Diabetes Flashcards
(41 cards)
1
Q
What are the 2 types of diabetes?
A
- Type 1
- Type 2
2
Q
What is type 1 diabetes?
A
- Auto-immune disease
- Idiopathic (unknown)
- Presents young
- Rapid onset
- Requires insulin for life
- Hallmark-ketones
3
Q
What triggers type 1 diabetes?
A
The vast majority of type 1 cases are caused by the autoimmune destruction of the pancreatic beta cells, which results in the inability to produce insulin.
The immune system mistakenly identifies these cells as foreign and attacks and destroys them
The precise cause of this error in immune function is unknown, but experts think that some are born with a genetic susceptibility to it.
Then, at some point in their life, an environmental trigger such as a virus or a toxin activates this genetic susceptibility to bring on the immune response that produces type 1 diabetes.
4
Q
What are some symptoms of hyperglycaemia?
A
- Increased thirst (polydipsia)
- Increased urination (polyuria)
- Blurry vision
- Fatigue/tiredness
- Slow healing of cuts or wounds
- More frequent infections
- Weight loss
- Nausea and vomiting
5
Q
What complications can arise from chronic hyperglycaemia
A
- Retinopathy
- Stroke
- Heart disease
- Nephropathy
- Autonomic neuropathy
- Peripheral neuropathy
6
Q
What are some more detailed complicates of hyperglycaemia under retinopathy?
A
- Macular edema
- Capillary non-perfusion
- Angiogenesis
- Haemorrhage
- Glaucoma
7
Q
What are some more detailed complications of hyperglycaemia with heart disease?
A
- Atherosclerosis
- Endothelial dysfunction
- Hypertension
- Dyslipidemia
- Procoagulant state
- Antifilbrinolitic state
- Vascular inflammation
8
Q
What are some more detailed complications of Hyperglycaemia under nephropathy?
A
- Damaged Glomeruli
- Hyperfiltration
- Renal damage
9
Q
What are some more detailed complications for Hyperglycaemia under Peripheral neuropathy?
A
- Nerve damage
- Ulceration
- Necrosis
10
Q
What are some more detailed complications for Hyperglycaemia under autonomic neuropathy?
A
- Nerve damage
- Gastrointestinal dysfunction
- Genitourinary dysfunction
11
Q
What are some of the causes for Hyperglycaemia?
A
- Insufficient insulin or oral diabetes medication
- Not injecting insulin properly or using expired insulin
- Diet
- Being inactive
- Illness or infection
- Certain medications, eg steroids, beta blockers
- Injury or surgery
- Experiencing emotional stress, such as family conflict or workplace challenges
12
Q
What is the definition of Hypergylcaemia?
A
High Blood Glucose (Blood sugar)
- when the body has not have enough insulin or can’t use it properly
13
Q
What is the definition of Hypoglycaemia?
A
Low blood glucose (blood sugar)
14
Q
Describe Hypoglycaemia
A
- Always a medical emergency
Consequences include: Sympathetic arousal, collapse, confusion, seizure, coma, death. - Needs IMMEDIATE treatment
- Once the patient stabilised, consider the cause and try to prevent a recurrence.
15
Q
Name some early symptoms of hypoglycaemia
A
- Sweating
- Shaking
- Dizziness
- Hunger
- Pins and needles around mouth
- Palpitations
- Headache
16
Q
How do you prevent Hypoglycaemia?
A
- Frequent BSL monitoring
- Monitor and encourage food intake
- Anticipate changes in insulin requirements eg. fasting, changes in activity level
- Give dextrose with insulin infusions* (Hospital)
- Educate them about symptoms of hypoglycaemia and encourage them to report these promptly.
- Ask patients on insulin about their experience of hypoglycaemia and awareness threshold.
17
Q
How do you manage Hypoglycaemia?
A
- Give 15-20g quick-acting carbohydrate (Jellybeans)
- Test BSL after 10min
- If still below 3.5mmol/L, repeat up to 3 times
- If still low, call for help, consider IV glucose or IM glucagon.
- Once BSL above 3.5 give a snack or next meal if available
18
Q
What do you need to consider before you start the management of Hypoglycaemia?
A
Patient is conscious, and able to swallow safely
19
Q
What risk factors can cause type 2 diabetes?
A
- Usually aged over 40
- Family history
- Gradual onset
- Maybe no symptoms
- Inefficient insulin
- Overweight (95-99.9%%)
- Lean (up to 5%)
20
Q
What is Metabolic Syndrome?
A
Defined as 3 or more of the following:
- Abdominal or visceral obesity(>102cm M, >88cm F)
- High triglycerides(ugly cholesterol)
- Low HDL (good) cholesterol
- High BP >130/80 (EPA SMI without DM 140/90)
- High fasting blood glucose
- Presence of Metabolic Syndrome another way to identify increased Cardiovascular disease risk and Diabetes Mellitus risk
- Prevalence greater for people with SMI 2-3 fold or 50%
21
Q
How should you manage type 2 diabetes?
A
- Healthy diet
- Exercise
- Weight loss
- Oral hypoglycaemics
- BP and lipid monitoring
22
Q
What is the normal blood glucose range?
A
3.5 - 7.7 mmol/L
23
Q
What laboratory test is the best predictor of blood glucose control over a period of months?
A
HbA1c - gives an average for 90 days
24
Q
What is diabetes?
A
- Diabetes involves inability to produce or use insulin
- When there is a lack of insulin glucose cannot be taken out of the blood by body cells
- Blood glucose levels rise.
- The main feature of diabetes is high blood glucose or hyperglycaemia.
25
What is insulin resistance?
The inability of cells to respond normally to insulin and allow the entry of glucose - type 2 diabetes. Insulin resistance in metabolic tissues, such as the liver, skeletal muscle, and adipose tissue, results in insufficient insulin usage.
26
What is HbA1c?
Glucose attaches to Haemoglobin
Red cells live for 8 -12 weeks before they are replaced. By measuring the HbA1c you can measure how high blood glucose has been on average over the last 8-12 weeks.
27
How do you monitor diabetes?
- Capillary blood tests
- Glycated Haemoglobin (HbA1c)
- Urine (polyuria, Urine may smell sweet if it contains extra glucose)
28
What is diabetic ketoacidosis?
- The lack of insulin causes mobilisation of fatty acids for energy, leading to an increased production of ketones. The kidneys can’t secrete the ketones and the cells are unable to use these, allowing ketones to accumulate in the blood resulting in acidosis. Acidosis leads to widespread cellular damage.
Osmotic diuresis is increased urination due to the presence of certain substances in the fluid filtered by the kidneys. This fluid eventually becomes urine. These substances cause additional water to come into the urine, increasing its amount.
29
What does diabetic ketoacidosis result from?
Results from insulin deficiency so occurs most commonly in type 1 diabetes. Develops over a few days and is triggered by an increased demand for insulin, situations that can cause this include severe stress, infection, overconsumption of food, pregnancy, or inadequate insulin administration
30
What are the symptoms of diabetic ketoacidosis?
The same as type 1 diabetes:
- polyuria (increased urination)
- polydipsia (extreme thirst),
- polyphagia (excessive eating)
- nocturia (frequent urination at night)
- weight loss
- fatigue.
Abdominal pain and vomiting also common. The breath has a sweet, fruity smell caused by the release of acetone, a volatile form of ketones. The decreased circulating blood promotes tachycardia and hypotension.
31
What are the causes of diabetic ketoacidosis?
Insulin withdrawal or reduction
Myocardial Infarction (heart attack), stroke, trauma or other medical stress
Infection such as pneumonia, gastroenteritis, influenza, UTI, meningitis
32
What is the treatment for diabetic ketoacidosis?
- Stabilising blood glucose levels – IV insulin infusion
- Correcting acidosis
- Fluid and electrolyte replacement
- Addressing any triggering causes (most important)\
Treat the underlying disorder. Then with supportive management, such as fluid and electrolyte replacement/oxygen therapy the body will correct the acid-base disorder.
33
What are some late symptoms for hypoglycaemia?
- Double vision
- Unusual behaviour
- Confusion
- Drowsiness which may lead to unconsciousness
34
Why are people with diabetes at increased risk of infection?
- Excess blood glucose is the optimal environment for pathogens
- Tissue ischemia from vascular changes
- Neuropathy and retinopathy prevent the individual from sensing changes
- RBCs and WBCs both impaired
35
What two groups of hypoglycaeic agents are used for control of diabetes? Name a drug within each group that helps with diabetes
Biguanides
- Metformin
Sulphonylureas
- Glipizide
- glibenclamide
- gliclazide
36
How does Biguanides help with diabetes?
Refers to a group of oral type 2 diabetes drugs that work by preventing the production of glucose in the liver, improving the body’s sensitivity towards insulin and reducing the amount of sugar absorbed by the intestines.
37
How does metformin work to reduce glucose levels in the blood?
Reducing the amount of sugar your liver releases into your blood. It also makes your body respond better to insulin.
38
What two metal illnesses have a higher genetic risk of developing diabetes?
Research has shown that people with schizophrenic and BPAD (bipolar) disorders have an increased genetic risk of developing diabetes
39
Why are people with a mental illness at higher risk of developing diabetes?
Partly because of the medications
- Atypical antipsychotic medications cause weight gain, hyperlipidaemia (high levels of fat particles in the blood) and insulin resistance
- Atypical antipsychotic medications are associated with significant increases in fasting glucose concentrations
- This hyperglycemia can result in new onset type 2 diabetes and Diabetic acidosis
40
What can we do before prescribing antipsychotic medications to reduce the risk of diabetes?
- Assess weight, BMI, fasting glucose, lipids and blood pressure before starting antipsychotic medications
- Reassess at least annually and actively manage these conditions if present
- If weight increases by more than 5% consider changing to a antipsychotic less likely to cause metabolic effects
41
How should we manage type 1 diabetes?
- There are many forms of insulin to treat diabetes. They are classified by how fast they start to work and how long their effects last.
The types of insulin include:
- Short acting e.g., Neutral (Actrapid, Humulin R)
- Intermediate acting e.g., Isophane (Humulin NPH, Protaphane)
- Long acting e.g., Glargine (Lantus)
- Fast acting e.g., Aspart (NovoRapid), Lispro (Humalog)
