Unit 8 Week 1: Type 2 Diabetes Flashcards
health behaviour
refers to the actions that an individual engages in that affect their health either positively or negatively.
physiology of no type 2 diabetes
glucose builds up in the bloodstream
body wants to store this glucose in places in the liver and muscle cells
beta cells in the pancreas secrete insulin into the blood as a response to rise in glucose
insulin allows glucose to be absorbed into organs such as muscle cells and liver
decreases blood glucose levels
insulin resistance
can be caused by genetics, family pre-dispositions, obesity and bad eating habits
cells in the body become insensitive to insulin
results in reduced glucose uptake by the cells
increased blood glucose levels
another way diabetes affects glucose
beta cells in the pancreas don’t release enough insulin
in response to the rising blood glucose levels
diabetes presentation
increased thirst
nocturia
fatigue
increased hunger
numbness and tingling in hands and feet
weight loss
increased thirst, nocturia
as blood sugar levels rise the kidneys try to filter and remove the excess glucose from the blood
can lead to dehydration
fatigue
body isnt able to effectively use glucsoe for energy
hunger
not effectively using glucose for energy
numbness and tingling in hands and feet
high blood sugar levels can damage nerve endings
weight loss
body is unable to use glucose for energy
how do you estimate risk for cardiovascular disease
QRISK3
Q risk 3
tool to calculate risk of CVD
takes into account risk factors: BMI, age, sex, lifestyle, past medical history, family history
complications of diabetes
storke
cerebrovascular disease
cardiovascular disease
diabetic neuropathy
diabetic nephropathy
foot damage
peripheral vascular damage
peridontal disease
diabetic retinopathy
cataract
glaucoma
diabetes and mechaisms of injury
diabetes: hyperglycemia, increased FFA and modified LDL cholesterol, decreased HDL cholesterol
mechanisms of injury: increased AGE, ROS, angiotensin 2, NFKB activity, inflammatory cytokines, leukocyte adhesion, PKC activity
how does diabetes cause different mechanisms of injury
when sugars in the bloodstream attach to proteins in the blood vessel walls, advanced glycation end products synthesised more
causes proteins to become in blood vessels to be stiffer and less elastic
leads to formation of free radicals
causes oxidative stress and damage to blood vessel walls
leads to inflammation and cell damage
atherosclerosis
cholesterol plaques may form
impair blood flow
diabetic nephropathy
damage to small blood vessels in the kidney that filter waste from the blood
causes scarring and kidney damage
impaired immnity
high blood sugar can impair the function of various immune cells
non-proliferative diabetic neuropathy
early stage of diabetic neuropathy
small blood vessels in the retina begin to leak fluid or blood
proliferative diabetic neuropathy
more advanced stage of diabetic retinopathy
new blood vessels grow in the retina
new blood vessels are fragile
can leak blood
cause severe vision loss and blindness
risk factors for type 2 diabetes
obesity
age
ethnicity
family history
sedentary lifestyle
prediabetes
gestational diabetes
PCOS
hypertension
sex
smoking
alcohol
antipsychotics
alcohol
sleep disturbances
low birth weight
obesity as a risk factor
biggest factor
high waist measurement also increases risk
age as a risk factor
over 45 if white
over 25 if afican caribbean, black african, chinese or south asian
family hisotry as a risk factor
15% if one parent has type 2
75% if both do
sedentary lifestyle as a risk factor
increased risk in those who spend prolonged periods sitting
gestational diabetes as a risk factor
seven fold increased for developing tpye 2
children born to mothers wiht gestational diabetes have 6 fold increase of developing
PCOS as a risk factor
associated with insulin resistance
higher levels of insulin circulating in blood
gender as a risk factor
men have slightly higher risk
smoking and alcohol as a risk factor
smoking increasesrisk
excessive consumption increases risk
some evidence shows moderate consumption decreases risk
wellman clinic
90 minutes with HCP
private walk-ins
complete: lifestyle questionnaire, mental health quesitonnaire, full physical exam, resp assessment, cardiovascular assesssment, BMI and body fat percentage, consultation, vital signs, blood tests and urinalysis, screening
barriers for accessing healthcarei n this case
competing social/economic demands
embarrassment/stigma
fear of being blamed
tendency to normalise results
fear of results
leack of awareness
past bad experience
key investigations in type 2 diabetes diagnosis
HbA1c
random blood sugar
fasting blood sugar
oral glucose tolerance
other useful tests in type 2 diabetes diagnosis
serum creatinine
EGFR
ACR
C peptide
type 1 diabetic
increased blood glucose levels
body unable to produce insulin
type 2 diabetic
cells unable to respond to insulin produced
insulin resistance
pre-diabetic
blood sugar levels higher than normal but not high enough to be classified as type 2 diabetic
Hba1c
Glycated haemoglobin blood test
Measures the amount of glucose that is attached to your haemoglobin
Indicates the average blood sugar levels for the past 2-3 months
This is the first test in order to diagnose
Hba1c results
normal below 5.7%
pre 5.7-6.4
diabetes 6.5 higher on 2 separate tests
random blood sugar test
Regardless of when patient last ate
Blood sugar value either expressed as mg/dL or mmol/L
random blood sugar test results
200mg/dL or 11.1mmol/L or higher suggests diabetes
Especially if these results are seen alongside typical symptoms such as frequent urination and extreme thirst
fasting blood sugar tests
Test completed after you haven’t eaten overight
fasting blood sugar test results
Less than 100mg/dL or 5.6mmol/L is healthhy
100 to 125mg/dL or 5.6 to 6.9mmol/L prediabetes
126mg/dL or 7mmol/L or higher on 2 separate tests diagnosed as diabetes
oral glucose tolerance test
Less commonly used than the others except during pregnancy
Not eat for a certain amount of time then drink sugary drink with the healthcare provider
Then blood glucose levels tested periodically for 2 hours
oral glucose tolerance test results
less 140 mg/dl normal
pre is 140-200
diabetes is over 200
serum creatinine
Is the primary metabolite of creatine in skeletal muscle
Is a waste product of creatine, amino acid made and stored in the liver
Result of normal muscle metabolism
Chemical enters bloodstream, kidneys remove from blood then exits body through urination
Reduced skeletal muscle has been suggested as a potential risk factor for type 2 diabetes
High levels of serum creatinine may be associated with increased risk of kidney failure
serum creatinine results
Normal for men: 0.6- 1.2 mg/dL
Normal for women: 0.5-1.1 mg/dL
egfr
Tests for creatinine to determine glomerular filtrate rate
To measure kidney function
Diabetic neuropathy (diabetic kidney disease) is often associated with reduced EGFR
Case relation: risk factors for DKD include sustained hyperglycaemia, hypertension and obesity
egfr results
normal is 90-120 ml/min/1.73m^2
ACR, urine albumin to creatinine ratio
Looks for signs that protein is leaking into urine
Often another early sign of kidney disease
Checks urine microalbumin
Should be checked as soon as a person is diagosed diabetic and measured annually especially if raised
ACR results
normal is less than 2.5 mg/mmol
Slightly raised= early kidney disease
Very low= normal function
Very high= more severe kidney disease
C peptide test
New test, not for diagnosis but potentially for distinguishing differences between type 1 and 2
Measures levels of C-peptide in blood or urine
Accurate way of finding the amount of insulin your body is producing
When producing insulin the pancreas also produces C-peptide at the same time in equal amounts
Doesn’t affect your blood glucose levels but stays in the blood longer than insulin to easier to measure
C peptide test results
normal is 0.5-2 mg/ml
High= too much insulin so can be indicative of type 2 diabetes and other conditions (kidney failure, insuloma, Cushing’s syndrome and low potassium levels in blood)
Low= not enough insulin so can be indicative of type 1 and some cases of type 2 and other conditions (Addison disease, liver disease)
healthcare professionals involved in management
primary care
endocrinologist
diabetes care and education specialist
registered dietician
ophthalmologist
optometrist
podiatrist
audiologist
pharmacist
dentis
nephrologist
mental health professional
weight management
85% diabetes tpye 2 overweight or obese
commercial weight loss programmes or planners
more life
managing my weight are examples
healthy lifestyle
base meals on starchy foods
fibre rich foods
5 a day
consume little fired food
minimize sedentary activities
what should effective weight loss programmes do
address reasons why someone may find it difficult to lose weight
sensitive to persons weight concerns
be based on a balanced healthy diet
identify and address barriers to change
patient education on weight
DSMES can help you improve blood sugar levels to delay or prevent serious complications
face to fac: DESMOND and X-PERT
drugs in this case
metformin
atorvastatin
annual diabetic review
with the diabetic nurse
BP
HbA1c
CVD risk
compliance with eye screening, foot checks, dental checks
other long term complications
foot checks
annual
podiatrist, GP or specialist
high BM causes peripheral neuropathy
look and ask for cuts, blisters, cramps and look at shoes
self maangement: stop smoking, check feet daily, manage sugars, moisturize, careful cutting nails, shoes fit well
eye checks
annual
optometrist
diabetic retinopathy
high BM’s can damage BV in eyes
compromising the blodo supply to the retina
retina photographed
visual acuity
self management: control BM’s, report vision changes
Hba1c annual
average glucose last 2-3 months
measured 3-6 months until stable
Normal: < 42mmol/mol
Pre-diabetes: 42-47mmol/mol
Have diabetes target <48mmol/mol (6.5%)
model for change
transtheoretical
transtheoretical model
in biopsych flashcards
health promotion campaigns for T2D
NHS diabetes prevention programme
diabetes UK
type 2 diabetes prevention week held annually
knowyour risk tool by diabetes uk
#beatdiabetes
integrated care system
partnerships of organisations that come together to plan and deliver joined up health and care services
to improve lives of people who live and work in their area
what is included in an integrated care system
integrated care partnership
integrated care board
local authorities
place based partnerships
provider collaboratives
integrated care partnership
responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area
broad alliance of partners concerned with improving the care, health and wellbeing of the population, with membership determined locally.
integrated care board
A statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. The establishment of ICBs resulted in clinical commissioning groups (CCGs) being closed down.
place based partnerships
lead the detailed design and delivery of integrated services across their localities and neighbourhoods
purpose of integrated care systems
improve outcomes in populaitn health and healthcare
tackle inequalities in outcomes, experience and access
enhance productivity and value for money
help NHS support broader social and economic development
collaborating as ICS’s will help health and care organisations tackle complex challenges including
improving health of children and young people
supporting people to stay well and independent
acting sooner to help those with preventable conditions
supporting long term conditions and mental health issues
caringfor those with multiple needs as populations age
getting best from collective resources
role of diabetes speicalist nurse
support and advice between appointments wiht blood sugar checks and adjusting medication
help run patient diabetes group educatoin courses
prevalence of T2D globally
increasing more in low and middle income countries than high income countries
how does diabetes impact renal physiology
damage to vessels in the glomerulus
leads to poor filtration from blood
BMI for overweight
overweight is a BMI greater than or equal to 25
BMI for obese
obesity is a BMI greater than or equal to 30
effects of obesity on body
risk of stroke
depression
increase risk of heart attack
sleep apnea
GERD
liver disease
cancer
skin fold rashes
T2D
gall bladder problems
infertility
kidney failure
weakened muscles and bones
benefits of exercise
improve your brain health, help manage weight, reduce the risk of disease, strengthen bones and muscles, and improve your ability to do everyday activities
