Diabetes

How does glucagon increase the amount of glucose in the bloodstream?

What does insulin do to glucose levels and explain?

What is diabetes?

It is a common endocrine disorder. It is characterised by persistent hyperglycaemia due to impaired insulin secretion, with or without insulin resistance.  it can be classified as type 1 or type 2, with 90% of people having type 2 diabetes mellitus.

What is the pathophysiology of type 1 diabetes?

Describe the pathophysiology of type 2 diabetes?

Describe and explain the clinical features of diabetes mellitus?

• Polyuria

• Polydipsia

• Polyphagia

• fatigue

• weight loss

• blurred vision

• increased infection rate

• poor wound healing

Describe the differences between type 1 and type 2 diabetes?

What are the macrovascular and microvascular complications related to diabetes?

Macrovascular: affecting large blood vessels- coronary arteries, aorta

• Ischaemic stroke (x2 more likely) (causes 1 in 5 strokes)

• Myocardial infarction (MI) (x2.5 more likely)

• Other CVD HF (x2.5 more likely)

• Microvascular: small large vessels- capillaries

• nephropathy (10,350 have end stage kidney failure in uk)

• retinopathy (responsible for 5% of sight loss)

• neuropathy

What interventions can be made to reduce a persons CV risk if  a person has a 10 year QRISK3 score of 10% or more?

Offer atorvastatin 20mg (primary prevention of CVD)

What interventation would you give someone with T1DM for primary prevention of CVD regardless of their QRISK3 score: older than 40, diabetes more than 10 years, established nephropathy, other CVD risk factors.

Atorvastatin 20mg OD

What is the diagnositic criteria for persistent hyperglycaemia?

HBA1c of 48 mmol/mol or more

fasting glucose level of 7.0 mmol/l or more

random plasma glucose of 11.1 mmol/l or more with presence of signs + symptoms

What is the diagnostic criteria of both type 1 and type 2 diabetes?

What is considered a diabetic emergency?

blood glucose <4 mmol/l

hypoglycaemia

what are the non-pharmocological and pharmacological management treatment for hypoglycaemia?

How does diabetic ketoacidosis arise and what is the diagnosis?

Diagnosis: 

• Blood sugar > 11mmol/l + clinical symptoms + ketones are high (2+ urine, 3mmol/l blood)

• preventable but associated with mortality. most seen in T1DM as severe insulin deficiency.

• can be first presentation of T1DM.

Management of DKA

insulin

intravenous fluids

potassium + other electrolyte supplementation. insulin binds to cells… movement of potassium allowed, blood stream to cells… leads to hypokalaemia.

How are insulin injections delivered?

Subcutaneously, 90 degrees