Flashcards in Diabetes Deck (53):
what is diabetes?
disorder of the metabolism causing excessive thirst and the production of large amounts of urine
two categories of diabetes?
what is diabetes mellitus?
group of metabollic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both
types of diabetes?
what is type one diabetes?
pancreatic beta cell destruction/insulin required for survival
= anti GAD, anti islet cell antibodies
what is type two diabetes?
if patient does not have type one, monogenic or result of other medical condition/tx = secondary diabetes
what are secondary causes of diabetes?
diabetes as a result of drugs
when was insulin discovered?
1922 - banting, best, macleod, collip - discovered insulin. Removed pancreas of a dog - treatment by insulin injections
when was the 1st diabetes patient treated with insulin?
1922 in toronto - 14yr old leonard thompson
Type 2 diabetes caused by?
insulin resistance and beta cell function has core defects
genetic susceptibility, obesity and western lifestyle lead to what that causes type 2 diabetes?
insulin resistance and beta cell dysfunction
normally what happens to insulin?
insulin binds to a receptor triggering production of glucose transport proteins to allow glucose to enter cell q
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
some causes of insulin resistance?
ectopic fat accumulation and increase in free fatty acids
increase in inflammatory mediators CRP
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
insulin resistance associated with?
intra abdominal obesity
what is the therapy staircase for type 2 diabetes?
diet and exercise
injectable and oral therapy
lifestyle changes for type 2?
drugs to treat type 2?
metformin - biguanide
considerations for drug choices in type 2?
duration of diabetes
degree of improvement required
mode of delivery
what is HbAIC?
measure of blood glucose over a prolonged period pf 6-8 weeks
ref range = 6.6-7.5%/ 48-58 mmol
how to do home blood glucose monitoring?
target should be between 4 and 7 before meals and under 10 after meals
reducing chronic complications allows?
avoidance of microvascular disease
avoidance of acute metabolic complications - DKA
reduced physiological morbidity
what is diabetes the leading cause of?
how to screen for microvascular complications?
- annual urinary albumin creatinin ratio ACR for diabetic kidney disease
- annual retinal photograph
- annual foot screening
what is metabolic syndrome?
high triglycerides - low hdl cholesterol
how is cholesterol treated in diabetes?
lipid lowering statins in all diabetic patients over 40 regardless of baseline cholesterol
ensure bp is what in a diabetic pt?
aspirin and diabetes?
not recommended for primary prevention but may be used in secondary prevention if CVR >10% in 10 years
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
symptoms of hypoglycaemia?
sweats, shakes, flushing, palpitations = autonomic
neuroglycopenic= confusion, reduced gcs, collapses, seizures, coma
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
precipitating factors for hypoglycaemia?
dosage of ohg/insulin
errors in dose given
timing of meds - esp insulin
delay in meals
co morbidity - e.g renal insufficiency
hyperglycaemia in type 1? type 2?
1 - diabetic ketoacidosis DKA
2 - hypermolar non ketotic coma
poor compliance/errors in compliance with tx
psychological or social issues
in hyperglycaemia measure?
need iv fluids and insulin
increased risk of hypo/hyperglycaemia in emergency patients bc
poor oral intake
= modification of normal drug regime
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
increase BG monitoring when?
during acute illness
what is the bg for a hypoglycaemic pt?
what patients should ketone monitor?
type 1 diabetic patients
what is being measured with a ketone monitor?
what is the range for ketone monitoring?
what is the normal ketone measurement?
insulin secreted at s low basal rate is responsible for how much of insulin produced?
post meal glucose stimulates?
post prandial insulin
what types of insulin are available?
how can insulin be administered?
reusable cartridge pen
continuous subcutaneous insulin fusion pump
what is a CSII?
for type 1
programmable infusion pump
pulsates alanouge insulin continuously
bolus dose of insulin pumped out at mealtimes calculated on CHO content of food
management of diabtes during illness?
insulin increased b/c body response to stress