Flashcards in Diabetes Deck (47):
Define the bascis of diabetes.
A group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action or both
What are the 4 criteria of which any can be used to diagnose diabetes?
HbA1c 48mmol/mol +
Fasting glucose - 7mmol/L+ 2hr glucose in OGTT 11.1mmol/L+
Random glucose 11.1mmol/L+
What are the 4 main types of Diabetes?
Other specific types
What are the 2 cardinal symptoms of diabetes?
Polydipsia (excessive thirst)
Give a list of other syptoms that can occur with any diabetes in general?
Thrush (candidal or other infection)
What are the 3 main microvascular complications in diabetes?
Define gestational diabetes.
any degree of glucose intolerance arising or diagnosed during pregnancy
Which autoantibodies are normally present in T1DM?
anti-GAD and /or anti-islet cell antibodies
What is type 2 DM?
A diagnosis of exclusion - not type 1 and not some other specific type
Does autoimmune destruction to the beta-cells occur in type 2 DM?
It is not an AI disease
Give 5 specific types of diabetes? Not incding T1, T2 or gestational diabetes
How does type 1 DM usually present?
Pre-school or peri-puberty
Acute onset of severe symptoms
Often severe weight loss
ketonuria with/wo metabolic acidosis
No evidence of complications
What is the basis pathogenesis of T1DM?
Interaction between genes imparting susceptibility and resistance --> Variable insulinitis and beta-cell sensitivity to injury -->
Pre-diabetes --> Overt diabetes
What is your risk of havin T1DM if both of your parents have it?
Briefly describe the management of type 1 DM.
BG and ketone monitoring
Dieticia and DSN contact
Annual review assessment
Record severe hypoglycaemia episodes and DKA
What is the typical presentation of T2DM?
Middle aged/ elderly
Pre-diagnosis duration of ~6-10 years
Ketonuria – minimal or absent
Evidence of microvascular disease/complications at diagnosis in 20-50 %
Give the risk factors for the development of T2DM.
Ethnicity (Asian, African, Afro-Carribean)
PMH - MI or CVA
What is a diagnosis of the "metabolic syndrome" made on?
Need insulin resistance and T2DM plus 2 of the following to have the metabolic syndrome:
Obesity (BMI >30 or WHR 1.7, HD <1.0
What are the basic steps of treatment for T2DM?
Therapeutic lifestyle change
Combination therapy (w/o insulin)
Combination therapy (with insulin)
What does LADA stand for?
Latent autoimmune diabetes of adults
When should you suspect LADA?
Associated AI conditions
What does MODY stand for?
Maturity onset diabetes of the young
What kind of inheritance does MODY express?
Autosomal dominant inheritance - rare
What are the 2 main types of MODY?
Glucokinase and transcripton factors
Which class of diabetic drugs works really well in MODY?
When is neonatal diabetes diagnosed and what is required?
Within the first 3 months of life and insulin treatment is required
What are the 3 macrovascular complications of diabetes?
The microvascular diabetic complication of retinopathy can present with what?
What is the scale used to measure diabetic retinopathy?
What are some further complications caused by the diabetic complication of nephropathy?
Development of HTN
Relentless decline in renal functtio
reduction in GFR
accelerated vascular disease
Which anti-hypertensive drug is particularly good at treating diabetic nephropathy?
What are the symptoms of peripheral neuropathy?
sharp pain or cramps
sensitivity to touch
loss of balance and coordination
What can diabetic neuropathy lead to?
deformities (charcot foot, rocker bottom foot)
What is the treatment for diabetic peripheral neuropathy?
Stronger opiods (Tramadol)
topical capsaicin cream
What other complications can diabetes lead to?
Erectile dysfunction or vaginal dryness
Psychiatric – depression, eating disorder, bi-polar, schizophrenia
What is the target blood pressure for diabetics?
What other measures besides diabetic drugs can help in controlling diabetes?
simvastatin 40 mg or atorvastatin 10 mg for T2DM regardless of baseline cholesterol
Is low dose aspirin recommended for primary prevention of CV disease in diabetics?
No but can be used for 2y prevention
Why is diabetes monitored?
Guide treatment decisions
reduce risk of compications
Safe in society
What is HbA1c?
Glycated haemoglobin formed by non-enzymatic glycation of haemoglobin on exposure to glucose
What does HbA1c measure?
Average blood glucose over a period of time
What HbA1c needs to be reached before diabetes can be diagnosed?
What is the targert HbA1c for diabetics?
For T1 and T2 DM how many times a day should they be monitoring their blood glucse via home BG monitoring machine?
T1 - 4-8 times a day
T2 - 1-4 times a day
What are the targets for home blood glucose monitoring before and after meals?
before - 4-7mmol/mol
1-2 hours after beginning of meal <10mmol/mol
What is the main purpose of bllod ketone monitoring at home?
Identifies early stages of ketone body formation when the patient often has no symptoms allowing preventative action to be carried out