuretics - increase glucose
ACEi - impair renal function
NSAIDs - impair renal function

HbA1c target

6.5% - 7.5%

Albumin: creatinine ratio

Albumin creatinine ratio indicates extra protein in urine.

Should not be more than 3g

Addressing risk factors

Tight BP control 
Smoking cessation 
Lose weight 
Decrease carbs and fats in diet 
Qrisk - statin

Causes of HHS (6 I’s)

``` Infection - pneumonia, UTI Inflammation - pancreatitis, cholangitis Insulin deficiency - type 2 Intoxication - cocaine or alcohol Infarction - MI, stroke Iatrogenic - steroids, surgery ```

Metformin

- inhibits gluconeogenesis and glycogenolysis - promotes satiety - increased glucose utilisation

Gliptin

- DPPV inhibitor | - prevents breakdown of incretin

Sulfonylurea - Gliclazide

- inhibits ATP dependent K+ channels | - increases insulin sensitivity

Thiazolidinediones - Glitazone

- activates PPAR - gamma - increases insulin sensitivity - decreased hepatic production of glucose - increases hepatic storage of FA so glucose used

Gliflozin

SGLT2 inhibitor | - inhibits sodium glucose transporter so more glucose excreted

Exenatide

GLP -1 analogue - increased insulin secretion and synthesis - increased satiety - decreased hepatic production of glucose - increased glucose uptake - decreased gastric emptying

Diabetic retinopathy Tx

Laser Photocoagulation

Signs of diabetic retinopathy

Background Retinopathy: Dots: microaneurysms Blot haemorrhages Hard exudates: yellow lipid patches Pre-proliferative Retinopathy: Cotton-wool spots (retinal infarcts) Venous beading Haemorrhages Proliferative Retinopathy: New vessels Pre-retinal or vitreous haemorrhage Maculopathy ↓ acuity may be only sign Hard exudates near macula

Lifestyle management alone

if metformin was first declined and the HbA1c level was between 48-56 mmol/mol and the patient is presenting with no diabetic complications