Diabetes Flashcards
(51 cards)
What is type 1 diabetes mellitus?
Autoimmune
Attacks beta cells so can’t produce insulin
Glucose can’t enter cells
What are some symptoms of T1DM?
Symptoms develop over few days or weeks:
peeing more than usual
feeling very thirsty
feeling very tired
losing weight quickly without trying to
blurred vision
breath that smells sweet or fruity (like nail
polish remover or pear drop sweets)
cuts and wounds taking longer to heal
getting frequent infections, such as thrush
How is gestational diabetes diagnosed?
Diagnosed if woman has either:
fasting plasma glucose level of 5.6mmol/l or above or
a 2-hour plasma glucose level of 7.8mmol/l or above
Whats the criteria for a diabetes diagnosis with symptoms?
Diabetes symptoms (e.g. polyuria, polydipsia and unexplained weight loss for Type 1) plus:
-a random venous plasma glucose concentration ≥ 11.1 mmol/l or
-a fasting plasma glucose concentration ≥ 7.0 mmol/l (whole blood ≥ 6.1 mmol/l) or
-two hour plasma glucose concentration ≥ 11.1 mmol/l two hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT)
Whats the criteria for diagnosing diabetes with no symptoms?
should not be based on a single glucose determination but requires confirmatory plasma venous determination
At least one additional glucose test result on another day with a value in the diabetic range is essential, either fasting, from a random sample or from the two hour post glucose load
When is HbA1c not appropriate for diagnosis of diabetes?
ALL children and young people
patients of any age suspected of having Type 1 diabetes
patients with symptoms of diabetes for less than 2 months
patients at high risk who are acutely ill (e.g. those requiring hospital admission)
patients with acute pancreatic damage, including pancreatic surgery
in pregnancy
presence of genetic, haematologic and illness-related factors that influence HbA1c and its measurement (see annex 1 of the WHO report for a list of factors which influence HbA1c and its measurement)
What HbA1c level is the recommended cut off for diagnosing diabetes?
48mmol/mol (6.5%)
value of less than 48mmol/mol (6.5%) does not exclude diabetes diagnosed using glucose tests
What other investigations should be done for a new diagnosis of T1DM?
FBC
TFTs and TPO
Anti-TTG
Insulin antibodies, anti-GAD antibodies and islet cell antibodies - to test for antibodies associated with destruction of the pancreas and the development of type 1 diabetes
What are some short term complications of T1DM?
-Hypoglycaemia: hunger, tremor, sweating, irritability, dizziness and pallor, reduced consciousness, coma and death
-hyperglycaemia, may need to increase insulin dose, if enter DKA they need hospital admission
What are some long term complications of T1DM?
Chronic exposure to hyperglycaemia causes damage to the endothelial cells of blood vessels
suppression of the immune system
What are some Macrovascular Complications of T1DM?
Coronary artery disease
Peripheral ischaemia causes poor healing, ulcers and “diabetic foot”
Stroke
Hypertension
What are some Microvascular Complications of T1DM?
Peripheral neuropathy
Retinopathy
Kidney disease, particularly glomerulosclerosis
What are some infection related complications of T1DM?
Urinary tract infections
Pneumonia
Skin and soft tissue infections, particularly in the feet
Fungal infections, particularly oral and vaginal candidiasis
How is T1DM managed?
Basal-bolus insulin regime
The basal part refers to an injection of a long acting insulin, such as “Lantus”
The bolus part refers to an injection of a short acting insulin, such as “Actrapid” - usually before meals
Use carb counting
Insulin pumps
How is blood sugar monitored?
HbA1c - counting glycated haemoglobin, average blood glucose level over the last 3 months. Measure ever 3-6mths
Capillary Blood Glucose
Flash Glucose Monitoring (e.g. FreeStyle Libre)- sensor on the skin that measures the glucose level of the interstitial fluid in the subcutaneous tissue. Has 5 min lag
What diabetes screenings are available and how often should they be done?
Once a year:
Eye problems (diabetic retinopathy) through retinopathy screening
Nerve damage and circulation through foot examinations
Cholesterol screening - blood test
Blood pressure screening
Kidney disease screening (diabetic nephropathy) - urine tested for proteins
What is T2DM?
combination of insulin resistance and reduced insulin production cause persistently high blood sugar levels
Repeated exposure to glucose and insulin makes the cells in the body resistant
What causes the T2DM complications?
A high carbohydrate diet combined with insulin resistance and reduced pancreatic function leads to chronic high blood glucose levels (hyperglycaemia). Chronic hyperglycaemia leads to microvascular, macrovascular and infectious complications
What are some risk factors for T2DM?
Non-modifiable risk factors:
-Older age
-Ethnicity (Black African or Caribbean and South Asian)
-Family history
Modifiable risk factors:
-Obesity
-Sedentary lifestyle
-High carbohydrate (particularly sugar) diet
What’s the presentation of T2DM?
Tiredness
Polyuria and polydipsia (frequent urination and excessive thirst)
Unintentional weight loss
Opportunistic infections (e.g., oral thrush)
Slow wound healing
Glucose in urine (on a dipstick)
What skin appearance is associated with insulin resistance?
Acanthosis nigricans
thickening and darkening of the skin, often at the neck, axilla and groin
What are the treatment targets for T2DM?
HbA1c measured every 3-6 months:
48 mmol/mol for new type 2 diabetics
53 mmol/mol for patients requiring more than one antidiabetic medication
What’s the recommended management for T2DM?
A structured education program
Low-glycaemic-index, high-fibre diet
Exercise
Weight loss (if overweight)
Antidiabetic drugs
Monitoring and managing complications
What is a complication unique to T2DM?
Hyperosmolar Hyperglycemic State
hyperosmolality (water loss leads to very concentrated blood), high sugar levels (hyperglycaemia) and the absence of ketones
presents with polyuria, polydipsia, weight loss, dehydration, tachycardia, hypotension and confusion.
Treated with IV fluids
