Type 2 Diabetes Flashcards
What is type 2
In Type 2 Diabetes Mellitus, pancreatic beta cell production of insulin becomes insufficient due to insulin resistance.
Onset is usually in adults and there is often a strong family history.
What are the causes
Causes include a combination of environmental and genetic factors, poor diet, lack of exercise and obesity.
What is required for a diagnosis
If symptomatic one of the following results is sufficient:
Random blood glucose =11.1mmol/l
Fasting plasma glucose =7mmol/l
2 hour glucose tolerance =11.1mmol/l
HbA1C =48mmol/mol (6.5%)
If the patient is asymptomatic two results are required from different days.
What would the random glucose be in a positive result
11.1
What would the fasting glucose be
7
What would be shown after the 2 hour glucose tolerance test
11,1
What would be a positive HbA1C result
48mmol/mol
What is gastroparesis
Gastroparesis is a recognised gastro-intestinal complication of diabetes, related to poor glycaemic control.
Gastroparesis is caused by nerve damage to the autonomic nervous system.
What happens in gastroparesis
Vagus nerve damage -l ead to delayed gastric emptying, offensive egg smelling burps due to bacterial overgrowth, early satiety, abnormal stomach wall movements and morning nausea
What is the management for gastroparesis
Treatment includes the use of motility agents such as metoclopramide or domperidone, tight glycaemic control, antibiotics such as Erythromycin to kill off the bacterial overgrowth and botox injections to relax the gastric outflow obstruction. Else gastric pacemakers
What happens in autonomic neuropathy
Postural or orthostatic hypotension is defined as a fall in systolic blood pressure by 20mmHg or more after changing position or posture, typically from lying to standing.
What are the treatments of autonomic nueropathy
Increased dietary salts
Use of fludrocortisone or miodrine to increase the presence of salt retaining hormones
raising bed head position to retrain baroreceptors and ted stocking use
How does peripheral artery disease manifest
If the circulation is compromised then this can manifest itself in several ways including foot discolouration, gangrene, intermittent claudication, rest pain, night pain and absent peripheral pulses (confirmed on doppler).
What has to be done if patient found with critical ischaemia
need to be urgently seen by a multi-disciplinary specialist diabetic foot team which includes a vascular surgeon.
What are the risks to the foot
high risk of diabetic foot ulceration and subsequent infection.
Once an infected diabetic ulcer sets in, it can be very difficult to treat and may take a very long time to treat and heal.
How to manage a diabetic foot
Management requires multi-disciplinary input with consideration to good glycaemic and blood pressure control, stopping smoking, improving the circulation (potentially with angioplasty or bypass surgery), debridement of the wound, the use of larvae therapy (maggots) and antibiotics.
When to use antibiotics
Targeted to organism especially if deep ulceration and if osteomyelitis is suspected
How to diagnose osteomyelitis
MRI is the imaging modality of choice to diagnose osteomyelitis as it does not reliably show up on plain X-rays.
What organisms cause diabetic foot infections
Gram positive organisms e.g. such as Staphylococcus aureus, Enterococcus, and gram-negative organisms like Pseudomonas aeruginosa, Escherichia coli, Klebsiella species, Proteus species and anaerobes.
How to screen for sexual dysfunction
Low testosterone (hypogonadism) can be primary (testicular failure) or secondary (pituitary) and needs to be screened for using a 9AM testosterone blood test (this is the peak time of release because of diurnal hormone secretion patterns) and gonadotrophins (LH and FSH).
What is the initial management
Initial drug treatment is usually metformin. Pioglitazone, DPP‑4 inhibitors, sulphonylureas or SGLT-2 inhibitors may be options for some patients who cannot take metformin.
