Clinical Presentations and Management of Diabetes Flashcards Preview

Clinical Teaching > Clinical Presentations and Management of Diabetes > Flashcards

Flashcards in Clinical Presentations and Management of Diabetes Deck (24)
Loading flashcards...
1

What is diabetes mellitus?

Diabetes melliitus is a group of metabolic disorders characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. 

Chronic hyperglycaemia is associated wth long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels.

2

What are the diagnostic tools used for diabetes?

  • Glycated haemoglobin ≥48mmol / mol
  • Fasting blood glucose ≥7.0mmol / L
  • 2 hour blood glucose ≥11.1mmol / L following OGTT
  • Random blood glucose ≥11.1mmol / L in the presence of symptoms

3

What percentage of diabetics are type 1, type 2 and other?

  • Type 1 - 10%
  • Type 2 - 80%
  • Other types - 5%
    • Genetic (MODY etc.)
    • Pancreatic disease
    • Endocrine disease
    • Drugs
  • Gestational diabetes

4

Describe the pathophysiology of type 1 diabetes.

  • Autoimmune disease
  • β-cell destruction
    • Symptoms when 80% β-cell mass lost
    • Environmental factors e.g. viral infection
  • Autoantibodies
    • Islet celll
    • Insulin
    • GAD (GAD65)
    • Tyrosine phosphates
    • 85-90% of individuals
  • Strong HLA associations 
    • Linkage to the DQA and DQB genes 
    • Influenced by the DRB genes

5

Compare and contrast the British diet and the diabetic diet.

British Diet

Diabetic Diet

Protein – 12%

Protein – 15%

Carbohydrate – 46%

Carbohydrate – 50%

Starch 

Fat – 42%

Fat – 35%

 

Fibre

6

List the factors which diabetes patients need to be educated about.

  • Diet
  • Hypoglycaemia
  • Sick day rules
  • Monitoring
    • Blood 
    • Urine
  • Driving - must tell the DVLA if you have type 1
  • Alcohol
  • Smoking
  • Insulin card
  • Pregnancy / contraception
  • Complications (mention these early to make them aware of why we make a big fuss about diabetes control)
    • Acute
    • Chronic

7

What does the freestyle libra do?

  • Measures interstitial glucose. 
  • Education required because it does not measure blood glucose (which can change more slowly).

8

Explain why glycated haemoglobin is used in diagnosis of diabetes.

Glycated haemoglobin (HbA1c)  is a form of hemoglobin that is measured primarily to identify the three-month average plasma glucose concentration. The test is limited to a three-month average because the lifespan of a red blood cell is four months.

9

Describe the pathophysiology of type 2 diabetes melltus.

  • Genetic factors:
    • Defect of β-cell
    • Insulin resistance 
  • Environmental factors 
    • Obesity 
    • Stress
    • Reduced physical activity

10

Describe the clinical presentation of type 2 diabetes mellitus.

  • Thirst, polyuria
  • Malaise, fatigue
  • Infections e.g. candidasis (yeast infections and itching can be a presentation of diabetes).
  • Blurred vision
  • Complications
  • Incidental finding (highly appropriate to screen for diabetes in an obesity clinic).

11

List drugs used in the management of diabetes.

  • Sulphonylureas
    • Chlorpropamide
    • Glipizide
    • Gliclazide
  • Biguanides
    • Metformin
  • α-glucosidase inhibitors
  • Thiazolidinediones
    • Pioglitazone
  • GLPI agonists
    • Exanitide
  • DPP IV inhibitors
  • SGLT2 inhibitors
  • Insulin

12

What are the different types of complications associated with diabetes mellitus?

  • Acute
    • ​Diabetic ketoacidosis
    • Hypoglycaemia
    • Other emergencies
  • Chronic
    • Microvascular
      • Eyes
      • Kidneys
      • Nerves
      • Feet
    • Macrovascular
      • Heart
      • Brain 
      • Feet

13

What are the clinical features of diabetic ketoacidosis?

  • Hyperglycaemia
    • Dehydration
    • Tachycardia
    • Hypotension
    • Clouding of consciousness
  • Acidosis
    • Air hunger (Kussmaul's respiration)
    • Acetone on breath
    • Abdominal pain
    • Vomiting
  • Plus features related to precipitating factors (e.g. sepsis)

14

Describe the cascade of events in diabetic ketoacidosis.

15

Describe the fluid and electrolyte losses associated with diabetic ketoacidosis.

  • Water - 5-10 litres
  • Sodium - 400-700 mmol
  • Chloride - 300-600 mmol
  • Potassium - 300-700 mmol
  • Magnesium - 30-60 mmol
  • Phosphate - 50-100 mmol
  • Calcium - 50-100 mmol
  • Bicarbonate - 300-500 mmol

16

What are the treatments for the symptoms of diabetic ketoacidosis?

  • Hyperglycaemia
    • Insulin intravenously 6 U/hour then by sliding scale
  • Dehydration
    • Saline initially
    • May require 4-6 litres
    • Dextrose 5% subsequently to replace water losses
  • Potassium 
    • Careful monitoring of K+
    • Replace as required

17

What are the symptoms of hypoglycaemia?

  • Adrenergic - flight or fright
    • Tachycardia
    • Palpitations
    • Sweating
    • Tremor
    • Hunger
  • Neuroglycopaenic - lack of glucose to brain
    • Dizziness
    • Confusion
    • Sleepiness
    • Coma
    • Seizure

18

Describe the pathophysiology of hypoglycaemia.

  • Formal definition:
    • Blood glucose ≤2.2 mmol/L-1
  • Causes
    • Too much insulin
    • Too little food
    • Unusual exercise
  • Four is the floor!

19

Describe the stages of hypoglycaemia.

20

Describe the human counter-regulatory mechanisms associated with hypoglycaemia.

21

What are the other emergencies associated with diabetes mellitus?

  • HyperOsmolar Non-Ketotic coma (HONK)
    • Elderly patients 
    • Often undiagnosed
    • Intercurrent stress
      • MI
      • Chest infection etc.
  • Metformin Associated Lactic Acidosis (MALA)
    • ​Renal impairment 

22

What are the stages of nephropathy associated with diabetes?

  • Hyperfiltration
  • Normal
  • Microalbuminuria
  • Overt nephropathy
  • Chronic renal failure

23

Describe the management of nephropathy.

  • Screening
    • Albustix
    • Microalbuminuria
    • Creatinine
  • Blood pressure
    • Aggressive treatment ACEI/AIIRA
    • 130/80 or lower
  • Hyperlipidaemia
    • Statin
  • Good glycaemic control
  • Diet

24

Outline the stages of diabetic retinopathy.

  • Background retinopathy
  • Preproliferative 
  • Proliferative*
  • Advances eye disease*
  • *Maculopathy
    • Exudative
    • Oedematous
    • Ischaemic
  • *Changes can cause blindness