Flashcards in Diabetes Deck (130)
How does insulin therapy work?
replaces insulin to form GLUT4 for glucose transport
Risks of insulin therapy?
weight gain, hypoglycaemia, localized lipoatrophy, hypokalaemia, CI in hypersensitivity to the ingredients and hypoglycaemia, drug interactions with repaglinide, MOI, corticosteroids, levothyroxine, thiazide diuretics
Complications of insulin therapy?
hypoglycaemia, lipohypertrophy, local allergic reactions, insulin resistance, weight gain
What is the most common cause of hypoglycemia?
form sulfonylurea treatment
Symptoms of hypoglycemia?
Causes of hypoglycemia?
exogenous drugs, pituitary insufficiency, liver failure, addison's, islet cell tumours, immune hypoglycemia, non pancreatic neoplasms
Diagnosis of hypoglycemia?
Treatment of hypoglycemia?
treat immediately with rapidly absorbed carbohydrate of glucogel orally or UV dextrose if unconscious, IM glycogen mobilizes hepatic glycogen, monitor levels to prevent recurrence
pancreas transplant if diabetic with immunosuppression for kidney transplant, lasting graft function, pancreatic islet transplant from cadaver harvesting and injecting into portal vein
How is glycaemic monitoring done?
finger prick blood test with reagent strips and reading meter, 4 samples 2x/week and record
urine test in those unable to do so but less reliable as urine glucose lags behind blood glucose
ketostix to measure ketones if unwell to indictae serious metabolic derangement
hospital detection of HbA1c is a good measurement of glucose over Hb lifespan
What is the aim of HbA1c in diabetic and non diabetic patients?
diabetic = 48-59mmol/mol
non diabetic = 20-42mmol/L
What test is useful for hypoglycemia in thalassemic patients?
glycosylated plasma proteins
What are insulinomas?
rare pancreatic islet cell tumours that secrete insulin and presents with fasting hypoglycemia and neuroglycopenia and SNS symptoms
Complications of diabetes?
hypertension, increased stroke risk, MI, diabetic foot, nephropathy, peripheral neuropathy, retinopathy, erectile dysfunction, depression, IHD, persistent and recurrent infections
What is the main cause of death in diabetics?
vascular disease, MI is 4x more common in DM and stroke 2x more common, women at a higher risk
What is macrovascular disease in DM and its treatment?
atherosclerosis, stroke, IHD, PVD - good diabetic control antihypertensives, modify risk factors, stop smoking, statins, ACEI, low dose aspirin
What is microvascular disease in DM?
specific to diabetes, affecting the small vessels including the retina, renal glomerulus, nerve sheath and occurs about 10-20 years after diagnosis?
How does nephropathy from glomerular disease present?
thickened glomerular basement membrane, diffuse of nodular glomerulosclerosis, microalbuminuria, negative protein in urine dipstick but urine ACR >3mg/mmol
How can nephropathy in glomerular disease develop?
progress to intermittent albuminuria and persistent proteinuria, frank nephrotic syndrome, eventually leading to end stage kidney failure
Treatment of nephropathy in glomerular disease?
yearly dipsticks to check protein and microalbuminuria to prevent frank proteinuria, control BP and ACE-I, dialysis and transplant
How does nephropathy from ischemic lesions present?
afferent and efferent arteriolar hypertrophy and hyalinisation
How does nephropathy with infective lesions present?
can lead to renal papillary necrosis and renal papillae can be shed in the urine and cause urethral obstruction
How common are eye problems in diabetics?
1/3 of young get visual problems, 5% become blind after 30 years, prevalence is falling
What are the different types of diabetic retinopathy?
background (30%)- microaneurysms, haemorrhages, hard exudates and can lead to maculopathy
pre proliferative - cotton wool spots (microvascular infarcts), hemorrhages and venous bleeding, signs of ischemia
proliferative - new vessels form due to retinal damage which can cause retinal ischemia, prolifferate, bleed, fibrose and detach from the retina
maculopathy - damage to the macular and can cause macular oedema causing low acuity
What is diabetic retinopathy?
lesions in the retina and iris, most common cause of blindness under 65 caused by capillary endothelial change causing vascular leak, microaneurysms, capillary occlusion, local hypoxia, ischemia and new vessel formation
Treatment of diabetic retinopathy
annual retinal screening with visual acuity, retinal photography, aspirin, better glycaemic control, lower BP, smoking cessation
Treatment of maculopathy?
prompt laser, intravitreal steroids, anti angiogenic agents if macular oedema
What other eye problems are caused in diabetes?
cataracts, external ocular palsies (mainly 6th and 3rd), rubeosis iridis (can lead to glaucoma)
What is cataracts?
can be juvenile snowflakes or senile which occur earlier in diabetic patients, leading to temporary blurred vision caused reversible osmotic changes in the lens in those with hyperglycemia
What is diabetic neuropathy?
decreased sensation, absent ankle jerks, neruopathic deformity (pes cavus, claw toes, loss of transverse arch, rocker bottom sole), patchy sensory loss, symmetrical sensory polyneuropathy