Diabetes Flashcards Preview

CMS > Diabetes > Flashcards

Flashcards in Diabetes Deck (53):
1

what is diabetes?

disorder of the metabolism causing excessive thirst and the production of large amounts of urine

2

two categories of diabetes?

mellitus
insiupidus
same symptoms

3

what is diabetes mellitus?

group of metabollic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both

4

types of diabetes?

type 1
type 2
MODY
gestational

5

what is type one diabetes?

pancreatic beta cell destruction/insulin required for survival
= anti GAD, anti islet cell antibodies

6

what is type two diabetes?

if patient does not have type one, monogenic or result of other medical condition/tx = secondary diabetes

7

what are secondary causes of diabetes?

diabetes as a result of drugs
pancreatic pathology
endocrine cause

8

when was insulin discovered?

1922 - banting, best, macleod, collip - discovered insulin. Removed pancreas of a dog - treatment by insulin injections

9

when was the 1st diabetes patient treated with insulin?

1922 in toronto - 14yr old leonard thompson

10

Type 2 diabetes caused by?

insulin resistance and beta cell function has core defects

11

genetic susceptibility, obesity and western lifestyle lead to what that causes type 2 diabetes?

insulin resistance and beta cell dysfunction

12

normally what happens to insulin?

insulin binds to a receptor triggering production of glucose transport proteins to allow glucose to enter cell q

13

if someone is insulin resistance what happens?

receptor not as responsive to the binding insulin molecule, therefore there is less glucose entering the cell and a build up of glucose in the blood

14

some causes of insulin resistance?

ectopic fat accumulation and increase in free fatty acids
increase in inflammatory mediators CRP

15

the increase in free fatty acids and CRP mediators results in?

inhibition of insulin via serine kinases responsible for phosphorylation of insulin receptor substrate 1 (IRS1)
= reduction in insulin stimulated glycogen synthesis due to reduced glucose transport

16

insulin resistance associated with?

intra abdominal obesity
inactivity
meds
genetics
smoking
fetal malmutrition
endothelial disease
aging
hypertension

17

what is the therapy staircase for type 2 diabetes?

diet and exercise
oral monotherapy
oral combination
injectable and oral therapy

18

lifestyle changes for type 2?

weight loss
smoking cessation
improve diet
exercise

19

drugs to treat type 2?

metformin - biguanide
sulfonylureas
insulin

20

considerations for drug choices in type 2?

duration of diabetes
degree of improvement required
mode of delivery
adverse effects
pt preference
cost

21

what is HbAIC?

measure of blood glucose over a prolonged period pf 6-8 weeks
ref range = 6.6-7.5%/ 48-58 mmol

22

how to do home blood glucose monitoring?

target should be between 4 and 7 before meals and under 10 after meals

23

reducing chronic complications allows?

avoidance of microvascular disease
avoidance of acute metabolic complications - DKA
reduced physiological morbidity

24

macrovascular disease?

IHD, stroke

25

microvascular disease?

neuropathy
nephropathy
retinopathy

26

what is diabetes the leading cause of?

blindness
dialysis
amputation

27

how to screen for microvascular complications?

- annual urinary albumin creatinin ratio ACR for diabetic kidney disease
- annual retinal photograph
- annual foot screening

28

what is metabolic syndrome?

central obesity
high bp
high triglycerides - low hdl cholesterol
insulin resistance

29

how is cholesterol treated in diabetes?

lipid lowering statins in all diabetic patients over 40 regardless of baseline cholesterol

30

ensure bp is what in a diabetic pt?

31

aspirin and diabetes?

not recommended for primary prevention but may be used in secondary prevention if CVR >10% in 10 years

32

what happens when glucose falls?

there is a release of counter regulatory hormones - glucagon, adrenaline and cortisol
aim is to stimulate glycogenolysis
side effects = sweats, palpitations, flushing

33

symptoms of hypoglycaemia?

sweats, shakes, flushing, palpitations = autonomic
neuroglycopenic= confusion, reduced gcs, collapses, seizures, coma

34

what happens with repeated exposures to hypo's?

a gradual reduction in warning signs
progressive loss of counter regulatory hormone response = glucagon, adrenaline
more likely to have neuroglycopenic symptoms

35

precipitating factors for hypoglycaemia?

dosage of ohg/insulin
errors in dose given
timing of meds - esp insulin
delay in meals
exercise
alcohol
co morbidity - e.g renal insufficiency
adrenal insufficiency
pituitary insufficiency

36

hyperglycaemia in type 1? type 2?

1 - diabetic ketoacidosis DKA
2 - hypermolar non ketotic coma

37

hyperglycaemic b/c?

acute illness
co morbidity
injury/infection
meds
poor compliance/errors in compliance with tx
psychological or social issues

38

in hyperglycaemia measure?

ketones
acidosis
need iv fluids and insulin

39

increased risk of hypo/hyperglycaemia in emergency patients bc

poor oral intake
sepsis
sleep deprivation
= modification of normal drug regime

40

higher risk of perio disease in diabetic pt's because?

high glucose = poor healing and increased infection risk
small blood vessel damage = reduced blood flow

41

increase BG monitoring when?

during acute illness

42

what is the bg for a hypoglycaemic pt?

43

what patients should ketone monitor?

type 1 diabetic patients

44

what is being measured with a ketone monitor?

beta hydroxybutyrate

45

what is the range for ketone monitoring?

0-8mmol/l

46

what is the normal ketone measurement?

47

insulin secreted at s low basal rate is responsible for how much of insulin produced?

50%

48

post meal glucose stimulates?

post prandial insulin

49

what types of insulin are available?

long acting
short acting
rapid acting

50

how can insulin be administered?

syringe
disposable pen
reusable cartridge pen
continuous subcutaneous insulin fusion pump

51

what is a CSII?

for type 1
programmable infusion pump
self managed
pulsates alanouge insulin continuously
bolus dose of insulin pumped out at mealtimes calculated on CHO content of food

52

management of diabtes during illness?

increased monitoring
insulin increased b/c body response to stress

53

what can corticosteroids precipitate?

hyperglycaemia