Endo: diabetes Flashcards
What is type 1 diabetes, what are the causes?
- autoimmune destruction to beta cells causing decreased insulin
- genetic + environmental trigger -> type 4 T-cell mediated hypersensitivity that destroys beta cells
- genetic: HLA- DR3-DQ2 and HLA-DR4-DQ8
- Environmental: viral or gestational infection
What are the symptoms of type 1 diabetes
Weight Loss, polyuria, polydipsia, polyphagia,
DKA: abdominal pain, vomiting, confusion
What are the different diagnoses of type 1 diabetes? When is each way suitable?
- Fasting glucose 7.0 mmol/l OR random glucose 11.1 mmol/l (twice if they have no diabetes symptoms ie, weight loss, polyuria & polydipsia)
- C- peptide (endogenous insulin production, low in T1DM) & autoantibodies (anti-GAD, ICA, IAA) used if patient is older & obese to distinguish from T2DM
What is the treatment of type 1 diabetes? Any side effects and how do you manage it?
Insulin injection in basal bolus regimen (basal is long acting once daily, bolus is short acting with each meal)
SE: hypoglycemia (give insulin analogue to help)
What is DKA? What are the causes?
- Increased acidity in blood due to excessive lipolysis creating fatty acid & ketone bodies
- Infection, miss insulin doses & myocardial infarction
What are the symptoms of DKA?
- Abdominal pain, polyuria, polydipsia, dehydration
- kussmaul respiration (hyperventilation to remove CO2 in blood to decrease acidity)
- Hyperkalaemia (in acidity, H+ entering cells in exchange for K+ into blood stream/ extra cellular space)
How is DKA diagnosed?
- Glucose of 11 mol/L +
- ketones> 3 mmol/l or positive ketones on dipstick
- pH> 7.3
- Bicarbonate < 15 mmol/l
How is DKA treated?
- Fluid replacement w/ isotonic saline (0.9% sodium chloride)
- Fixed-rate IV insulin at 0.1 unit/kg/ hour
- potassium if patient is hypokalemic
How is type 2 diabetes diagnosed?
Symptomatic + glucose levels (if no symps check twice)
Fasting blood glucose: 7.0mmol/ mol
Random blood glucose: 11.1mmol/L
Hb1Ac: 48 mmol/mol (6.5%)
What are the treatments for type 2 diabetes?
Life style: high fiber, low glycaemic index carb
Metformin + (DPP-4i/ pioglitazone/ sulfonylurea)
Metformin + 2x (DPP-4i/ pioglitazone/ sulfonylurea)
Insulin based therapy or replacing one drug with GLP-1 ( weight loss)
SGLT-2 is given to any CVD patients, can be started at ANY point
What are side effects and contraindications for metformin?
- GI upsets, reduce vitamin B12 absorption
- Metformin associated lactic acidosis (MALA) from increased lactate production in gut and liver, lactate is cleared by liver and kidney
- contraindicated in patients with kidney disease, sepsis (liver impaired), recent myocardial infarction
What are the symptoms of MALA
abdominal pain + severe diarrhea
increased lactate in report
how to minimize the side effects of metformin & what if it is contraindicated?
- Titrate up slowly, modified-release (delayed administration) if severe side effects
- SGLT-2 for CVD patients OR DPP-4i/ pioglitazone/ sulfonylurea
What are the target HbA1c for type 2 diabetes patients?
- Aim for 48 mmol/mol (6.5%) if only on lifestyle and/or metformin
- Aim for 53 mmol/mol (7.0%) for dual therapy or any treatment with sulfonylurea (may cause hypoglycemia)
what are the special factors of SGLT-2, GLP-1, and Sulfonyurea
SGLT-2: CVD patients only, pee sugar
GLP-1: weight loss
sulfonyurea: hypoglycaemia, no truck drivers