Please enable JavaScript.
Coggle requires JavaScript to display documents.
Diabetes (Type I (Associated with (HLA-DR3 & HLA-DR4, Pernicious…
Diabetes
Type I
Absolute insulin deficiency
Type IV hypersensitivity reaction
Destruction of beta-islet cells of pancreas
Targets GAD, IA-2 and ZnT8
Most common in <5 year olds and 10-14 year olds
Family history
Father > mother
Short duration of onset
Associated with
HLA-DR3 & HLA-DR4
Pernicious anaemia
Addison's disease
Coeliac disease
Autoimmune thyroiditis
Presentation
Polyuria
Polydipsia
Weight loss
Polyphagia
Ketonuria
Investigation
Fasting blood glucose >7mmol/L
Random blood glucose > 11mmol/L
HbA1C>48mmol/L
Management
Life-long insulin
Type II
Investigation
Fasting blood glucose >7mmol/L
Random blood glucose > 11mmol/L
HbA1C>48mmol/L
Insulin resistance with reduced beta-cell function
Presentation
Obesity
Polydipsia
Polyuria
Fatigue
Candidal infection
Visual blurring
Erectile dysfunction
Peripheral neuropathy
Genetic associations
Management
Lifestyle
Weight loss
Physical activity
Dietary advice
Smoking cessation
Reduce alcohol consumption
Medication
Meformin
Diabetic ketoacidosis
Major complication of type I diabetes
Accumulation of ketone bodies from metabolism of fatty acids in liver
Caused by perception of hypoglycaemia in an actually hyperglycaemic state
Exacerbated by illness/infection
Presentation
Kussmaul breathing
Vomiting
Abdominal pain
Hyperglycaemia
Hypokalaemia
Management
Fluid replacement
Electrolyte replacement
Insulin
Treat underlying cause
Complications
Hyperosmolar hyperglycaemic state
Major complication of Type II diabetes
Occurs most often in elderly
Causes
High sugar intake
Stroke/ MI
Sepsis
Glucocorticoid medication
Thiazide diuretics
Investigations
Biochemistry
Hyperglycaemia
Raised osmolality
Hypernatraemia
Ketonaemia
Acidosis
Management
Fluid replacement
Consideration of insulin
Sodium replacement
Screen for vascular event
Lactic acidosis
Type A
Tissue hypoxaemia
Type B
Liver disease
Diabetes
Presents as per DKA
Investigations
Biochemistry
Low HCO3
Raised anion gap
Hyperglycaemia
Hyperphosphataemia
Management
Fluids
Antibiotics
Neuropathy
Peripheral
Loss of feeling/ pain in feet and hands
Cramps
Hypersensitivity
Foot ulcers
Charcot foot
Painless trauma
Treated with amitriptyline/ gabapentin
Autonomic
Changes in bowel habits
Gastroparesis
Constipation/ diarrhoea
Nausea/ vomiting/ loss of appetite
Dysphagia
Management
Smaller/ more frequent meals
Promotility drugs
Anti-emetics
NSAIDs
Bladder dysfunction
Erectile dysfunction
Anhidrosis/ hyperhidrosis
Orthostatic hypotension
Tachycardia
Loss of pupillary light reflex
Proximal
Pain in thighs/ hips/ buttocks
Amyotrophy
Often due to lumbosacral neuropathy
Accompanied by weight loss
Focal
Sudden weakness
Carpal tunnel syndrome
Foot drop
Bell's palsy
Nephropathy
Nephrotic syndrome + nodular glomerulosclerosis
Blood pressure control essential
Ocular disease
Retinopathy
Staging
Background
Moderate non-proliferative
Severe non-proliferative
Proliferative
Neovascularisation
Vitreous haemorrhage
Opthalmoscopy
Flame haemorrhages
Cotton wool spots
Hard exudates
Intra-retinal microvascular abnormalities
Cataracts
Glaucoma
MODY
Autosomal dominance inheritance
Glucokinase mutations
Onset at birth
Stable hyperglycaemia
Treated with diet
Transcription factor mutations
Onset in adolescence
Progressive hyperglycaemia
Controlled with diet
Frequent complications
May necessitate insulin therapy
Sensitive to sulphonylurea treatment
Medications
Oral
Biguanides
Metformin
Insulin sensitisers
Reduces insulin resistance
Non-hypoglycaemic
Weight neutral
Prevents micro/macrovascular complications
Safe in pregnancy
Side-effects
Anorexia
Nausea/vomiting
Diarrhoea
Abdominal pain
B12/folate malabsorption
Lactic acidosis
1st line
Sulphonylureas
Glicliazide
Insulin secretagogues
Prevents microvascular complications
Doesn't prevent macrovascular complications
Weight gain
Hypoglycaemic
Side-effects
GI upset
Headache
Hypersensitivity
Hepatorenal toxicity
2nd line
Thiazolidinediones
Pioglitazone
PPAR-gamma agonists
Increases insulin sensitivity
Must be used in conjunction with sulphonylurea
Monotherapy can cause hypoglycaemia
Weight gain
No prevention of microvascular complications
Prevents macrovascular complications
Can cause heart failure
SGLT2 inhibitors
Dapagliflozin
Decreases sugar uptake
Weight loss
Urinary tract infections
GLP-1 receptor agonists
Amplify incretin pathway
Promotes endogenous insulin secretion
Non-hypoglycaemic
Suppresses glucagon
Gastroparesis
Early satiety
Risk of pancreatitis/ pancreatic malignancy
Weight loss
DPP-IV inhibitors
Sitagliptin
Less potent than GLP-1 agonists
Promotes endogenous insulin secretion
Non-hypoglycaemic
Weight neutral
Risk of pancreatitis/ pancreatic cancer
Insulin