Diabetes Flashcards
(14 cards)
Describe Type 1 Diabetes:
- cause
- prevalence
- treatment
- symptoms
- diagnosis
Cause:
- Autoimmune condition
- Exact cause unknown
- Family history (genes linked to T1D)
- Environmental trigger (e.g., viral infection)
Prevalence:
- Typically diagnosed in childhood/adolescence
Treatment:
- Insulin
Symptoms:
- 4 T’s (toilet, thirst, thinner, tired)
- Increased hunger
- Dizziness
- Blurred vision
Diagnosis:
- HbA1c level >48mmol/mol
- Random Plasma Glucose (RPG) >11.1 mmol/L
- Fasting Blood Glucose test >7 mmol/L
- Oral Glucose tolerance test (OGTT)
Describe Type 2 Diabetes:
- cause
- risk factors
- prevalence
- treatment
- symptoms
- diagnosis
T2D is a condition characterised by inadequate response to insulin by insulin receptors on cell membrane - insulin resistance.
Most common form of diabetes (90% cases).
Cause:
- Overweight and obesity
- Family history
Risk factors:
- Genetic links
- Overweight/obesity (central obesity). Excess adiposity reflected by higher body mass index (BMI) is the strongest risk factor for diabetes
- 80% of individuals diagnosed with T2D are overweight
- Ethnicity (South Asian, Black African, African Caribbean at higher risk).
- History of polycystic ovaries, gestational diabetes or macrosomic birth.
Prevalence:
- Older adults
- Overweight/obese people
- Becoming more common in younger people
Treatment:
- Lifestyle modifications (diet & exercise)
- Antidiabetic Therapies (Metformin, Sulphonylureas, GLP1, Acarbose, Gliptin)
- Insulin
Symptoms:
- 4 T’s (toilet, thirst, thinner, tired)
- Increased hunger
- Dizziness
- Blurred vision
- Itching
- Slow wound healing
- Candida type infection
Diagnosis:
- HbA1c level >48mmol/mol
- Random Plasma Glucose (RPG) >11.1 mmol/L
- Fasting Blood Glucose test >7 mmol/L
- Oral Glucose tolerance test (OGTT)
Describe Gestational Diabetes:
- cause
- risk factors
- prevalence
- treatment
- symptoms
- diagnosis
Gestational diabetes is diabetes that develops during pregnancy in women who DO NOT already have diabetes.
Causes:
- Hormonal changes during pregnancy can make it hard for your body to use insulin properly
–> insulin resistance
–> some women can’t produce enough insulin to overcome it
–> raised blood sugar levels
Risk factors:
- overweight or obese
- family history of diabetes
- previous macrosomic baby
Prevalence:
- about 1 in 20 pregnancies (4-5% of pregnancies) in the UK
- women who have GDM are 60% more likely to develop T2M
Treatment:
Symptoms:
Diagnosis:
What are the acute and chronic complications of diabetes?
Acute:
- Hypoglycaemia or hyperglycaemia
- Hyperosmolar Hyperglycaemic State - (HHS): life-threatening emergency brought on by severe dehydration + very high blood sugars (only in T2D).
Diabetic ketoacidosis (DKA): life-threatening emergency where lack of insulin and high blood sugars leads to a build-up of ketones as fat is used for energy. Ketones can build up and make your blood become acidic (only in T1D).
Chronic:
- Retinopathy
- Foot problems
- Heart attack and stroke
- Kidney problems (nephropathy)
- Nerve damage (neuropathy)
- Gum/other mouth problems
- Cancer
- Sexual problems (men & women)
Briefly describe how T2D can be prevented.
50% of cases of T2D can be avoided if prevention strategies are implemented.
Weight management:
- Losing just 5% of body weight can significantly reduce risk
Diet:
- DASH (dietary approach to stop hypertension)
- Mediterranean diet
- High fibre, low GI, low foods
- Low carb, high protein diet
Physical activity:
- both aerobic and resistance training
What are the primary goals of diabetes treatment?
how is this achieved?
what are diabetes management strategies for T1D & T2D?
To bring the elevated blood sugars down to a normal range:
- to improve symptoms of diabetes
- to prevent or delay diabetic complications
Achieving this goal requires a comprehensive, coordinated, patient-centred approach that considers all aspects of a patient e.g., culture, religion, geography, SES…
Strategies:
T1D:
- insulin replacement
- diet & lifestyle modification
T2D:
- diet & exercise regime
- antidiabetic therapy (used alongside diet & exercise regime if diet & exercise alone unsuccessful
What are the most common antidiabetic drugs and explain their modes of action.
- Metformin
- SGLT-2
- GLP-1
Describe the following types of diabetes in terms of pathophysiology and risk factors:
- Type 1 Diabetes
- Type 2 Diabetes
- Gestational Diabetes
- MODY
- LADA
- Type 3 Diabetes
- Type 3c Diabetes
Type 1 Diabetes
Pathophysiology:
- Auto immune condition
- Pancreatic b-cells do not produce insulin.
Risk factors:
- Typically diagnosed in childhood
- no clear aetiology though linked to environment e.g., exposure to pathogens
Type 2 Diabetes
Pathophysiology:
- Cells develop insulin resistance
Risk factors:
- Linked to diet, lifestyle and obesity
Gestational diabetes
Pathophysiology:
- Insulin resistance induced by pregnancy hormones
Risk factors:
- Overweight/obesity
- Family history
- Ethnicity (South Asian & African-Caribbean)
MODY (Maturity Onset Diabetes in the Young)
Pathophysiology:
- Rare form of diabetes
- Typically develops before 25y caused by genetic mutation
Risk factors:
- Hereditary disease
LADA (Latent Autoimmune Diabetes in Adults)
Pathophysiology:
- Autoimmune condition
- Immune system attacks insulin producing cells in pancreas leading to reduced insulin production.
Risk factors:
- Family history of LADA
- Low birth weight
- Diet & lifestyle (smoking, alcohol, SSBs)
Type 3c Diabetes:
Pathophysiology:
- Also known as ‘pancreatogenic diabetes’
- Linked to pancreatic conditions e.g., chronic pancreatitis, cystic fibrosis, pancreatic cancer.
Type 3 Diabetes
Pathophysiology:
- Theory that insulin resistance in the brain may lead to development of Alzheimers
How are the different types of diabetes diagnosed?
Fasted blood glucose test:
pre diabetes = 5.6 - 6.9 mmol/L (100 – 125 mg/dL) =
diabetes = >7 mmol/L (126 mg/dL)
Random blood glucose test
prediabetes = 7.8 and 11.0 mmol/L (140 – 199 mg/dL)
diabetes = <11 mmol/L (200 mg/dL)
HbA1c level (average blood sugar over 3 months)
normal = <39 mmol/mol (5.7%)
prediabetes = 39 - 47 mmol/mol (5.7% - 6.4%)
diabetes = >48 mmol/mol (6.5%)
OGGT (gestational diabetes)
fasting > 5.6 mmol/L
2 hr post glucose > 7.8 mmol/L
Antibody tests/C-peptide tests can be used to help differentiate between the types of diabetes.
Define hypoglycaemia and hyperglycaemia in terms of:
- blood parameters
- symptoms
- management
Hypoglycaemia
Blood parameters:
- Blood glucose < 4 mmol/mol
Symptoms:
- dizziness, confusion, shaking, sweating, coma
Management:
- Administer oral glucose equivalent to 15-20g CHO (200ml OJ, 3 x glucose tablets, 150ml fizzy drink)
- IV glucose infusion or glucagon injection
Hyperglycaemia
Blood parameters:
- Blood glucose > 11 mmol/mol
Symptoms:
- polyurea, polydipsia, fatigue, infection, blurred vision, weight loss
Management:
- Insulin administration
- Antidiabetic medication
- Diet and lifestyle modification
What are the common complications associated with Gestational diabetes?
Increased risk of T2D later in life or post-partum
Pre-eclampsia
LGA baby/Macrosomic birth (and associated birth injuries)
Foetal malformation
Hypoglycaemia in the infant shortly after birth
Baby at higher risk of obesity and T2D later in life
What advice is given to those with gestational diabetes and how is this different to advice given for T1D/T2D?
1st line advice is diet and exercise.
Not advisable to lose weight during pregnancy.
May be offered Metformin or insulin.
Explain the difference between glycamic index and glycaemic load
Glycaemic index – score between 1 – 100 indicating how quickly a food raises blood sugar levels compared to glucose (reference – 100).
Glycaemic load – considers GI score and quantity of CHO per serve to give more realistic overview of the effect of a food on glycaemic control.
GI focuses on the rate of blood sugar rise, while GL focuses on the magnitude of the rise based on the portion size.
e.g., Watermelon has a high GI, but its low carbohydrate content in a serving results in a low GL
