Intro To Diabetes Flashcards
Diabetes
Chronic disease that occurs either when pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces
Types of diabetes
Multiple types - insulin
Non insulin dependent
Gestational (during pregnancy)
MODY - maturity onset diabetes of the young
Symptoms of diabetes
- thirst (polydipsia)
- nocturia + polyuria
- weight loss
- fatigue
- thrush + visual disturbances
What does lack of insulin or effect of insulin result in
Reduced uptake of glucose into cells
Type 1 diabetes
- commonly earlier on life however can develop in progression of illness
- insulin deficiency-pancreas not producing insulin correctly
- auto immune
- incurable
Diagnosis for type 1 diabetes
Medical history-discuss symptoms
Physical examination - BP (supplementary), eyes
Supplementary tests - finger prick test and urine dipstick
Non fasting tests- HBA1C - should be below 42 mmol/l
Fasting tests - 126mg/dl (7mmol/l) in children above 11 mmol/l (random)
OGTT = oral glucose tolerance test post prandial levels checked after night of fasting and having a sugary drink in pregnancy
Antibody test TYPE 1 - autoantibodies attack specific proteins in the pancreas
Children should be urgently referred
DKA
Diabetic ketone acidosis
Treatment for type 1 diabetes
- replace insulin often by sub cut route
- insulin pumps-delivers throughout the day
- rapid (just before meal)
- short
- intermediate
- long
- combined/mix
Regimens for type 1 diabetes
- not a single one fit regimen
- basal-bonus (baseline + top ups) = more adaptable
- bi-phasic - short intermediate injections often reserved for more stable individuals = less adaptable
Type 2 diabetes
- insulin defiance or intolerance
- can be reversible
- diagnosed after in life
- often considered to be impacted by environment
Risk factors for type 2 diabetes
Modifiable:
- obesity
- physical activity
- hypertension
- smoking
- diet
Non-modifiable:
- age
- family history
- ethnicity
- gestational = temporary in pregnancy
Diagnosis of type 2 diabetes
persistent hyperglycaemia:
- HbA1c of 48 mmol/l or more
- fasting plasma glucose level of 7 mmol/l or more
- random plasma glucose of 11.1 mmol/l or more (normal 4-7)
- symptoms/signs of diabetes
Patient symptomatic - single abnormal HbA1c or fasting plasma glucose level can be used
Patient asymptomatic- repeat testing is required
Treatment for type 2 diabetes
Non pharmacological management:
- diet/weight loss
- exercise
Pharmacological management
- biguanudes e.g. metformin
- sulfonylureas .e.g. gliclazide
- inhibitor of intestinal alpha glucosidases e.g. acarbose
- DPP-4 inhibitors e.g. sitagliptin
- SGLT2 inhibitors e.g. dapagliflozin
Hypoglycaemic
- blood sugar levels fall too low - less than 4 mmol/l
- develop quickly
- symptoms:
Feeling shaky, blurred vision, sweating, headache, tiredness etc.
Managing hypoglycaemia
- if patient is was give 15-20g of a fast acting carbohydrate
- test blood sugars after 10-15mins
- still less than 4 mmol/l have more fasting acting carbohydrate
- retest after further 10 mins
- after hypo eat 15-20g slower acting carbohydrate = to prevent blood sugar levels going down again
- in severe hypo, patient unconscious DO NOT give anything to drink/eat
- put patient in recovery position
- give glucagon injection
- call ambulance if patient doesn’t have glucose injections or if they haven’t recovered 10 mins after administration of glucagon
Hyperglycemic
Over 7mmol/l pre prandial or over 8.5 mmol/l 2 hours post prandial. After meal above 11 mmol/l
Signs and symptoms:
Polyuria (especially at night)
Excess thirst
Tiredness
Blurred vision
Nausea
One common symptom in hyperglycaemia and hypoglycaemia
Blurred vision
Causes of hyperglycaemia
- missed dose of medication
- eaten high amounts of carbohydrates
- stress
- illness
- over-treating hypoglycaemia
Managing hyperglycaemia
- take medication as usual
- if only for a short time, emergency treatment not usually needs
- if blood sugar is > 15 mmol/l check blood or urine for ketones
- may administer an additional dose of insulin
- drink sugar free fluids to prevent dehydration
- follow sick day rules if unwell, especially if vomitting
Sick day rules
- keep taking diabetes medications
- if usually check blood sugars at home, test more regularly
- if don’t check be aware of signs of hypoglycaemia
- keep well hydrated
- eat little and often
- type 1, test for ketones
- type 2 and on an SGLT2i stop taking them as they can increase risk of DKA
