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Medicine: PBL wrap-ups > Unit 8 Week 1: Type 2 Diabetes > Flashcards

Unit 8 Week 1: Type 2 Diabetes Flashcards

(79 cards)

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1
Q

health behaviour

A

refers to the actions that an individual engages in that affect their health either positively or negatively.

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2
Q

physiology of no type 2 diabetes

A

glucose builds up in the bloodstream
body wants to store this glucose in places in the liver and muscle cells
beta cells in the pancreas secrete insulin into the blood as a response to rise in glucose
insulin allows glucose to be absorbed into organs such as muscle cells and liver
decreases blood glucose levels

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3
Q

insulin resistance

A

can be caused by genetics, family pre-dispositions, obesity and bad eating habits
cells in the body become insensitive to insulin
results in reduced glucose uptake by the cells
increased blood glucose levels

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4
Q

another way diabetes affects glucose

A

beta cells in the pancreas don’t release enough insulin
in response to the rising blood glucose levels

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5
Q

diabetes presentation

A

increased thirst
nocturia
fatigue
increased hunger
numbness and tingling in hands and feet
weight loss

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6
Q

increased thirst, nocturia

A

as blood sugar levels rise the kidneys try to filter and remove the excess glucose from the blood
can lead to dehydration

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7
Q

fatigue

A

body isnt able to effectively use glucsoe for energy

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8
Q

hunger

A

not effectively using glucose for energy

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9
Q

numbness and tingling in hands and feet

A

high blood sugar levels can damage nerve endings

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10
Q

weight loss

A

body is unable to use glucose for energy

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11
Q

how do you estimate risk for cardiovascular disease

A

QRISK3

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12
Q

Q risk 3

A

tool to calculate risk of CVD
takes into account risk factors: BMI, age, sex, lifestyle, past medical history, family history

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13
Q

complications of diabetes

A

storke
cerebrovascular disease
cardiovascular disease
diabetic neuropathy
diabetic nephropathy
foot damage
peripheral vascular damage
peridontal disease
diabetic retinopathy
cataract
glaucoma

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14
Q

diabetes and mechaisms of injury

A

diabetes: hyperglycemia, increased FFA and modified LDL cholesterol, decreased HDL cholesterol
mechanisms of injury: increased AGE, ROS, angiotensin 2, NFKB activity, inflammatory cytokines, leukocyte adhesion, PKC activity

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15
Q

how does diabetes cause different mechanisms of injury

A

when sugars in the bloodstream attach to proteins in the blood vessel walls, advanced glycation end products synthesised more
causes proteins to become in blood vessels to be stiffer and less elastic
leads to formation of free radicals
causes oxidative stress and damage to blood vessel walls
leads to inflammation and cell damage

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16
Q

atherosclerosis

A

cholesterol plaques may form
impair blood flow

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17
Q

diabetic nephropathy

A

damage to small blood vessels in the kidney that filter waste from the blood
causes scarring and kidney damage

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18
Q

impaired immnity

A

high blood sugar can impair the function of various immune cells

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19
Q

non-proliferative diabetic neuropathy

A

early stage of diabetic neuropathy
small blood vessels in the retina begin to leak fluid or blood

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20
Q

proliferative diabetic neuropathy

A

more advanced stage of diabetic retinopathy
new blood vessels grow in the retina
new blood vessels are fragile
can leak blood
cause severe vision loss and blindness

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21
Q

risk factors for type 2 diabetes

A

obesity
age
ethnicity
family history
sedentary lifestyle
prediabetes
gestational diabetes
PCOS
hypertension
sex
smoking
alcohol
antipsychotics
alcohol
sleep disturbances
low birth weight

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22
Q

obesity as a risk factor

A

biggest factor
high waist measurement also increases risk

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23
Q

age as a risk factor

A

over 45 if white
over 25 if afican caribbean, black african, chinese or south asian

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24
Q

family hisotry as a risk factor

A

15% if one parent has type 2
75% if both do

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25
sedentary lifestyle as a risk factor
increased risk in those who spend prolonged periods sitting
26
gestational diabetes as a risk factor
seven fold increased for developing tpye 2 children born to mothers wiht gestational diabetes have 6 fold increase of developing
27
PCOS as a risk factor
associated with insulin resistance higher levels of insulin circulating in blood
28
gender as a risk factor
men have slightly higher risk
29
smoking and alcohol as a risk factor
smoking increasesrisk excessive consumption increases risk some evidence shows moderate consumption decreases risk
30
wellman clinic
90 minutes with HCP private walk-ins complete: lifestyle questionnaire, mental health quesitonnaire, full physical exam, resp assessment, cardiovascular assesssment, BMI and body fat percentage, consultation, vital signs, blood tests and urinalysis, screening
31
barriers for accessing healthcarei n this case
competing social/economic demands embarrassment/stigma fear of being blamed tendency to normalise results fear of results leack of awareness past bad experience
32
key investigations in type 2 diabetes diagnosis
HbA1c random blood sugar fasting blood sugar oral glucose tolerance
33
other useful tests in type 2 diabetes diagnosis
serum creatinine EGFR ACR C peptide
34
type 1 diabetic
increased blood glucose levels body unable to produce insulin
35
type 2 diabetic
cells unable to respond to insulin produced insulin resistance
36
pre-diabetic
blood sugar levels higher than normal but not high enough to be classified as type 2 diabetic
37
Hba1c
Glycated haemoglobin blood test​ Measures the amount of glucose that is attached to your haemoglobin​ Indicates the average blood sugar levels for the past 2-3 months ​ This is the first test in order to diagnose
38
Hba1c results
normal below 5.7% pre 5.7-6.4 diabetes 6.5 higher on 2 separate tests
39
random blood sugar test
Regardless of when patient last ate ​ Blood sugar value either expressed as mg/dL or mmol/L
40
random blood sugar test results
200mg/dL or 11.1mmol/L or higher suggests diabetes ​ Especially if these results are seen alongside typical symptoms such as frequent urination and extreme thirst
41
fasting blood sugar tests
Test completed after you haven't eaten overight
42
fasting blood sugar test results
Less than 100mg/dL or 5.6mmol/L is healthhy ​ 100 to 125mg/dL or 5.6 to 6.9mmol/L prediabetes ​ 126mg/dL or 7mmol/L or higher on 2 separate tests diagnosed as diabetes
43
oral glucose tolerance test
Less commonly used than the others except during pregnancy ​ Not eat for a certain amount of time then drink sugary drink with the healthcare provider ​ Then blood glucose levels tested periodically for 2 hours
44
oral glucose tolerance test results
less 140 mg/dl normal pre is 140-200 diabetes is over 200
45
serum creatinine
Is the primary metabolite of creatine in skeletal muscle ​ Is a waste product of creatine, amino acid made and stored in the liver ​ Result of normal muscle metabolism ​ Chemical enters bloodstream, kidneys remove from blood then exits body through urination ​ Reduced skeletal muscle has been suggested as a potential risk factor for type 2 diabetes ​ High levels of serum creatinine may be associated with increased risk of kidney failure
46
serum creatinine results
Normal for men: 0.6- 1.2 mg/dL ​ Normal for women: 0.5-1.1 mg/dL
47
egfr
Tests for creatinine to determine glomerular filtrate rate ​ To measure kidney function ​ Diabetic neuropathy (diabetic kidney disease) is often associated with reduced EGFR ​ Case relation: risk factors for DKD include sustained hyperglycaemia, hypertension and obesity
48
egfr results
normal is 90-120 ml/min/1.73m^2
49
ACR, urine albumin to creatinine ratio
Looks for signs that protein is leaking into urine ​ Often another early sign of kidney disease ​ Checks urine microalbumin ​ Should be checked as soon as a person is diagosed diabetic and measured annually especially if raised
50
ACR results
normal is less than 2.5 mg/mmol Slightly raised= early kidney disease ​ Very low= normal function ​ Very high= more severe kidney disease
51
C peptide test
New test, not for diagnosis but potentially for distinguishing differences between type 1 and 2​ Measures levels of C-peptide in blood or urine ​ Accurate way of finding the amount of insulin your body is producing ​ When producing insulin the pancreas also produces C-peptide at the same time in equal amounts ​ Doesn’t affect your blood glucose levels but stays in the blood longer than insulin to easier to measure
52
C peptide test results
normal is 0.5-2 mg/ml High= too much insulin so can be indicative of type 2 diabetes and other conditions (kidney failure, insuloma, Cushing's syndrome and low potassium levels in blood) ​ Low= not enough insulin so can be indicative of type 1 and some cases of type 2 and other conditions (Addison disease, liver disease)
53
healthcare professionals involved in management
primary care endocrinologist diabetes care and education specialist registered dietician ophthalmologist optometrist podiatrist audiologist pharmacist dentis nephrologist mental health professional
54
weight management
85% diabetes tpye 2 overweight or obese commercial weight loss programmes or planners more life managing my weight are examples
55
healthy lifestyle
base meals on starchy foods fibre rich foods 5 a day consume little fired food minimize sedentary activities
56
what should effective weight loss programmes do
address reasons why someone may find it difficult to lose weight sensitive to persons weight concerns be based on a balanced healthy diet identify and address barriers to change
57
patient education on weight
DSMES can help you improve blood sugar levels to delay or prevent serious complications face to fac: DESMOND and X-PERT
58
drugs in this case
metformin atorvastatin
59
annual diabetic review
with the diabetic nurse BP HbA1c CVD risk compliance with eye screening, foot checks, dental checks other long term complications
60
foot checks
annual podiatrist, GP or specialist high BM causes peripheral neuropathy look and ask for cuts, blisters, cramps and look at shoes self maangement: stop smoking, check feet daily, manage sugars, moisturize, careful cutting nails, shoes fit well
61
eye checks
annual optometrist diabetic retinopathy high BM's can damage BV in eyes compromising the blodo supply to the retina retina photographed visual acuity self management: control BM's, report vision changes
62
Hba1c annual
average glucose last 2-3 months measured 3-6 months until stable Normal: < 42mmol/mol​ Pre-diabetes: 42-47mmol/mol​ Have diabetes target <48mmol/mol (6.5%)
63
model for change
transtheoretical
64
transtheoretical model
in biopsych flashcards
65
health promotion campaigns for T2D
NHS diabetes prevention programme diabetes UK type 2 diabetes prevention week held annually knowyour risk tool by diabetes uk #beatdiabetes
66
integrated care system
partnerships of organisations that come together to plan and deliver joined up health and care services to improve lives of people who live and work in their area
67
what is included in an integrated care system
integrated care partnership integrated care board local authorities place based partnerships provider collaboratives
68
integrated care partnership
responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area broad alliance of partners concerned with improving the care, health and wellbeing of the population, with membership determined locally.
69
integrated care board
A statutory NHS organisation responsible for developing a plan for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the ICS area. The establishment of ICBs resulted in clinical commissioning groups (CCGs) being closed down.
70
place based partnerships
lead the detailed design and delivery of integrated services across their localities and neighbourhoods
71
purpose of integrated care systems
improve outcomes in populaitn health and healthcare tackle inequalities in outcomes, experience and access enhance productivity and value for money help NHS support broader social and economic development
72
collaborating as ICS's will help health and care organisations tackle complex challenges including
improving health of children and young people supporting people to stay well and independent acting sooner to help those with preventable conditions supporting long term conditions and mental health issues caringfor those with multiple needs as populations age getting best from collective resources
73
role of diabetes speicalist nurse
support and advice between appointments wiht blood sugar checks and adjusting medication help run patient diabetes group educatoin courses
74
prevalence of T2D globally
increasing more in low and middle income countries than high income countries
75
how does diabetes impact renal physiology
damage to vessels in the glomerulus leads to poor filtration from blood
76
BMI for overweight
overweight is a BMI greater than or equal to 25
77
BMI for obese
obesity is a BMI greater than or equal to 30
78
effects of obesity on body
risk of stroke depression increase risk of heart attack sleep apnea GERD liver disease cancer skin fold rashes T2D gall bladder problems infertility kidney failure weakened muscles and bones
79
benefits of exercise
improve your brain health, help manage weight, reduce the risk of disease, strengthen bones and muscles, and improve your ability to do everyday activities

Medicine: PBL wrap-ups (21 decks)

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