Week 23 - Cases 1-4 Flashcards
what is balantitis circinata
a skin condition associated with reactive arthritis which presents with ring shaped dematitis on the glans penis
what is balantitis xerotica albicans
lichen sclerosis affecting the male genitals
what can candidal balantitis be caused by
diabetes
what are the risk factors for candidal balantitis
- Diabetes mellitus
- Use of oral antibiotics
- Poor hygiene in uncircumcised males
- Immunosuppression (including HIV infection)
what is the criteria to diagnose diabetes in symptomatic patients
fasting glucose test greater than or equal to 7
random glucose test greater than or equal to 11.1
what is the criteria to diagnosis diabetes if the patient is asymptomatic
Fasting Glucose Test greater than or equal to 7
Random Glucose Test greater than or equal to 11.1.
- this criteria must be met on 2 separate occasions
if a patient is asymptomatic what should be requested in regards to the HbA1c request
a second Hba1c shoud be requested.
Two consecutive Hba1c results equal to or greater than 48 is diagnostic of type 2 diabetes. However, it is not as sensitive as fasting samples and therefore cannot exclude diabetes if the HBA1c is less than 48.
what are the occasions where you should not use hb1Ac to diagnose diabetes
● Pregnant women or women who are 2 months postpartum.
● People with symptoms of diabetes for less than 2 months.
● People at high diabetes risk who are acutely ill.
● People taking
medication that may cause hyperglycaemia (for example long-term corticosteroid treatment).
● People with acute pancreatic damage,
including pancreatic surgery
.
● People with end-stage renal disease (ESRD).
● People with HIV infection
what are the hallmark symptoms of type 2 diabetes
● Tiredness
● Polyuria/polydipsia
● Recurrent infections e.g., thrush
● Increased hunger
● Unintentional weight loss
● Blurred vision (retinopathy)
● Foot ulcers/sores (due to peripheral neuropathy)
● Areas of dark skin e.g., in armpits/neck (acanthosis nigricans):
what is acanthosis nigricans due to
insulin resistance
what is checked at an annual diabetic review
urine
HbA1c
Foot examination
height and weight
BP
eye tests
cholesterol
blood sugards
what is the most common cause of blindness in adults aged 35-65 years of age
retinopathy
what is important to monitor in regards to the kidneys in diabetics
the albumin:crreatinine ratio
how do we decide if medication is necessary for a patient with diabetes
HbA1c is checked every 3-6 months until it is at a stable level on unchanging therapy, if lifestyle measures have failed and HbA1c is 48 or higher, then medication is considered
what is the first line medical treatment of type 2 diabetes and what is its mechanism of action
Metformin is the first line medical therapy for type 2 Diabetes. It is a biguanide which leads to activation of AMP-activated protein kinase (AMPK). This has a dual effect of increasing insulin sensitivity and decreasing hepatic gluconeogenesis.
what is the most common side effect of metformin
GI disturbances
an initial starting regimine would be 500mg once daily, but this can be titrated up to 1g twice daily if necessary. taking metformin with meals or using modified release preparations can reduce GI side effects
what kind of medications might need to be considered, other than blood sugar medications
statins and anti-hypertensives
who are statins recommended in
Recommended in most Type 1 diabetics, and Type 2 diabetics with a QRISK over 10%
what is the BP target for patients with diabetes
below 140/80 for all patients with diabetes
If there is ‘end organ damage’ (kidneys, eyes or any conditions affecting blood vessels), then it is 130/80.
what is the diagnostic criteria for diabetic ketoacidosis
● Capillary Blood Glucose (BM) >11 (or known diabetes)
● Capillary Ketones >3mmol/L (or urinary >2+)
● Venous pH <7.3 or venous bicarb <15mmol/L
Must have all three for a diagnosis.
what are the principles of management of diabetic ketoacidosis
● Fluid resuscitation to restore circulatory volume
● Correct electrolyte imbalances (in particular; potassium)
● To treat hyperglycaemia, clear ketones and suppress further ketogenesis
Management of diabetic ketoacidosis (DKA) is mostly following a set algorithm which all trusts will have, however establishing why someone has developed DKA is just as important. For example: Treating an underlying infection.
is sliding scale insulin used for diabetic ketoacidosis treatment
no, the treatment is a fixed rate infusion of insulin
what is the aggressive fluid resuscitation given for diabetic ketoacidosis
Initially, aggressive fluid therapy is needed. One litre of IV fluid over one hour (if the systolic BP is over 90), or if it is lower, boluses of fluid are required (This would be 500ml of 0.9% sodium chloride over less than 15 minutes).
what electrolyte is essential to monitor during DKA therapy
potassium
when is diabetic ketoacidosis treatment stopped and what is given next
When a patient is eating and drinking normally, and their pH is over 7.3, or their blood ketones are less than 0.6 mmol/L, stop the fixed rate insulin infusion, and go onto subcutaneous insulin.
what is the diagnosis for type 1 diabetes in adults - as stated by NICE
Diagnose Type 1 diabetes on clinical grounds in adults presenting with hyperglycaemia, bearing in mind that people with Type 1 diabetes typically (but not always) have one or more of:
ketosis
rapid weight loss
age of onset below 50 years
BMI below 25 kg/m²
personal and/or family history of autoimmune disease
what are the three different types of insulin available in the UK
Human Insulin produced by recombinant DNA technology.
Human insulin analogues: modified insulin to produce specific kinetic characteristics e.g., modified duration of action.
Animal insulins (rarely used) from pigs or cows.
what is a basal bolus mode of administration
This is where a long-acting insulin is given by subcutaneous injection to act as the endogenous insulin (basal or base insulin); and then rapid acting insulin is given with meals to replicate the normal response to food (bolus). Typically, three boluses are given a day with meals, but the amount of insulin will vary, as will the number of boluses, if a different number of meals are consumed. Patients become experts at managing their own diabetes.