Diabetes Flashcards
(44 cards)
What microvascular complications does diabetes cause?
Retinopathy
Neuropathy
Nephropathy
What macrovascular complications does diabetes cause?
Stroke
MI
Renovascular disease
Limb ischaemia
What is MODY?
Maturity onset diabetes of the young
Autosomal dominant form of type 2 DM affecting young people.
What is the WHO criteria for the diagnosis of DM?
- Raised fasting plasma glucose >7 mmol/L
- Random plasma glucose >11.1 mmol/L.
If symptomatic, one value only but if asymptomatic then two values.
For borderline cases: OGTT 2h value >11.1 mmol/L.
- HbA1c > 48 mmol/L
What is impaired glucose tolerance?
Fasting plasma glucose < 7mmol/L
OGTT 2 hour between >7.8 - 11.1 mmol/L
How do you treat a patient with impaired glucose tolerance?
Lifestyle intervention to stop progression to diabetes.
What are other causes of DM?
Medications: steroids, anti-HIV drugs
Pancreatic: pancreatitis, surgery, trauma, cancer
Cushing’s disease, acromegaly, pheochromocytoma, hyperthyroidism, pregnancy.
Define metabolic syndrome?
Central obesity (BMI>30) plus two of:
- BP >130/85
- raised triglycerides
- low HDL
- fasting glucose >5.6 mmol/L
- T2DM
What is the cause of T2DM?
Combination of insulin resistance and pancreatic beta-cell dysfunction.
What should you consider in an older patient presenting with diabetes, which you assume is T2, but not responding to oral hypoglycaemics?
LADA - latent autoimmune diabetes in adults.
A form of T1DM that progresses to insulin dependence later in life.
How would you test for LADA?
Measure islet cell antibodies
What auto-antibodies are present in T1DM?
Islet cell antibodies (ICA)
Anti-glutatmic acid decarboxylase (GAD)
What diet would you recommend a patient with type 2 diabetes?
Low carbohydrate Low‑glycaemic‑index sources of carbohydrate e.g. fruit, veg, grains, pulses High fibre Oily fish Limit saturated fats
How do fingerpick glucose levels influence insulin doses?
Before meal - informs about long acting dose
After meal - informs about short acting dose
What is the blood pressure target for people with diabetes?
140/80
130/80 if kidney, eye or cerebrovascular disease
What is the target HbA1c for patients not at risk of hypoglycaemia?
48 mmol/mol (6.5%)
What is the target HbA1c for patients at risk of hypoglycaemia (taking drug associated with)?
53 mmol/mol (7.0%)
What level of HbA1c might you consider intensifying drug treatment?
58 mmol/mol (7.5%)
What should you look out for in patients taking insulin? How can these complications be prevented?
Injection site for infection and lipohypertrophy (fatty change)
Adv to rotate injection sites
How is the raised risk of CVD managed in patients with DM?
Statin therapy for all patients regardless of lipid levels
How is the risk of nephropathy reduced?
ACE-I renoprotective if microalbuminuria present - negative urine dip but Urine A:CR >3
What are the 4 stages of diabetic retinopathy?
Background retinopathy
Pre-proliferative
Proliferative
Maculopathy
What might you see on fundoscopy in a patient with background retinopathy?
Microaneurysms - dots Haemorrhages - blots Hard exudates (lipid deposits)
What might you see in pre-proliferative retinopathy?
Cotton wool spots (infarcts)
Venous beading
