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DEN303 - IHD > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diagnosis of diabetes

OGTT

A 
Symptoms
Random plasma glucose 
Fasting plasma glucose > 7mmol
HbA1c > 48 mmol/mol
No symptoms - oral glucose tolerance test fasting
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2
Q

Presenting features of diabetes

A

Thirst - osmotic activation of hypothalamus
Polyuria - osmotic diuresis
Weight loss and fatigue - dehydration, lipid and muscle loss
Pruritus vulvae and balanitis - vaginal candidiasis
Hunger
Blurred vision - altered acuity due to uptake of glucose/water into lens

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3
Q

Clinical features of newly diagnosed type 1

A

Short history of severe symptoms e.g weeks
Moderate or large urinary ketones present
Weight loss
Any 2/3 features indicate type 1 diabetes and are an indication of immediate insulin Tx at any age

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4
Q

Commonest age at diagnosis of Type 1 diabetes
Prevalence
What kind of disease

Treatment

A

5-15 years but can occur at any age
Rare - 250000
Insulin deficiency disease
Autoimmune destruction of beta cell

Restoring appropriate insulin concentrations

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5
Q

Aims of treatment of type 1 diabetes

A

Relieve symptoms and prevent ketoacidosis
Prevent microvascular and microvascular disease
Avoid hypoglycaemia

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6
Q

Microvascular complications

e.g kidney

A

30% in UK
Diabetic nephropathy - much smaller, higher urine protein, decreased fx
CV mortality x30

Proliferative retinopathy and severe neuropathy

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7
Q

What can happen in retina

A

Blood vessels burst due to excess glucose

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8
Q

Tx of type 1 diabetes - restore physiology of beta cell

A

Insulin tx

  • twice daily mixture of short and medium acting insulin
  • basal bolus injection - 1/2x daily medium acting insulin plus pre meal quick acting insulin

Ability to judge carbohydrate intake

Awareness of blood glucose lowering effect of exercise

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9
Q

Symptoms of insulin XS

Risk of?

A 
Dizzy
Warm 
Nauseous 
Tachycardia 
Increased breathing

Insulin shock

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10
Q

Benefits and risk of tight glucose control

A

Good glucose control - very low chances of retinopathy and v.v

Tight glucose control - higher risk of hypoglycaemia and v.v

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11
Q

Dilemma for type 1

Solution

A

Setting higher glucose targets will decrease risk of hypoglycaemia but increase risk of diabetic complications
Setting lower glucose targets will decrease risk of complications but increase risk of hypoglycaemia

Engage students for their own management

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12
Q

Type 2 diabetes

A

Greatest non-infective threat to global health
1/20 in UK
Meds cost £1000 million
Disease of western industrialised lifestyle - obesity and lack of exercise

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13
Q

Pathogenesis of type 2 diabetes

A

Major cardiovascular risk

Insulin resistance 
Hypertension 
Hyperglycaemia 
Abnormal lipids 
Early hyperinsulinaemia 
Increased thrombogenesis
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14
Q

Insulin resistance

Common in?

A

Probably inherited and demands increased production of insulin to maintain normal glucose levels before development of diabetes
Beta cells lose ability to produce sufficient insulin for amount of glucose intake
Progressive failure of insulin secretion

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15
Q

Complications in type 2 diabetes and examples

A

Macrovascular affect the majority and often advance at diagnosis - MI, stroke, Peripheral vascular disease

Microvascular affect 20-25% at diagnosis and modified by underlying vascular disease

Life expectancy is shortened at diagnosis by 5-10 years

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16
Q

Treatment in type 2 diabetes

A

Ideally consists of weight loss and exercise (improve insulin resistance) which if substantial will reverse hyperglycaemia
- but most of those with Type 2 diabetes have been making the ‘wrong’ lifestyle choices all their lives
At present, management usually consists of medication to control BP, blood glucose and lipids
Tight control of BP and lipids has a greater effect in reducing the risk of macrovascular disease (and reduces microvascular complications) and is usually easier to achieve than blood glucose control

17
Q

Typical treatment pathways in type 2

A

Eat less and reduce refined CHO

Metformin
Sulphonylurea

INSULIN

18
Q

Metformin is a

What does it do

Side effects

A

Biguanide

Reduces blood glucose by impoving glucose uptake without increasing body weight and also reduces CV disease in the longterm

Abdo pain
Diarrhoea limit dose

19
Q

Sulphonylureas - mechanism

A

Stimulating release of insulin from pancreatic beta cells so can cause weight gain and hypoglycaemia e.g gliclazide and glibenclamide

20
Q

Insulin - secretion in type 2 what happens to it over time

A

Declines progressively

21
Q

Type 2 - conclusions

A

The ‘best’ treatment, weight loss and increased exercise is rarely achieved
Needs multiple medications, many of which are probably not taken
The challenge is to engage the patient in the management of their own condition
This is not ‘mild’ diabetes - high risk of premature vascular death and other vascular complications

22
Q

Diabetic ketoacidosis

Definition
Symptoms

Causes

Mortality

A

Condition of severe insulin deficiency where fats are broken down to ketones which results in acid excess and lowered blood pH. Blood glucose also rising = osmotic diuresis and dehydration

Thirst, polyuria, SOB, confusion and coma

Hyperglycaemia
Venous bicarbonate less than 15mmol
Ketones

Infections
Omitting insulin
New diagnosis of Type 1

Mortality
1-5%
Elderly - associated co morbidity and late diagnosis
Young - severe DKA recognised late
- rare and poorly understood condition of cerebral oedema in children

23
Q

Hyperosmolar Hyperglycaemic State (HHS) or

Hyperosmolar Non-Ketotic Coma (HONK)

A

Definition
Hyperglycaemia (blood glucose usually over 50 mmol/l)
Hyperosmolality (osmolality usually over 350 mosmoles/l)
Accompanied by dehydration

Those at risk
Poorly controlled Type 2 diabetes
Newly diagnosed Type 2 diabetes patients, often elderly

24
Q

Symptoms and signs of hypoglycaemia

Autonomic

Neuroglycopenic

A

Sweating
Tremor
Palpitations

Loss of concentration
Drowsiness
Anger sadness confusion

25
Q

Hypoglycaemic management

Patient conscious

Patient unconscious

A

Oral glucose, dextrose tablets, chocolate is not good as fat hinders glucose absorption

Glucogon, IV glucose

Check glucose after 10 mins

Identify cause, re-educate and adopt measures to avoid hypos

26
Q

Monitoring diabetes

A 
Venous blood glucose
HbA1c 
Blood ketones
Urinary ketones 
Capilliary blood glucose
27
Q

Dental relevance

Infection will

A

Increased rates of gingivitis / periodonitis (2-5 fold) / dental caries / candidiasis / endocarditis
Stress – both physical & emotional raises blood glucose levels
Beware of hypoglycaemic medications
Type 1 diabetes is autoimmune process, therefore Sjorgrens is more likely
Some studies suggest improvements in glycaemic control after periodontal intervention
Dentists can help in the early recognition of T2DM (and rarely T1DM)

Affect glucose conc and diabetes makes treating infection much harder

DEN303 - IHD (58 decks)

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