Diabetes 2 Flashcards
(19 cards)
Metabolic syndrome
A cluster of several risk factors for heart disease. e.g. type 2 diabetes, insulin resistance, impaired glucose tolerance, together with 2 or more from list:-
obesity with high bmi
hypertension bp >140/90
micro albuminuria or dyslipidoemia (WHO 1999)
Patient education
.Structured education to patient/carer
.annual review (nice 2014)
.patient education programme laid down by DH(diabetes uk 2006)
.evidence based patient education programme individualised, always meet cultural, linguistic cognitive needs.
Beta cells Alpha cells ?
Insulin beta cells
Glucagon alpha cells.
Alpha secrete glucagon- function is to increase blood levels of glucose
Beta secrete insulin - function to decrease blood levels of glucose.
Blood glucose levels control secretion of glucagon and insulin
What is insulin
Hormone from pancreas which allows glucose to enter cells where it is used for energy and is vital for life. Glucose is also produced by the liver.
in diabetes can’t make proper use of this glucose, builds up in blood and can’t be used as energy.
So - glucose builds up in blood and body unable to maintain blood glucose levels 3.5 7 mol/l. In response live produces more glucose but body can’t use it.
Type 1 - no insulin
Glucose builds up in blood. Body tries to get energy elsewhere, breaks down fat stores and protein = weight loss and glucose passes in urine. Cause thought to be abnormal reaction to cells , virus maybe
Type 2 - not enough insulin
not enough insulin or insulin doesn’t work properly so cells are partially unlocked - glucose builds up in blood.
Ketones
When body can’t make use of glucose and body starts breaking down fat and protein stores to produce more glucose but cannot still be used for energy and produces ketones in blood. this is the body burning its own fat and a common complication of diabetes. If left untreated can lead to ketoacidosis and then coma then death (nhs uk 2014)
ketoacidosis
symptoms - vomit, dehydration, sweet smell on breath, rapid heartbeat, hyperventilation, confusion, disorientation.
causes - blood glucose constantly over 15mmol/l, missing injections, excess alcohol, illness or infection.
Management of blood glucose
HbA1c test every 3 - 6 months to check levels aim for 4.8mmol/l or 6.5% or lower (nice 2015)
Complications
Retinopathy - affects blood vessels in eye can damage vision.
Neuropathy - affects nervous system, damage to nerves that message the brain, muscles and organs. Need to control blood glucose levels - affects up to 50% of patients with diabetes.
Nephropathy - kidney has many tiny blood vessels that filter waste from your blood. High blood sugar from diabetes can destroy these blood vessels. Over time, the kidney isn’t able to do its job as well. can result in kidney failure
CHD
STROKE
CLAUDICATION - cramping pain in leg caused by obstruction in arteries.
Hypoglycaemia
caused by insufficient food, delayed meals, too much insulin, stress,
blood levels drop below 4mmol/l little warning, hungry and irritable, sweating, faint
Hyperglycaemia
Blood glucose levels above 13 and rising fast. caused by treatment omission, diet, imbalance in U & E, can lead to MI
sweating, irritable, confusion, dehydration, ketosis, inbalance in U & E’s
Erectile Dysfunction
10% of men above 40 suffer with ED. Ma affect half of patients with diabetes, increases to 3/4 in diabetic men over 70
Microalbumuria
protein present in blood. can signal onset of diabetic nephropathy
risk factor for CVD
DRUGS-
Alpha Glucosidase Inhibitors
prevent digestion of carbs
DRUGS-
Sulfonylurea
Increase insulin release from beta cells in pancreas
DRUGS-
Meglinitides
increase insulin produced by beta cells in pancreas
DRUGS-
Biguanides (Metformin)
Prevent production of glucose in liver
High glucose levels in blood affect walls of arteries - develop fatty deposits (atheroma)
RISK of CVD
(who 2006)
normal blood glucose 4.4 - 6.1 mol/l
pre diabetes 6.1 - 6.9
diabetes 7mmol/l and above
