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Flashcards in Diabetes Mellitus Symposium Deck (15)
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1

Describe Diabetes Type I

-Typically develops as a child or young adult

-Autoimmune destruction of pancreatic beta cells

-Sudden onset usually associated with rapid weight loss

2

Describe Diabetes Type II

-Typically affects people > 45 years old

-Insulin resistance and relative insulin deficiency

-Slow onset often associated with patients who are overweight

3

Describe LADA (Type 1.5) Latent Autoimmune Diabetes in Adults

-Gradual autoimmune destruction of pancreatic beta cells

-Commonly presents with a slower onset in patients > 30 years old

-Not linked to insulin resistance

4

Describe MODY Maturity Onset Diabetes of the Young

-Hereditary condition - autosomal gene mutation

-Ineffective insulin production

-Commonly presents with a slow onset in patients > 45

5

What is diabetic ketoacidosis and what are the associated symptoms?

-Occurs when your body produces high levels of blood acids called ketones.

-Develops when your body can't produce enough insulin. Insulin normally plays a key role in helping glucose enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

-Symptoms:
*Vomiting
*Dehydration
*Sweet smelling breath
*Deep laboured breathing or hyperventilation
*Rapid heartbeat
*Confusion and disorientation

6

How do you manage diabetic ketoacidosis?

1. Fluid replacement
-Restoration of circulatory volume
-Clearance of ketones
-Correction of electrolyte imbalance

2. Continuous IV insulin infusion
-To inhibit gluconeogeneis and lipolysis
-To facilitate the uptake of glucose into cells

3. Start SC insulin once out of ketoacidosis

7

What is the HbA1c target in a patient with DM?

-For patients on lifestyle or monotherapy with low risk of hypoglycaemia, e.g. metformin = < 48 mmol/mol (6.5 %)

-For patients on monotherapy with risk of hypoglycaemia, e.g. gliclazide = < 53 mmol/mol (7.0 %)

8

What are the NICE recommended target blood glucose level ranges?

-T2DM:
*Before meals = 4-7 mmol/L
*Atleast 90 mins after meals = < 8.5 mmol/L

-T1DM:
*Upon waking = 5-7 mmol/L
*Before meals = 4-7 mmol/L
*Atleast 90 mins after meals = 5-9 mmol/L

-T1DM (12-18 years):
*Upon waking = 4-7 mmol/L
*Before meals = 4-7 mmol/L
*Atleast 90 mins after meals = 5-9 mmol/L

9

What are the 4 main types of insulin?

-Rapid/short action = Lispro, Aspart/Humulin S:
*Onset = 5-15/15-60 mins
*Peak = 1/1-2 hours
*Duration = 3-5/3-8 hours

-Intermediate = Insulatard, Humulin I:
*Onset = 1-2 hours
*Peak = 6-10 hours
*Duration = 12-18 hours

-Long = Glargine, Determir (Degludec is very long acting):
*Onset = 1-2 hours
*Peak = Flat profile
*Duration = 18-36 hours

-Mix (biphasic) = Novomix:
*Onset = 15-60 mins
*Peak = 1-10 hours
*Duration = 12-18 hours

10

Which patients are considered appropriate for using continuous subcutaneous insulin pump?

-Patients with recurrent hypoglycaemia and HbA1c levels have remained high ( > 69 mmol/mol)

11

How do you monitor a DM patient?

-HbA1c levels: 3-6 monthly
-BP
-Lipid profile
-Annual monitoring for complications

12

What are the risk factors of hypoglycaemia?

-Increasing age
-Insulin and sulphonylureas
-Rigid glycemic control
-Poor eating habits
-Impaired renal function
-Alcohol intake
-Medication errors
-Accelerated absorption, e.g by exercise of changing site of injection

13

What are the symptoms of hypoglycaemia?

-Autonomic symptoms: tremor, sweating, palpitations, hunger

-Neuroglycopenic symptoms: atypical behaviour, visual disturbance, speech difficulty, drowsiness

-Symptoms may be masked by beta blockers

14

How would you manage hypoglycaemia?

-Give short-acting carbohydrates:
*120 mL glass of non-diet soft drink
*4 or more glucose glucose tablets

-Give long-acting carbohydrates:
*Half a sandwich
*Biscuits and milk

15

Guidelines for diabetes

-1st line:
*Biguanide:
>Metformin (can be used in combination with sulphonylureas), reduces weight gain

-2nd line:
*Sulphonylureas:
>Gliclazide (used when metformin is contraindicated due to impairment or poorly tolerated), causes increased risk of hypoglycaemia

-3rd line:
*Thiazolidinediones:
>Pioglitazone (used as a single agent in overweight patients where metformin is contraindicated or poorly tolerated) (used as a 2nd agent to metformin or a sulphonylurea where blood glucose control is inadequate) (used as a 3rd agent as an alternative to insulin)