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Medicine: PBL wrap-ups > Unit 8 Week 1: Type 2 Diabetes > Flashcards

Unit 8 Week 1: Type 2 Diabetes Flashcards

1
Q

health behaviour

A

refers to the actions that an individual engages in that affect their health either positively or negatively.

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2
Q

physiology of no type 2 diabetes

A

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

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3
Q

insulin resistance

A

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

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4
Q

another way diabetes affects glucose

A

beta cells in the pancreas don’t release enough insulin
in response to the rising blood glucose levels

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5
Q

diabetes presentation

A

increased thirst
nocturia
fatigue
increased hunger
numbness and tingling in hands and feet
weight loss

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6
Q

increased thirst, nocturia

A

as blood sugar levels rise the kidneys try to filter and remove the excess glucose from the blood
can lead to dehydration

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7
Q

fatigue

A

body isnt able to effectively use glucsoe for energy

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8
Q

hunger

A

not effectively using glucose for energy

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9
Q

numbness and tingling in hands and feet

A

high blood sugar levels can damage nerve endings

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10
Q

weight loss

A

body is unable to use glucose for energy

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11
Q

how do you estimate risk for cardiovascular disease

A

QRISK3

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12
Q

Q risk 3

A

tool to calculate risk of CVD
takes into account risk factors: BMI, age, sex, lifestyle, past medical history, family history

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13
Q

complications of diabetes

A

storke
cerebrovascular disease
cardiovascular disease
diabetic neuropathy
diabetic nephropathy
foot damage
peripheral vascular damage
peridontal disease
diabetic retinopathy
cataract
glaucoma

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14
Q

diabetes and mechaisms of injury

A

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

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15
Q

how does diabetes cause different mechanisms of injury

A

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

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16
Q

atherosclerosis

A

cholesterol plaques may form
impair blood flow

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17
Q

diabetic nephropathy

A

damage to small blood vessels in the kidney that filter waste from the blood
causes scarring and kidney damage

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18
Q

impaired immnity

A

high blood sugar can impair the function of various immune cells

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19
Q

non-proliferative diabetic neuropathy

A

early stage of diabetic neuropathy
small blood vessels in the retina begin to leak fluid or blood

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20
Q

proliferative diabetic neuropathy

A

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

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21
Q

risk factors for type 2 diabetes

A

obesity
age
ethnicity
family history
sedentary lifestyle
prediabetes
gestational diabetes
PCOS
hypertension
sex
smoking
alcohol
antipsychotics
alcohol
sleep disturbances
low birth weight

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22
Q

obesity as a risk factor

A

biggest factor
high waist measurement also increases risk

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23
Q

age as a risk factor

A

over 45 if white
over 25 if afican caribbean, black african, chinese or south asian

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24
Q

family hisotry as a risk factor

A

15% if one parent has type 2
75% if both do

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25
Q

sedentary lifestyle as a risk factor

A

increased risk in those who spend prolonged periods sitting

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26
Q

gestational diabetes as a risk factor

A

seven fold increased for developing tpye 2
children born to mothers wiht gestational diabetes have 6 fold increase of developing

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27
Q

PCOS as a risk factor

A

associated with insulin resistance
higher levels of insulin circulating in blood

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28
Q

gender as a risk factor

A

men have slightly higher risk

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29
Q

smoking and alcohol as a risk factor

A

smoking increasesrisk
excessive consumption increases risk
some evidence shows moderate consumption decreases risk

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30
Q

wellman clinic

A

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

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31
Q

barriers for accessing healthcarei n this case

A

competing social/economic demands
embarrassment/stigma
fear of being blamed
tendency to normalise results
fear of results
leack of awareness
past bad experience

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32
Q

key investigations in type 2 diabetes diagnosis

A

HbA1c
random blood sugar
fasting blood sugar
oral glucose tolerance

33
Q

other useful tests in type 2 diabetes diagnosis

A

serum creatinine
EGFR
ACR
C peptide

34
Q

type 1 diabetic

A

increased blood glucose levels
body unable to produce insulin

35
Q

type 2 diabetic

A

cells unable to respond to insulin produced
insulin resistance

36
Q

pre-diabetic

A

blood sugar levels higher than normal but not high enough to be classified as type 2 diabetic

37
Q

Hba1c

A

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

38
Q

Hba1c results

A

normal below 5.7%
pre 5.7-6.4
diabetes 6.5 higher on 2 separate tests

39
Q

random blood sugar test

A

Regardless of when patient last ate ​

Blood sugar value either expressed as mg/dL or mmol/L

40
Q

random blood sugar test results

A

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

41
Q

fasting blood sugar tests

A

Test completed after you haven’t eaten overight

42
Q

fasting blood sugar test results

A

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

43
Q

oral glucose tolerance test

A

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

44
Q

oral glucose tolerance test results

A

less 140 mg/dl normal
pre is 140-200
diabetes is over 200

45
Q

serum creatinine

A

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

46
Q

serum creatinine results

A

Normal for men: 0.6- 1.2 mg/dL ​

Normal for women: 0.5-1.1 mg/dL

47
Q

egfr

A

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

48
Q

egfr results

A

normal is 90-120 ml/min/1.73m^2

49
Q

ACR, urine albumin to creatinine ratio

A

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

50
Q

ACR results

A

normal is less than 2.5 mg/mmol
Slightly raised= early kidney disease ​

Very low= normal function ​

Very high= more severe kidney disease

51
Q

C peptide test

A

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

52
Q

C peptide test results

A

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)

53
Q

healthcare professionals involved in management

A

primary care
endocrinologist
diabetes care and education specialist
registered dietician
ophthalmologist
optometrist
podiatrist
audiologist
pharmacist
dentis
nephrologist
mental health professional

54
Q

weight management

A

85% diabetes tpye 2 overweight or obese
commercial weight loss programmes or planners
more life
managing my weight are examples

55
Q

healthy lifestyle

A

base meals on starchy foods
fibre rich foods
5 a day
consume little fired food
minimize sedentary activities

56
Q

what should effective weight loss programmes do

A

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

57
Q

patient education on weight

A

DSMES can help you improve blood sugar levels to delay or prevent serious complications
face to fac: DESMOND and X-PERT

58
Q

drugs in this case

A

metformin
atorvastatin

59
Q

annual diabetic review

A

with the diabetic nurse
BP
HbA1c
CVD risk
compliance with eye screening, foot checks, dental checks
other long term complications

60
Q

foot checks

A

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

61
Q

eye checks

A

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

62
Q

Hba1c annual

A

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%)

63
Q

model for change

A

transtheoretical

64
Q

transtheoretical model

A

in biopsych flashcards

65
Q

health promotion campaigns for T2D

A

NHS diabetes prevention programme
diabetes UK
type 2 diabetes prevention week held annually
knowyour risk tool by diabetes uk
#beatdiabetes

66
Q

integrated care system

A

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

67
Q

what is included in an integrated care system

A

integrated care partnership
integrated care board
local authorities
place based partnerships
provider collaboratives

68
Q

integrated care partnership

A

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.

69
Q

integrated care board

A

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.

70
Q

place based partnerships

A

lead the detailed design and delivery of integrated services across their localities and neighbourhoods

71
Q

purpose of integrated care systems

A

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

72
Q

collaborating as ICS’s will help health and care organisations tackle complex challenges including

A

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

73
Q

role of diabetes speicalist nurse

A

support and advice between appointments wiht blood sugar checks and adjusting medication
help run patient diabetes group educatoin courses

74
Q

prevalence of T2D globally

A

increasing more in low and middle income countries than high income countries

75
Q

how does diabetes impact renal physiology

A

damage to vessels in the glomerulus
leads to poor filtration from blood

76
Q

BMI for overweight

A

overweight is a BMI greater than or equal to 25

77
Q

BMI for obese

A

obesity is a BMI greater than or equal to 30

78
Q

effects of obesity on body

A

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

79
Q

benefits of exercise

A

improve your brain health, help manage weight, reduce the risk of disease, strengthen bones and muscles, and improve your ability to do everyday activities

Medicine: PBL wrap-ups (21 decks)

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