Flashcards in Diabetes Deck (33)
What is normal blood glucose level?
Fasting = 4-6 mmol/L
After meal = less than 7.8 mmol/L
What is the normal response to high blood glucose levels?
Insulin is released by beta cells of the pancreas so that fats take in glucose from the blood
What is the normal response to low blood glucose levels?
Glucagon is released by alpha cells of the pancreas so that the liver releases glucose cells into the blood
What is the difference between type 1 and type 2 diabetes?
Type 1 = no insulin is released
Type 2 = cells dont respond to insulin
What are the symptoms of type 1 diabetes?
dramatic weight loss
What are the symptoms of type 2 diabetes?
Night time urination
Dark skin around the neck or armpits
What characteristics do you need to diagnose diabetes?
Diabetes symptoms +
random plasma glucose over 11mmol/L or fasting over 7
no diabetes symptoms but positive results in the two tests
HbA1c over 48mmol/mol
What does the treatment for diabetes aim to achieve?
Keep patient feeling well
Delay the onset of micro and macrovascular problems
What is the main determinant of microvascular problems?
Tight glycaemic control
What is the main determinant of macrovascular problems?
What are the 5 main complications from diabetes?
Poor healing - AMPUTATION
Damaged blood vessel in the retina - BLINDNESS
What is the treatment for type 1 diabetes?
Insulin (pump or pen device)
What is the treatment for type 2 diabetes?
Insulin via pen devices
What is the difference between different types of insulin?
Rate of absorption
Peak onset of action
Duration of action
Where can insulin be injected?
Upper outer thigh
Upper outer arm
What is insulin pump therapy?
Pump attached to stomach and injects insulin automatically
Insulin must be kept in the fridge, unless being used - then room temperature OK
What is the duration of action of insulin?
Rapid acting = 1-4 hours
Short acting = 1-7 hours
Intermediate acting = 1 -10 hours
Long acting = 1-24 hours
What is metformin?
Treatment for type 2 diabetes
1st line for obese type 2
Dose max 2g per day with or after meals
Prevents any cardiovascular complications with diabetes
Doesnt cause hypoglycaemia
Aids weight loss
Gastrointestional changes – diarrhoea, vomiting,
loss of appetite
What are sulphonylureas?
Eg GLICLAZIDE - stimulates pancreatic beta cells to produce insulin
Dose 160 mg twice a day taken before meals
What are glitazones?
Improve insulin resistance
Dose max 45g once daily at any time
Increased risk of bone fracture
What are the effects of incretin hormones (GLP)?
Stimulates release of insulin in the presence of glucose
Reduces hepatic gluconeogenesis
Delays gastric emptying
What inactivates GLP?
What are SGLT2 inhibitors?
Taken orally, 5 or 10mg
Increase frequency of UTI
Increase frequency of thrush
Modest diuretic effect ( due to osmotic diuresis from urinary glucose excretion)
What is the action of SGLT2
SGLT2 are responsible for 90% of glucose reabsorption in the kidney
What is hypoglycaemia?
Refers to any episode of low blood glucose
What are the symptoms of hypoglycaemia?
1) Autonomic – due to activation of autonomic nervous systems ( sweating, tremor, anxiety, palpitation, etc)
2) Neuroglycopaenic – due to reduced glucose delivery to the brain ( poor concentration, odd behaviour, dizziness, blurr vision etc )
3) Coma / death
What is the treatment for hypoglycaemia?
Glucose tablet or drink, jelly babies if mild
Im glucagon or Intravenous glucose if severe
What are the consequences of hypoglycaemia?
1) Quality of life
2) Fear of further hypoglycaemia – poor control of diabetes
3) Falls – leading to fracture
4) Cardiovascular – prolongation of QT interval, leading to arrthymia and death
5) Repeated hypoglycaemia
- Probably cognitive impairment
- Hypoglycaemia unawareness
6) Driving consequences
What is the law surrounding hypoglycaemics driving?
• Must have awareness of hypoglycaemia
• Not more than one hypoglycaemia needing third party assistance in last 12 months
• Appropriate blood glucose monitoring
What is diabetic ketacidosis?
Acute insulin deficiency causing
1) less glucose uptake - hyperglycaemia - polyuria, thrist
2) Lipolysis leading to the formation of fatty acids - ketone formation - ketoacidosis - nausea and respiratory compensation
Who is prone to diabetic ketoacidosis?
Type 1 diabetics
How do we diagnose diabetic ketoacidosis?
Capillary blood glucose > 11 mmol/l
Capillary ketones > 3mmol/l