Diabetes Mellitus (Type Two) Flashcards
(187 cards)
1
Q
What is type two diabetes mellitus?
A
It is defined as chronic condition in which there is abnormally elevated blood glucose levels
This is due to a relative deficiency of insulin, resulting from increased amounts of adipose tissue
2
Q
What is the pathophysiology of type two diabetes mellitus?
A
In type two diabetes mellitus, there is development of insulin resistance due to repeated exposure to insulin – resulting in peripheral tissues becoming insensitive
Therefore, the body requires hyperinsulinemia to ensure normal uptake of glucose into cells
The beta-pancreatic cells become damaged due to this increased insulin secretion, resulting in the production of decreasing insulin levels
This insulin deficiency results in altered lipolysis in adipose tissue, increased glucose production in liver tissue and reduced glucose uptake in muscle tissue
This is therefore a positive feedback process, which further increases glucose levels and results in hyperglycaemia
3
Q
What are the four risk factors associated with type two diabetes mellitus?
A
Older Age > 45 Years Old
Black, Chinese & South Asian Ethnicity
Central Obesity
Reduced Physical Activity
4
Q
What are the five clinical features of type two diabetes mellitus?
A
Polyuria
Polydipsia
Nocturia
Feet Ulcers
Blurred Vision
5
Q
What is polyuria?
A
It is defined an increased urine frequency, > 3L per day
6
Q
What is polydyspia?
A
It is defined as increased thirst
7
Q
What are the four investigations used to diagnose type two diabetes mellitus?
A
Glycated Haemoglobin (HbA1c) Test
Random Blood Glucose Test
Fasting Blood Glucose Test
Oral Glucose Tolerance Test (OGTT)
8
Q
What is a HbA1c test?
A
It measures the quantity of glucose bound to haemoglobin
9
Q
What does a HbA1c test indicate? How?
A
It indicates an average glucose level for the past two to three months
This is due to the fact that glucose permanently binds to haemoglobin and haemoglobin cells last up to a period of three months
10
Q
What HbA1c test result indicates a diagnosis of type two diabetes mellitus?
A
> 48mmol/mol (6.5%)
11
Q
In which nine circumstances is a HbA1c test contraindicated?
A
Haemoglobinopathies
Haemolytic Anaemia
Untreated Iron Deficiency Anaemia
Children
Pregnant Patients
HIV Patients
Chronic Kidney Disease Patients
Corticosteroid Administration
Patients with A Short Duration of Diabetes Symptoms
12
Q
When after pregnancy is a HbA1c test no longer contraindicated?
A
> 2 months
13
Q
What four conditions/treatments can result in a falsely low HbA1c reading?
A
Sickle Cell Anaemia
GP6D Deficiency
Hereditary Spherocytosis
Haemodialysis
14
Q
What five conditions/treatments can result in a falsely high HbA1c reading?
A
Splenectomy
Iron Deficiency Anaemia
Vitamin B12 Deficiency
Folic Acid Deficiency
Alcoholism
15
Q
Why are HbA1c tests not deemed as useful for diagnosing type one diabetes?
A
This is due to the fact that is may not accurately reflect a recent rapid rise in serum glucose
Therefore, a HbA1c < 6.5% does not exclude a diagnosis
16
Q
What is a random blood glucose test?
A
It involves taking a blood sample and a random time, which may be confirmed by repeat testing
17
Q
What random blood glucose test indicates type two diabetes mellitus?
A
> 11.1 mmol/L
18
Q
What is the diagnostic criteria for a random blood glucose test for type two diabetes?
A
It should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic
19
Q
What is a fasting blood glucose test?
A
It involves taking a blood sample after an individual has fasted overnight
20
Q
What is a normal fasting blood glucose test result?
A
< 5.6mmol/L
21
Q
What fasting blood glucose test indicates type two diabetes mellitus?
A
> 7mmol/L
22
Q
What is the diagnostic criteria for a fasting blood glucose test for type two diabetes?
A
It should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic
23
Q
What is an OGTT?
A
It involves taking a patient’s baseline fasting plasma glucose, giving them a 75g glucose drink and then measuring their plasma glucose two hours later
24
Q
What OGTT result indicates type two diabetes mellitus?
A
> 11.1mmol/
25
What is the diagnostic criteria for OGTT for type two diabetes?
It should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic
26
Does an unrecordable blood glucose indicate a DKA or hypogylcaemia?
DKA
27
What are the four conservative management options of type two diabetes mellitus?
Dietary Modification
Regular Exercise
Smoking Cessation
Driving Advice
28
What dietary advice is recommended in type two diabetes?
To eat regular meals – which are high in fibre and low in starchy carbohydrates
29
What is the glycemic index?
A rating system for foods containing carbohydrates
It shows how quickly each food affects blood glucose levels when that food is eaten on its own
30
What is a high glycaemic index?
It suggests carbohydrates are broken down quickly during digestion and therefore release their glucose into blood quickly
31
What is a low glycaemic index?
It suggests carbohydrates are broken down slowly during digestion and therefore release their glucose into the blood gradually
32
Why is it important that diabetic patients are aware of what foods have a high and low glycemic index?
It is recommended that individuals have a diet consistent of low glycaemia sources of carbohydrates
33
Why do we encourage diabetics to exercise regularly?
Weight loss
Increases insulin sensitivity
34
What is the initial target weight loss in type two diabetics who are overweight?
5% – 10%
35
Why do advise type two diabetics to stop smoking?
It increases the risk of ischaemic heart disease, which is a common complication of diabetes
36
Do individuals need to inform the DVLA if they are on insulin?
Yes
37
What are the three criteria type two diabetes require to obtain a group one licence?
Hypoglycaemic awareness
They must not an episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months
They have no relevant visual impairments
38
What are the five criteria type one diabetes require to obtain a group two licence?
They should not have a severe hypoglycaemic event in the previous 12 months
They should have full hypoglycaemic awareness
They should show adequate control by regular glucose monitoring
They should demonstrate an understanding of the hypoglycaemia risks
They should have no debarring complications of diabetes
39
How long prior to driving should individuals check glucose levels?
2 hours
40
How long should patients wait after a hypo to start driving?
45 minutes
41
What is a curative management option of type two diabetics?
Conservative lifestyle advice
42
When is metformin used to manage type two diabetes?
It is the first line pharmacological management option
43
What are the four mechanism actions of metformin?
AMP-Activated Protein Kinase (AMPK) Activation
Increased Insulin Sensitivity
Decreased Hepatic Gluconeogenesis
Reduced Carbohydrate Gastrointestinal Absorption
44
Whar are the three side effects of metformin?
Gastrointestinal Upset
Vitamin B12 Malabsorption
Lactic Acidosis
45
What are the two factors which make type two diabetics susceptible to lactic acidosis when administered metformin?
Liver disease
Renal failure
46
How do we reduce the risk of gastrointestinal side effects associated with metformin?
The metformin dose should be started at a low dose and tritiated up slowly
47
What is the most appropriate management step when individuals develop unacceptable metformin side effects?
We switch to modified-release metformin
48
What are the six contraindications of metformin?
Chronic Kidney Disease, eGFR < 30ml/min
Recent Myocardial Infarction
Sepsis
Acute Kidney Injury
Alcohol Abuse
Severe Dehydration
49
In which condition should metformin be stopped in? Explain
Myocardial Infarction
Lactic acidosis risk
50
What advice should be given to type two diabetics who are administered metformin and are schuled to undergo an iodine-containing x-ray contrast media procedure? Why?
They should be advised to discontinue metformin on the day procedure and 48 hours following
This is due to the increased risk of renal impairment due to contrast nephropathy
51
What advice should be given to diabetics administered metformin who are scheduled for elective surgery?
In cases where it is administered once daily or twice daily, it can be continued as normal
In cases where it is administered three times daily, the lunchtime dose should be missed
This assumes only one meal will be missed during surgery, eGFR > 60 and no contrast during procedure
52
When are sulfonylureas used to manage type two diabetics?
They are a second line pharmacological management option
53
What is the mechanism of action of sulfonylureas?
They increase pancreatic insulin secretion, through inhibition of ATP-dependent K+ (KATP) channels on the cell membranes of pancreatic beta cells
54
Name three sulfonylureas used to manage type two diabetics
'ides'
Glimepiride
Gliclazide
Glipizide
55
What are the six side effects associated with sulfonylureas?
Hypoglycaemic Episodes
Weight Gain
Hyponatraemia (SIADH)
Hepatotoxicity
Peripheral Neuropathy
Bone Marrow Suppression
56
What are the four contraindications of sulfonylureas?
Pregnancy
Breastfeeding
Renal Failure
Hepatic Failure
57
What advice should be given to diabetics administered sulfonylureas who are scheduled for elective surgery?
It should be omitted on the day of surgery
The exception is morning surgery patients who take twice daily, they can have the afternoon dose
58
What are the two blood test results of gliclazide overdose?
Increased Insulin Levels
Increased C-Peptide Levels
59
When are thiazolidinediones used to manage type two diabetes?
It is a second line pharmacological treatment option
60
What is the mechanism of action of thiazolidinediones?
They are agonists to the peroxisome proliferator activated-gamma receptors (PPAR) in adipocytes and reduce peripheral insulin resistance
61
Name a thiazolidinedione used to manage type two diabetes
Pioglitazone
62
What are the five side effects associated with thiazolidinediones?
Weight Gain
Liver Impairment
Fluid Retention
Bone Fractures
Urinary Bladder Cancer
63
What are the two contraindications of thiazolidinones?
Heart Failure
Obesity
64
When are SGLT-2 inhibitors used to manage type two diabetes?
They are a second line pharmacological management option
They should be introduced in all cases where individuals develop cardiovascular disease, have a high risk of cardiovascular disease (QRISK > 10%) or develop heart failure
65
What is the mechanism of action of SGLT-2 inhibitors?
They reversibly inhibit SGLT-2 in the renal proximal convoluted tubule, which reduces glucose reabsorption and increases urinary glucose excretion
66
Name three SGLT-2 inhibitors used to manage type two diabetes
'glifozin'
Canagliflozin
Dapagliflozin
Empagliflozin
67
What is an advantage of SLGT-2 inhibitor administration?
It reduces cardiovascular disease
68
What are the five side effects associated with SGLT-2 inhibitors?
Weight Loss
Urinary Tract Infection
Thrush
Fournier’s Gangrene
Normoglycaemia Ketoacidosis
Diabetic Foot Disease = Amputation
69
What is Fournier’s gangrene?
It is defined as necrotising fasciitis of the genitalia or perineum
70
What are the two clinical features of Fournier’s gangrene?
A red, swollen patch of skin in the perineal area
Perineal pain
71
When are DPP-4 inhibitors used to manage type two diabetes?
They are a second line pharmacological treatment option
72
What are incretin mimetics?
They are gastrointestinal hormones, which reduce blood glucose through increased insulin secretion, inhibiting glucagon production and reducing gastrointestinal absorption
73
Name an incretin mimetic
GLP-1
74
What enzyme inhibits incretin mimetics?
Dipeptidyl peptidase-4 (DPP-4)
75
What is the mechanism of action of DPP-4 inhibitors?
They reduce the peripheral breakdown of incretin mimetics, increasing their levels
76
Name three DPP-4 inhibitors used to manage type two diabetes
'gliptin'
Saxagliptin
Sitagliptin
Vildagliptin
77
What are the two side effects associated with DPP-4 inhibitors?
Nausea & Vomiting
Acute Pancreatitis
78
Why are DPP-4 inhibitors preferable to thiazolidinediones and sulfonylureas?
They dont cause weight gain
79
What advice should be given to diabetics administered DPP-4 inhibitors who are scheduled for elective surgery?
They can be continued on the day of surgery
80
When are GLP-1 analogues used to manage type two diabetes?
They are a fourth line pharmacological treatment option
81
What two other hypoglycaemic drugs are GLP-1 analogues administered with?
Metformin
Sulfonylureas
82
In which two circumstances, do we administer GLP-1 analogues?
In individuals with a BMI > 35kg/m2, who are of European descent and there are complications associated with their increased weight
In individuals with a BMI < 35kg/m2, on which insulin is unacceptable due to occupational implications or weight loss would benefit their comorbidities
83
What criteria is required for an ongoing administration of GLP-1 analogues?
There should be evidence of a HbA1C reduction > 11mmol/mol (1%) and 3% weight loss in 6 months
84
Name three GLP-1 analogues used to manage type two diabetes
'tide'
Exenatide
Liraglutide
Lixisenatide
85
What is the mechanism of action of GLP-1 analogues?
They mimic the action of GLP-1, thus increased insulin secretion, inhibiting glucagon secretion and slowing absorption by the gastrointestinal tract
86
What is the administration route of GLP-1 analogues?
Subcutaneous injection
87
How is exenatide adminstered to manage type two diabetes?
It is administered within 60 minutes before the morning and evening meals.
It should not be administered after a meal
88
How is liraglutide adminstered to manage type two diabetes?
It is administered 60 minutes before a meal
It is only administered once daily
89
What are the three side effects of GLP-1 analogues?
Weight Loss
Nausea & Vomiting
Acute Pancreatitis
90
What advice should be given to diabetics administered GLP-1 analogues who are scheduled for elective surgery?
They can be continued on the day of surgery
91
When is insulin used to manage type two diabetes?
It It is a third line pharmacological management option, which should be co-administered with metformin
92
What are the two administration routes of insulin?
Subcutaneous injections
Insulin pumps
93
Why can insulin not be prescribed as an oral tablet?
It is a polypeptide inactivated by the GI tract
94
What are the three side effects of insulin?
Hypoglycaemia
Weight gain
Lipodystrophy
95
What insulin class is used to manage type two diabetes?
Intermediate-acting insulin
96
What intermediate-acting insulin is used to manage type two diabetes?
Isophane
97
What insulin regimen is used to manage type two diabetes?
It is administered at bedtime (BBed)
98
In which three regions of the body is insulin injected?
Abdominal region
Thighs
Buttocks
99
Why do we recommend that individuals rotate their insulin injection site?
This prevents the development of lipodystrophy
100
What is lipodystrophy?
It occurs when the subcutaneous fat hardens, and patients don’t absorb insulin properly from further injections into this spot
101
What is a clinical feature of lipodystrophy?
A patient is not responding to insulin as expected
102
What is factitious hypoglycaemia? What does it indicate?
It is defined as high insulin levels in the absence of elevated c-peptide levels
It indicates that individuals are injecting too much insulin
103
What is insulinoma? What does it indicate?
It is defined as high insulin and c-peptide levels
It indicates an insulin secreting tumour
104
What are the five sick day rules of insulin?
They should increase the frequency of blood glucose and ketone monitoring
In cases where individuals have elevated blood glucose and ketone levels, they should administer a corrective dose of insulin
They should encourage fluid intake aiming for at least 3L in 24 hours
In cases where they are struggling to eat, they should intake sugary drinks to maintain carbohydrate levels
They should never stop their insulin, even if they are struggling to eat
105
How often should individuals monitor blood glucose and ketone levels when unwell?
Up to four hourly
106
How can individuals work out the corrective dose of insulin - when unwell and high glucose/ketone levels?
The total daily insulin dose divided by 6 – with a maximum of 15 units
107
Why should individuals never stop their insulin - even when ill?
To prevent a DKA
108
What should all individuals treated with insulin recieve?
Glucagon Kit
109
What is the step one pharmacological management option of type two diabetes?
Metformin
110
Which hypoglycaemic drug can be administered first line with metformin?
SGLT-2 inhibitors
111
In which three circumstances, do we administer SGLT-2 inhibitors first line with metformin?
High Cardiovascular Risk, QRISK > 10%
Established Cardiovascular Disease
Chronic Heart Failure
112
How do we administer SGLT-2 inhibitors with metformin first line?
Metformin should be established and titrated up before the introduction of a SGLT-2 inhibitor
SGLT-2 inhibitors should be started regardless of whether glycemic control is achieved with metformin
113
What is the maximum dose metformin can be titrated up to?
500mg three times daily
114
What are the four hypoglycaemic agents which can be administered first line when metformin is contraindicated?
SLGT-2 Inhibitors
Sulfonylureas
Thiazolidines
DPP-4 Inhibitors
115
When are SGLT-2 inhibitors recommended to manage type two diabetes first line?
When metformin is contraindicated
It is recommended in cases where individuals are at high risk of cardiovascular disease, have established cardiovascular disease or have chronic heart failure
116
When are sulfonylureas, thiazolidines or DPP-4 inhibitors recommended to manage type two diabetes first line?
When metformin is contraindicated
In cases where individuals are at low risk of cardiovascular disease, don’t have established cardiovascular disease and don’t have chronic heart failure
117
When is step two management of type two diabetes recommended?
In cases where glycaemic control is not established on monotherapy, with HbA1c > 58mmol/mol (7.5%)
118
What is the step two pharmacological management option of type two diabetes melitus?
It involves dual therapy, with metformin and the addition of one of the following pharmacological options to metformin...
- Sulfonylurea
- Thiazolidinedione
- DPP-4 Inhibitor
- SGLT-2 Inhibitor
119
When is step three management of type two diabetes recommended?
In cases where glycaemic control is not established on dual therapy, with HbA1c > 58mmol/mol (7.5%)
120
What is the step three pharmacological management option of type two diabetes melitus?
It involves triple therapy, with administration of the following...
- Metformin, DPP-4 Inhibitor & Sulfonylurea
- Metformin, Thiazolidine & Sulfonylurea
- Metformin, SGLT-2 & Thiazolidine OR Sulfonylurea OR DPP-4 Inhibitor
- Metformin & Insulin Treatment
121
When is step four management of type two diabetes recommended?
In cases where glycaemic control is not established on triple therapy, with HbA1c > 58mmol/mol (7.5%)
122
What is the step four pharmacological management option of type two diabetes?
It involves switching a second line pharmacological management option with a GLP-1 analogue
123
Which oral hypoglycaemic drug is safe to continue during breastfeeding?
Metformin
124
How often do we conduct a HbA1c test in type two diabetics?
Every 3 to 6 months, until stable
Following stability, they should be conducted six monthly
125
What is the target HbA1c level in type two diabetics who are managed with lifestyle advice only?
48mmol/L (6.5%)
126
What is the target HbA1c level in type two diabetics who are managed with lifestyle advice and metformin?
48mmol/L (6.5%)
127
What is the target HbA1c level in type two diabetics who are managed with lifestyle advice and a sulfylnourea?
53mmol/L (7%)
128
What is the target HbA1c level in type two diabetics who are managed with dual-therapy, triple-therapy and fourth line management?
53mmol/L (7%)
129
How often should digital retinal screening be conducted in type one diabetics? What is an exception to this?
Annually
In pregnancy, this should be more frequent
130
Why do we conduct digital retinal screening in type one diabetics?
To monitor the development of diabetic retinopathy
131
How often should foot screening be conducted in type one diabetics?
15 months
132
Why do we conduct foot screening in type one diabetics?
To monitor the development of diabetic foot complications
133
How do we manage diabetic patients who develop foot problems, other than simple calluses?
A referral to the local diabetic foot clinic
134
How often should a urine test be conducted in type one diabetics?
Annually
135
Why do we conduct a urine test in type one diabetics?
To check for microalbuminuria and neuropathy development
136
What urine test is used to monitor type one diabetes?
Albumin: creatinine ratio (ACR)
137
What ACR urine test result indicates microalbuminuria development?
Increased ACR > 2.5
138
What are the three short term complications of type two diabetes?
Hypoglycaemia
Hyperglycaemia
Potassium Imbalance
139
What is hypoglycaemia?
It is defined as a low blood glucose level, specifically below 4mmol/L
140
What are the five reasons for hypoglycaemia in type two diabetics?
Skipping a meal
Injecting too much insulin
Lipodystrophy
Physical activity
Alcohol intake
141
What are the five clinical signs of hypoglycaemia?
Tremor
Sweating
Hunger
Dizziness
Blurred Vision
142
What is the first line management option of hypoglycaemia in a community setting?
Oral glucose 10 - 20g should be given in liquid, gel or tablet form
OR
A quick acting carbohydrate may be given - glycogen or dextrogel
143
What is the first line management option of hypoglycaemia in a hospital setting - when the patient is alert?
A quick acting carbohydrate may be given - glycogen or dextrogel
144
What is the first line management option of hypoglycaemia in a hospital setting - when the patient is unconscious or unable to swallow?
SC or IM glucagon
145
What is the second line management option of hypoglycaemia in a hospital setting - when the patient is unconscious or unable to swallow?
IV 20% glucose
146
What are the four reasons for hyperglycaemia in type two diabetics?
Eating too much
Eating the wrong types of foods
Not injecting enough insulin
Illness
147
How do we treat mild hyperglycaemia?
Patients can treat themselves by administrating an additional dose of insulin that should bring their glucose levels back to normal
Diabetic patients should be aware that it can take several hours to take effect and repeated doses could lead to hypoglycaemia
148
What glucose level indicates DKA?
> 40mmol/l
149
What are the five clinical features of DKA?
Nausea
Vomiting
Abdominal pain
Kaussmal breathing
Ketone breath
150
What six blood test results indicate DKAs?
Decreased Na levels
Increased K levels
Increased urea levels
Increased creatinine levels
Increased glucose levels
Decreased bicarbonate levels
151
What are the four macrovascular complications of type two diabetes?
Coronary Artery Disease
Peripheral Ischaemia
Stroke
Hypertension
152
When is a statin administered as secondary prevention in type two diabetics?
QRISK score > 10%
153
What is the first line antihypertensive used to manage hypertension in type two diabetes?
ACEI/ARBs
In Afro-Carribean patients, ARBS are preferred
In those with renovascular disease, we administer CCBs
154
What is the clinic blood pressure target in type two diabetics with hypertension?
< 140/90mmHg
155
What is the home/ABPM blood pressure target in type two diabetics with hypertension?
< 135/85mmHg
156
How does type two diabetes result in macrovascular complications?
Diabetes accelerates the process of atherosclerosis
This is due to the fact that when glucose binds to LDL, it inhibits its ability to binds to liver cell receptors
This means that LDL continues to circulate within the bloodstream, resulting in hyperlipidaemia and thus atherosclerosis
157
What are the three management options after developing macrovascular complication development in type two diabetics?
We review the patient’s diabetic treatment
We can consider prescribing statins
We encourage patients to adopt healthier lifestyle choices, such as smoking cessation, diet modifications, etc
158
What is the most common cause of death in diabetic patients?
Myocardial Infarction
159
What are the four microvascular complications of type two diabetes?
Diabetic Retinopathy
Diabetic Neuropathy
Gastrointestinal Autonomic Neuropathy
Diabetic Nephropathy
160
What is diabetic retinopathy?
It is defined as damage to the blood vessels supplying the retina of the eye
161
What are the four clinical features of diabetic retinopathy?
Retinal infarction
Exudate formation
Haemorrhage
Cataract formation
162
What is diabetic neuropathy?
It is defined as nerve damage, which results in sensory loss to the bodies’ extremities – hands, feet and arms
163
What are the three clinical features of diabetic neuropathy?
Paraesthesia
Burning Neuropathic Pain
Neuropathic Ulcers
164
What is the characteristic feature of diabetic neuropathy?
'Glove and stocking’ distribution’
165
What is a glove and stocking’ distribution’?
It describes a distribution in which the lower legs are affected first
166
What are the two main contributing factors of diabetic foot disease?
Peripheral Arterial Disease
Loos of Sensation
167
What are the four pharmacological management options of diabetes neuropathy?
Amitriptyline
Duloxetine
Gabapentin
Pregabalin
168
What is the second line management option of diabetic neuropathy?
We trial one of the other three pharmacological management options
169
What is the management option of resistant diabetic neuropathy?
We can refer individuals to pain management clinics
170
What is gastrointestinal autonomic neuropathy?
It is defined as nerve damage involving those that control autonomic body functions of the gastrointestinal system
171
What are the three clinical features of gastrointestinal autonomic neuropathy?
Gastroparesis
Chronic diarrhoea
Gastro-oesophageal reflux disease
172
What is gastroparesis?
It is defined as bloating and vomiting associated with erratic blood glucose control
173
What are the three pharmacological management options of gastrointestinal autonomic neuropathy?
Metoclopramide
Domperidone
Erythromycin
174
What is diabetic nephropathy?
It is is defined as damage to the renal blood vessels
175
What are the three complications of diabetic nephropathy, if untreated?
Microalbuminuria
End-stage renal disease
Renal failure
176
What is a feature of diabetic retinopathy on US?
Enlarged Kidneys
177
What are the four management options of diabetic nephropathy?
Dietary Protein Restriction
Glycaemic Control
ACE Inhibitor/Angiotensin-II Receptor Antagonist
Atorvastatin Administration
178
When are ACEI/ARBs recommended to manage diabetic nephropathy?
ACR > 3
179
How do microvascular complications develop in diabetic patients?
In arterioles and capillaries, there is a subendothelial space located between the endothelial cells and the basal lamina layers. This subendothelial space allows the movement of molecules into and out of the vessel lumen.
In diabetes, molecules are unable to move out of this subendothelial space. This results in a build-up of trapped molecules, which thickens the basal lamina layer and narrows the vessel lumen. Overtime, this lumen narrowing can result in ischemia – which tends to affect the nerve and arteries of the kidney, foot and eyes.
There are two reasons as to which molecules are unable to move out of the subendothelial space in diabetic patients...
Albumin is a protein which freely moves in and out of the subendothelial space. However, in diabetic patients, albumin binds to glycosylated collagen fibres in the outermost layer of the vessel – thus trapping it in the subendothelial space.
In normal circumstances, basal lamina proteins don’t cross link and can therefore be removed from the subendothelial space. However, in diabetes, the glycosylated proteins bind to their neighbouring proteins (cross link) and therefore cannot be easily removed.
180
How is diabetes associated with the development of infections?
It causes suppression of the immune system
181
What are the four infections associated with type one diabetics?
Urinary Tract Infections
Pneumonia
Fungal Infections
Skin & Soft Tissue Infections
182
What fungal infection is associated with type one diabetes?
Candidiasis
183
What skin and soft tissue infection is associated with type one diabetes?
Feet
184
What organism is most commonly associated with diabetic foot infections?
Pseudomonas Aeruginosa
185
What drugs induce type one diabetes?
Thiaziade diuretics
186
What drug reduces hypoglycaemic awareness?
Beta-blockers
187
What are the differences between type one and type two diabetes?
Type one = onset < 20, more acute onset, recent weight loss, DKA features, ketonuria common
Type two = onset > 40, onset slower, obesity strong risk factor, milder symptoms, ketonuria rare
