Diabetes Flashcards
(43 cards)
Define DM:
Metabolic disorder of multiple aetiologies characterised by chronic hyperglycemia with disturbance of carbohydrate, protein and fat metabolism resulting from defects from insulin secretion, resistance or both
WHO criteria for DM:
Fasting plasma >7mmol/L
Oral glucose tolerance test/ Random Plasma: >11.1mmol/L
HbA1c >6.5% / 48mmmol
*need one abnormal value + symptoms
**need two abnormal values if asymptomatic
Important out with unequivocal hyperglycemia, these results should be repeated on another day.
***only oral glucose tolerance test needed for GDM
Can diabetes be diagnosed via urine dip stick?
No.
There are two phenotypes that lie somewhere between typical T1DM and typical T2DM, what are they?
Mature onset diabetes of the young
Secondary DM
What are some commonly associated hereditary markers of T1DM?
HLA DR3
HLA DR4
What is a common antibody found in Type I?
Glutamic Acid Decarboxylase - GAD
What’s a useful marker for endogenous insulin secretion?
C - peptide
Outline disease progression of Diabetes Type I:
- Genetic Risk factor
- HLA DR3 - Immune activation
- Immune response
- antibody made - Stage I
- 2 autoantibodies made
- normal blood glucose - Stage II:
- abnormal blood glucose - Stage III
- clinical diagnosis - Stage IV
- long standing diabetes
What are some supposed risks for T1DM?
Viral infections
- entovirus
Immunization
Diet
- early exposure to cows milk
Obesity
Vit D deficiency
If you have a first degree relative with T2DM, how much more likely are you to develop type II?
5-10x more likely
What’s the most common cause of MODY?
Single gene change.
HNF- alpha
disrupt normal insulin cascade production
what are the main features of MODY?
< 25 years old
runs in families
Manaed by diet, medication and occasionally insulin.
Define Gestational Diabetes:
Where the first onset is recognised during pregnancy
Fasting >5.1
OGTT: >8.5
When should GLP-1 be offered?
BMI >30kg/m2
in combination with oral glucose lowering drugs
in treatment where oral glucose lowering drugs haven’t been sufficient
Type II and cardiovascular disease
When should SGLT2 inhibitors be offered?
Type II add on therapy to metformin
Type II and cardiovascular disease
- proven cardiovascular disease benefits
How does metformin achieve its action?
Working on the AMP - activated protein kinase - AMPK
- insulin signallying
- energy balancing
- metabolism of glucose and lipids
in consequence there is:
- reduced hepatic gluconeogenesis
- increase in peripheral insulin sensitivity
- reduced uptake from intestines
What is the stages of insulin?
Pre
Pro
Insulin + C peptide
If you have a twin with T1DM, what is the increased risk?
36% of developing it
If you carry out a random plasma glucose test and the result comes back >6.1, what should your next step be?
Carry out a fasting plasma glucose test
What are the typical loses during DKA?
Fluid loss of 6-8L
K+ 300- 1000
What methods can be used for glycaemic control?
Short term:
Home blood glucose monitoring
Long term:
HbA1c. Target is 53mmol/ 7%
Education that is needed prior to discharge of a newly discovered diabetic:
- never stop insulin
- How to use the insulin - pens etc
- outline the base regime of insulin use
- sick day rules
- hypo’s
- alcohol
- smoking
- driving
- exercise
- diabetes UK
- contact diabetes specialist nurse
- reasons why long term control is important
- pregnancy planning
What s a complication of gestational diabetes?
shoulder dystocia
very large babies
What features are typical of a T2DM?
>30s gradual onset diagnosis often missed 25-30% typically over weight not associated with ketoacidosis negative autoimmune markers
