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Long Term Conditions > Diabetes Type 1 and 2 > Flashcards

Diabetes Type 1 and 2 Flashcards

1
Q

Defenition of diabetes mellitus

A

A group of metabolic disorders where there is persistant hyperglycaemia caused by insufficient insulin secretion or resistance to action of insulin

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2
Q

Type 1 DM definition

A

Autoimmune destruction of the pancreatic beta cell.=s.

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3
Q

Type 2 DM definition

A

Metabolic condition characterized by inadequate insulin production from pancreatic beta cells, resulting in insulin resistance

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4
Q

Gestational Diabetes defintion

A

Hyperglycaemia develops during pregnancy and usually resolves after delivery

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5
Q

Risk Factors for Type 2 Diabetes - 6

A
  • Obesity and Inactivity
  • Poor diet (low fibre, high glycaemic index diet)
  • Ethnicity (asian, african or afro-caribbean are more likely)
  • Hx of gestational diabetes
  • PCOS
  • Drugs (statins, steroids and combined trx of thiazides and beta blockers)
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6
Q

Presentation of type 2 DM - 6

A
  • polyuria
  • polydipsia
  • unexplained weight loss
  • blurry vision
  • fatigue
  • acanthosis nigricans (skin causing dark pigmentation of skin folds)
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7
Q

Differentials of T2 DM - 3

A
  • Type 1 diabetes mellitus
  • MODY (maturity onset diabetes of the young)
  • Secondary diabetes mellitus (DM caused by pancreatic disease)
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8
Q

What are the diagnostic criteria of T2 DM if theyre symptomatic or non-symptomatic - 4

A
  • Random blood glucose ≥ 11.1mmol/l
  • Fasting plasma glucose ≥ 7mmol/l
  • 2-hour glucose tolerance ≥ 11.1mmol/l
  • HbA1C ≥ 48mmol/mol (6.5%)

If symptomatic, only need one of the results for diagnosis

If asymptomatic, need two results from two different days

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9
Q

Management of T2 DM (lifestyle) - 4

A

Give advice on
- Diet
- Regular physical activity
- Smoking cessation
- Alcohol

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10
Q

Pharmacological management of T2 DM - 3

A
  1. Standard release metformin is always 1st line, whether they have CVD risk or not. If they have GI issues then give modified release metformin​
  2. In patients with a QRISK2 of over 10% or confirmed CVD, then offer an SGLT2 inhibitor as soon as metformin tolerability is confirmed as it has CVD protective qualities​
  3. If metformin is contraindicated then offer SGLT2 inhibitors, Sulfonylureas, Glitazones, DDP-4 inhibitors.​
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11
Q

Metformin contraindications - 3

A

Renal impairment (low eGFR)
HF
Metabolic acidosis

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12
Q

Metformin mechanism of action

A

Decreases hepatic glucose production by inhibiting gluconeogenesis

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13
Q

Name the 5 other hypoglycaemics other than metformin and give examples

A
  • Sulfonylureas - Gliclazide
  • Glitazones - pioglitazone
  • SGLT-2 Inhibitors - dapagliflozin
  • DDP-4 Inhibitors - sitagliptin
  • GLP-1 Receptor Agonists - liraglutide
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14
Q

What are the HbA1c treatment targets for T2 DM - 3

A
  • Only lifestyle management - 48mmol/l
  • Lifestyle and metformin - 48mmol/l
  • Drug therapy associated with hypoglycaemia - 53mmol/l
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15
Q

Macrovascular complications of T2 DM - 4

A
  • Atherosclerotic cardio vascular disease
  • Stroke
  • MI
  • Peripheral arterial disease
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16
Q

Microvascular complications of T2 DM - 5

A
  • Diabetic nephropathy
  • Retinopathy
  • Peripheral neuropathy
  • Autonomic neuropathy
  • Diabetic foot ulcers and infections
17
Q

Metabolic complications of T2 DM - 3

A
  • Dyslipidaemia (risk factor for CVD)
  • Diabetic ketoacidosis
  • Hyperosmolar hyperglycaemic state
18
Q

Define and explain signs of DKA - 5

A

Metabolic state characterised by the triad of hyperglycaemia, metabolic acidosis and ketonaemia

  • dehydration
  • Ketone smelling breath
  • tachypneoa
  • N and V
  • Fatigue and confusion
19
Q

Define and explain signs of Hyperosmolar hyperglycaemic state - 5

A

A state of severe hyperglycaemia, often due to an acute illness

  • urinary frequnecy
  • thirst
  • nausea
  • confusion
  • severe dehydration
20
Q

Who mainly gets T1 DM

A

Predominantly diagnosed in children and young adults but can occur at any age

21
Q

Risk Factors of T1 DM

A
  • Genetics (its a heritable polygenic disease)
  • Some environmental factors can trigger it (diet, vit d exposure, certain viruses)
22
Q

Presentation of T1 DM - 3

A
  • Polyuria
  • Polydipsia
  • Weight Loss
23
Q

Differentials of T1 DM - 2

A
  • diabetes insipidus
  • Hyperthyroidism (also has weight loss)
24
Q

How is T1 DM diagnosed - 4

A
  • Random blood glucose > 11mmol/l
  • Fasting glucose >7mmol/l
  • HbA1c elevated over 2-3 months
  • Presence of ketones in urine may suggest DKA
25
Q

Management of T1 DM

A

Insulin therapy - consisting of a personalised regimen involved short acting and long term insulin initiated and managed by a diabetes specialist

26
Q

What is target HbA1c for T1DM

A

48mmol/l or lower

27
Q

How often should HbA1c be measured in T1 and T2 patients

A

every 3-6 months

28
Q

How is a hypoglycaemic episode managed in a T1 patient - 2

A
  • Prompt intake of sugary drinks/ snacks
  • if unconcious, administer IM glucagon or IV dextrose
29
Q

What is meant by the honeymoon period in T1 Patients

A

Immediately after diagnosis, insulin requirements may be very low if the pancreas is still able to produce a significant amount of insulin. This is known as the ‘honeymoon period’.

Important to monitor closely as insulin requirements can suddenly increase as the remaining beta cells are destroyed.

Additionally, as the blood glucose may be normal in this period on very low insulin doses, parents may incorrectly think that the condition has gone away.

30
Q

Complications of T1 Dm

A
  • growth and pubertal delay
  • HTN
  • Nephropathy
  • Retinopathy
  • Foot issues
  • Thyroid and coeliac disease

Long Term Conditions (10 decks)

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