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Flashcards in Diabetes Deck (33):
1

What is normal blood glucose level?

Fasting = 4-6 mmol/L
After meal = less than 7.8 mmol/L

2

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

3

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

4

What is the difference between type 1 and type 2 diabetes?

Type 1 = no insulin is released
Type 2 = cells dont respond to insulin

5

What are the symptoms of type 1 diabetes?

Frequent urination
excessive thirst
extreme hunger
dramatic weight loss
Irritability
Fatigue
Nausea

6

What are the symptoms of type 2 diabetes?

Increased thirst
Night time urination
Blurry vision
Unusual fatigue
Dark skin around the neck or armpits

7

What characteristics do you need to diagnose diabetes?

Diabetes symptoms +
random plasma glucose over 11mmol/L or fasting over 7
OR
no diabetes symptoms but positive results in the two tests
OR
HbA1c over 48mmol/mol

8

What does the treatment for diabetes aim to achieve?

Keep patient feeling well
Prevent hypoglycaemia
Delay the onset of micro and macrovascular problems

9

What is the main determinant of microvascular problems?

Tight glycaemic control

10

What is the main determinant of macrovascular problems?

Hypercholesterol
Smoking
Obesity

11

What are the 5 main complications from diabetes?

Poor healing - AMPUTATION
HEART DISEASE
KIDNEY FAILURE
STROKE
Damaged blood vessel in the retina - BLINDNESS

12

What is the treatment for type 1 diabetes?

Insulin (pump or pen device)

13

What is the treatment for type 2 diabetes?

ORAL FORM
Metformin
Sulphonylureas
Glitazones
DPP4 inhibitor
SGLT2 inhibitor
INJECTABLE FORM
GLP-1 agonist
Insulin via pen devices

14

What is the difference between different types of insulin?

Rate of absorption
Peak onset of action
Duration of action

15

Where can insulin be injected?

Bum
Upper outer thigh
Upper outer arm
Abdomen

16

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

17

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

18

What is metformin?

Treatment for type 2 diabetes
1st line for obese type 2
Dose max 2g per day with or after meals

+VES
Prevents any cardiovascular complications with diabetes
Doesnt cause hypoglycaemia
Aids weight loss

-VES
Gastrointestional changes – diarrhoea, vomiting,
loss of appetite
Lactic acidosis
B12 deficiency

19

What are sulphonylureas?

Eg GLICLAZIDE - stimulates pancreatic beta cells to produce insulin
Dose 160 mg twice a day taken before meals
Weight gain
Hypoglycaemia

20

What are glitazones?

Eg Pioglitazones
Improve insulin resistance
Dose max 45g once daily at any time
Fluid retention
Haematuria
Increased risk of bone fracture
Weight gain
Hepatotoxicity

21

What are the effects of incretin hormones (GLP)?

Stimulates release of insulin in the presence of glucose
Reduce apatite
Reduces hepatic gluconeogenesis
Delays gastric emptying

22

What inactivates GLP?

DPP4

23

What are SGLT2 inhibitors?

Eg Dapaglifozin
Taken orally, 5 or 10mg
Increase frequency of UTI
Increase frequency of thrush
Modest diuretic effect ( due to osmotic diuresis from urinary glucose excretion)

24

What is the action of SGLT2

SGLT2 are responsible for 90% of glucose reabsorption in the kidney

25

What is hypoglycaemia?

Refers to any episode of low blood glucose

26

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

27

What is the treatment for hypoglycaemia?

Glucose tablet or drink, jelly babies if mild
Im glucagon or Intravenous glucose if severe

28

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

29

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

30

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

31

Who is prone to diabetic ketoacidosis?

Type 1 diabetics

32

How do we diagnose diabetic ketoacidosis?

Capillary blood glucose > 11 mmol/l
Capillary ketones > 3mmol/l
Venous pH

33

What is the treatment for diabetic ketoacidosis?

1) Fluid resuscitation is main priority – to correct dehydration and hypotension
( a typical patient of 70kg would have lost about 7 liters of fluids at
presentation )
2) Insulin infusion – to shut down production of
ketone and improve acidosis
3) Screen and treat for any underlying infection
4) DVT prophylaxis
Aim for resolution of DKA within 6-12 hours