Diabetes Mellitus Flashcards
(33 cards)
Type 1: __________ onset, Autoimmune __________ destruction, ___________ insulin deficiency
Type 2: ___________ onset, _____________ loss of adequate ___________ insulin secretion
abrupt; beta-cell; absolute; insidious; progressive; beta-cell
What is gestational DM?
Diabetes diagnosed in 2nd/ 3rd trimester of pregnancy, usually disappears after giving birth
Normal range of (random) blood glucose for:
1. adults
2. elderly
3. adults fasting
4. HbA1C
- 5.0-8.0 mmol/L
- 4.4-8.3 mmol/L
- =<5.6mmol/L
- 4-6%
Prediabetes diagnostic criteria (fasting, 2hr pp & HBA1C)
Fasting: 5.6-6.9mmol/L
2hr plasma glucose: 7.8-11.0mmol/L
HBA1C: 5.7-6.4%
Diabetes diagnostic criteria (fasting, 2hr pp & HbA1C)
Fasting: >=7.0mmol/L
2hr pp: >=11.1mmol/L
HbA1C: >=6.5%
Definition of fasting plasma glucose?
no caloric intake for 8 hrs
What is glycated haemoglobin (HbA1C) & contraindications?
It determines glycaemic control over 3 months through irreversible attachment of glucose to RBC, average RBC life span is 120 days and result is not affected by recent change in diet/ medication
contraindications: anaemia patients
Hyperglycemia 4 classic signs & symptoms
Polyuria - frequent urination
Polydipsia - increased fluid intake & thirst
Polyphagia - increased food intake & hunger
Unexplained weight loss
(others: dry mouth & skin, blurred vision, glycosuria, ketouria)
2 complications of Hyperglycemia + their main S/S
Diabetic Ketoacidosis: occurs primarily in DM1; severe insulin deficiency w/ severe hyper, ketouria & acidosis
*s/s: kussmaul breathing, acetone breath, dysrhythmias
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNKS): affects DM2, ketone bodies usually absent
*s/s: dry mucous membrane, sunken eyeballs, poor skin turgor
Chronic complications of Hyperglycemia (list 4/7)
- Macroangiopathy (coronary artery disease & cerbrovascular disease; peripheral vascular disease)
- Microangiopathy (retinopathy, nephropathy)
- Neuropathy (autonomic & peripheral; early manifestation - albuminuria),
- Orthostatic hypotension
- Impaired immune function
- Diarrhoea
- Sexual dysfunction/ impotence
3 levels of Hypoglycemia
Lev1: 3.0-3.9mmol/L
Lev2: <3.0mmol/L
Lev3: altered mental/ physical state
Glycemic target for hyperglycemic patients
(HbA1C, Preprandial, 2hr pp, BP)
HbA1C: <7%
Preprandial: 4.4-7.2 mmol/L
2hrpp (peak postprandial): <10mmol/L
BP - Systolic: <140 mmHg; Diastolic: <90 mmHg
3 main principles of diet management for diabetic patients
- Energy balance & weight management
- Carbohydrate amount & quality
- Eating pattern & nutrient distribution
4 diet choices for diabetic patients (out of 6)
- High fibre, non-starchy veggies
- Carbohydrate counting (for flexible insulin dose)
- Consistent carbohydrate intake (for fixed insulin dose)
- Avoid carbs high in protein
- Cardiovascular: diet shd be rich in monounsaturated, polyunsaturated fats
- Alcohol: <1 for adult women; <2 for adult men
*check glucose 3hrs after eating, determine if additional insulin adjustments are required
4 aims of physical activities for diabetic patients
- Improve blood glucose control
- Lower insulin resistance
- Lower cardiovascular system (CVS) risks
- Lower weight
4 eg of physical activities for diabetic patients (out of 7)
- Aerobic activity - 30min/ day; 75min/ week
- Break up prolonged sedentary time, eg stand up every 30mins
- Resistance exercise - free weights/ machines with >= 5 repetitive ex motions involving large muscles
- Higher frequency of regular leisure-time physical activities
- Flexibility & balance training (older adults)
- Tech assistance to deliver lifestyle interventions
- Customise ex to individual needs
2 main types of oral antidiabetic agents (2 effects & 2 contraindications/ risks each)
- Biguanide - glucophage (Metformin)
- Decrease hepatic glucose production & intestinal absorption of glucose
- Increase muscle glucose uptake
*contraindicate in lactic acidosis & hypoperfusion (less blood flow to organs)
*withheld on day of surgery - Sodium Glucose Co-Transporter 2 (SGLT2) inhibitors - dapagliflozin (Forxiga)/ canagliflozin(Invokana)/ empagliflozin (Jardiance)
- Inhibits SGLT2 in proximal nephrons (insulin-dependent pathway) to produce glycosuria
- Reduce glucose absorption in nephrons
*may cause euglycemia DKA during fasting
*discontinued 3-4days before surgery
Rapid-acting insulin example? (onset, peak, duration)
Lispo/ Aspart (usually administer with meal)
Onset: 5-10mins
Peak: 30min-1hr
Duration: 2-4hrs
Short-acting insulin example? (onset, peak, duration)
Actrapid HM (administer 30mins before meal) (basal prandial regimen)
Onset: 0.5hr
Peak: 1-3hrs
Duration: 8hrs
Intermediate-acting insulin example? (onset, peak, duration)
Protaphane (administer at nighttime) (basal prandial regimen)
Onset: 1.5hrs
Peak: 4-12hrs
Duration: 24hrs
Long-acting insulin example? (onset, peak, duration)
Insulin Glargine (Lantus)
Onset: 1-5hrs
Peak: Plateau
Duration: 24hrs
Example of an injectable antidiabetic drug (2 effects & 2 adverse effects)
Glucagon-like peptide 1 receptor agonist (GLP-1-RA) - exenatide (Byetta)
- Increase endogenous incretin conc, glucose-dependent insulin secretion
- Glucagon suppression
- Delayed gastric emptying (increase satiety)
*Adverse effects: pancreatitis, gallstone
*potent glucose lowering actions, less weight gain & hypoglycemia when compared to intensified insulin regimen
What is the rate of glucose reduction for critical diabetic cases? (what is the risk of reducing too fast)
3mmol/L per hour; cerebral oedema
What are pancreas? Location?
A lobulated gland surrounded by extensive capillary network to transport hormones to target cells
it lies retroperitoneally in the posterior part of the upper abdomen
