Year 2 - Week 3 - Diabetes Flashcards
What is diabetes mellitus?
Problem with regulation of blood glucose levels - generated from body’s inability to regulate serum glucose concentration with intake - stems from a failure to produce/lack of response to the insulin which controls this process.
How many people in the UK have diabetes mellitus?
What proportion of this is T2 diabetes?
4.9m - about 7.3% of UK pop
90% have T2 DM
What is T1 Diabetes?
An autoimmune mediated loss of pancreatic β-islet cells leading to absolute reduction in insulin production.
What is T2 Diabetes?
An acquired condition mediated through (a) reduction in insulin sensitivity or (b) an inadequate amount of insulin secretion - leading to inadequate serum glucose concentration control
What is gestational diabetes?
Disease of pregnancy where insulin production does not match the physiological requirements needed in pregnancy.
What occurs during hyperglycaemia?
Significant glycosuria + high osmotic pressure - osmotic diuresis occurs - causing dehydration.
Which is the most common disease often found in Ps with T1DM?
Thyroid disease
What is the triad of DKA?
Hyperglycaemia
Ketonaemiea
Acidosis
What are the management principles of DKA?
Rehydration of the patient (helps clear the ketosis) + insulin . May need to correct electrolyte imbalances.
Which medication puts T2DM Ps more at risk of DKA?
SGLT-2 inhibitors
What level does HbA1c have to be at to be diagnosed with T2DM?
How many readings at this level are needed if
- symptomatic?
- asymptomatic?
> 48 mmol/mol
1 reading if symptomatic
2 readings if asymptomatic
What reading in fasting plasma glucose indicates T2DM?
> 7mmol/L
Which factors can cause HbA1c to be falsely low?
Rapid rise in blood sugar (T1DM, acute illness, drugs - steroids)
Increased red cell turnover
Blood transfusion
Pregnancy
HIV infection (drugs may result in red blood cell destruction)
CKD (reduced red blood cell lifespan)
Which factors can cause HbA1c to be falsely high?
Splenectomy
Reduced reticulocytes (aplastic anaemia)
Increased glycation
What is the glycemic index?
A measure of how food can affect how quickly blood glucose levels rise
What are the common symptoms of DM?
Tiredness, skin infections (boils / fungal), polyuria, polydipsia, urine infections, blurred vision
What complications can arise from DM?
Visual retinopathy
HT can cause kidney, eye and heart damage
Peripheral neuropathy
Which tests can check blood glucose
Hba1c or Fasting blood glucose
Which tests can check for possible CVD?
Lipid profile
Which tests check renal function?
Urea, creatinine & electrolytes
Albumin:Creatinine ratio
What should you do before starting metformin?
Give it 6 weeks to see if dietary measures can reverse - unless the BG is very high or P is symptomatic
What is the target range for Hba1C?
48-58 mmol / mol
Who is most at risk for hypos?
Elderly
Those who drink too much alcohol
Cognitive impairment
How is gestational diabetes diagnosed?
Glucose tolerance test
What does maternal diabetes inc the risk of?
Larger full term babies
Shoulder dystocia
Pre-term labour
Pre-term preeclampsia
Who should be screened for gestational diabetes?
Previous stillbirth
Previous large baby full term (over 4.5kg)
BMI >30
Previous gestational diabetes
1st degree relative with diabetes
Ethnic background with high diabetic risk (Middle Easter, Black Caribbean, South Asian)
What do we do for Ps with gestational diabetes
Self-monitor glucose
Monthly scans
If uncontrollable - start insulin
