T1DM, T2DM & Me Flashcards Preview

R - endocrine pathology (Rachel) > T1DM, T2DM & Me > Flashcards

Flashcards in T1DM, T2DM & Me Deck (26)
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1

what is T1DM

autoimmune destruction of the pancreas
beta cells are destroyed so less insulin is made
less insulin means cells can't take up glucose and the body thinks it is starving so the liver produces more glucose resulting in hyperglycaemia

2

what can cause T1DM

genetics + unknown trigger
acromegaly
cushing's
autoimmune disease
pheochromocytoma

3

what are symptoms of T1DM

thirst - polydipsia
tiredness
toilet - polyuria
thinner - weight loss

4

what are clinical signs of T1DM

polyuria
hyperglycaemia
glucosuria
sweet breath if in ketosis

5

what tests could you do for T1DM

finger prick blood glucose test in clinic - if >11.1 send for same day investigations
fasting blood glucose >7 indicates diabetes
oral glucose tolerance test > 11.1
HbA1c represents past 2-3 months, below 6% glycated is normal

6

how could you manage T1DM

patient education - STEP
2 weeks leave to understand management
inform about sick day rules
insulin regimes

7

what is the twice daily insulin regime

rapid acting + intermediate acting insulin before breakfast and dinner

8

what is the 3x daily insulin regime

rapid + intermediate before breakfast
rapid before tea
intermediate before bed

9

what is the 4x daily insulin regime

short acting before breakfast lunch and dinner
intermediate before bed
long acting at a fixed time daily

10

what is diabetic ketoacidosis

high levels of ketone acids in the blood

11

how does diabetic ketoacidosis happen

no insulin = no glucose getting into the cells
body converts FFAs into ketone bodies in the liver as an alternate energy source
the ketone bodies cannot be taken up by the brain without insulin
ketones build up in the blood causing metabolic acidosis

12

how does DKA present

sweet breath from acetone (breakdown product of ketones that escapes in lungs)
nausea
vomiting
breathing abnormalities
drowsiness
coma
death

13

what investigations could you do in ketoacidosis

urine dipstick for glucose and ketones
arterial blood gas
ECG

14

how would you treat ketoacidosis

IV saline to rehydrate
IV insulin
IV potassium
monitor closely - NEWS, GCS, blood glucose

15

what is T2DM

tissues loose their sensitivity to insulin - could be because there is less receptors or some are damaged
more insulin is required to have the same effect
the beta cells have an increased demand so undergo hyperplasia but then burn themselves out and become atrophied so less insulin is produced resulting in hyperglycaemia

16

what are risk factors for T2DM

genetics
obesity
poor diet/lifestyle
60+
alcohol
asian

17

how does T2DM present

often asymptomatic until there are complications
tiredness
thirst
weight loss
polyuria
blurred vision
thrush or other low grade infections

18

what investigations could you do for T2DM

blood glucose
random glucose
oral glucose tolerance test
urine dipstick

19

what are complications of diabetes mellitus

vascular disease - peripheral, coronary and cerebral
retinopathy
nephropathy
neuropathy
diabetic ulcers

20

what is a hypoglycaemic attack

when blood sugars get dangerously low
4 is the floor but less than 3mmol/l is common threshold

21

what causes a hypo

taking too much insulin in T1DM compared to glucose consumed
missed meals or overactivity in T1DM

22

what can cause a hypo in non-diabetics

EXPLAIN
exogenous drugs
pituitary insufficiency
liver failure
addison's disease
islet cell tumours
non-pancreatic tumours

23

how does a hypoglycaemic attack present

sweating
anxiety
hunger
tremor
palpitations
dizzy
confusion
drowsy
visual disturbances
coma
seizures
can be misdiagnosed as alcohol overdose

24

how do you manage a hypo

15-20g quick acting carbohydrate snack - 200ml orange juice and check BG 15-20 mins later, repeat snack up to three times
glucose gel between teeth and gums if conscious but not cooperative
IV glucose if unconscious - 10% at 200ml/hour
can also give glucagon - won't work if patient is malnourished
once glucose is over 4mmol/l give long acting carbohydrate - toast

25

how do you treat T2DM

lifestyle advice - diet, exercise alcohol etc
screen for complications
start with metformin
if HbA1c is still 58 or above add on DDP4 inhibitor or pioglitazone or Sulphonylureas or SGLT-2 inhibitor
if its still above 58 add on SU (SGLT-2i for metformin + SU)
if that doesn't work consider
insulin based therapy
triple therapy - metformin, SU and GLP1 mimetic

26

what are HbA1c targets

48mmol/l for new T2DM
53 for patients who use more than just metformin