Outline of Diabetes Mellitus

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Outline of Diabetes Mellitus Dr F Dunne Dept of Medicine

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Definition Diagnosis Classification Symptoms Annual Assessment Treatment alternatives Metabolic difficulties Macrovascular intricacies Microvascular entanglements Layout

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Definition A disorder brought about by a reduction or aggregate absence of insulin or lessened viability of circling (insulin resistance) Characterized by hyperglycaemia

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Insulin Enhances fringe glucose take-up Inhibits breakdown of liver glycogen Enhances stockpiling of glucose as glycogen Increases protein combination Increases triglyceride stockpiling

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Fasting blood glucose > 7mmol/l Random blood glucose >11.1mmol/l 75g OGTT Diagnosis

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75g OGTT Diabetic: FBG>7; 2h >11.1 mmol/l IGT : FBG <7; 2h 7.8-11.1 mmol/l IFG: FBG 6.1-6.9 mmol/l

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Classification Type 1 diabetes Type 2 diabetes Secondary diabetes

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Older age Slow onset Family history Not immune system No ketones Partial Insulin def/Resistance Insulin requiring Diet/OHA Type 1 diabetes;Type 2 diabetes Juvenille Abrupt onset Family history Autoimmune Ketones Total insulin def, Islet cell AB pos HLA DR3 DR4 Insulin subordinate

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Steroids Thiazide Diuretics Drugs for HIV Pancreatectomy Acute pancreatitis Chronic Pancreatitis Haemachromatosis Cystic Fibrosis Cushings Disease Acromegaly MODY DIDMOAD Secondary Diabetes

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Polyuria Polydypsia Weight misfortune Lethargy Tiredness Blurred Vision Boils/abscesses Pruritus Vulvae DKA Retinopathy Nephropathy Neuropathy Foot ulcers/gangrene Angina/MI/CVA Symptoms

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Osmotic side effects Hypoglycaemia Injection destinations Treatment Diabetes nurture pro Dietitian Blood weight VAs Fundoscopy Pulses/CFT Neurology of Legs Urinalysis HbA1C Lipids Renal capacity Annual Assessment

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Treatment Relief of osmotic indications Avoid complexities Choice of medications subject to sort, age, family bolster and so on

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Rapid acting Insulin Long acting Insulin Mixed Insulins Short acting analogues Long acting analogues Treatments of Glucose Diet Metformin Sulphonylureas Acarbose Thiazolidinediones Netaglinide/Repag.

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Other medications Anti-hypertensives Statins/fibrates Aspirin ACE inhibitors ARBs

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Treat to Target HbA1C < 7% BP < 140/80 Cholesterol <5 mmol/l HDL-C >1mmol/l LDL-C < 2mmol/l Triglycerides <1.5mmol/l

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Too much insulin Food exclusion Sulphonylureas Renal impairement Hypoglycaemia <2.5mmol/l Autonomic Neuroglycopenic LOC Cerebral Oedema

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Treatment Food Dextrose tablets Hypostop Glucose implantation Glucagon

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Infection Omits insulin Dehydration Ketotic Hyperventilating Hypotensive Tachycardia Coma Glucose/ketones/ acidotic on ABG IV Fluids Insulin Potassium Antibiotics DKA – Serious/Life debilitating

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Type 2 Unwell for a considerable length of time Not acidotic No ketones Very high glucose Risk of coagulating Fluids Insulin Potassium Heparin HONK

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Peripheral Neurop Femoral Amyotrophy Mononeuritis multiplex Autonomic Neuropathy Postural hypotension Diarrhea Impotence Atonic bladder Sweating Loss of hypo. awarenes Neuropathy

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PVD CVD CAD Diabetes Hypertension Proteinuria Lipids Cigarettes Obesity Vascular Disease

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Intermittent Claudication Cold Legs Pulseless Leg Foot Ulcers Gangrene Doppler Studies Duplex Scanning Angiography Angioplasty Treat chance elements PVD

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TIAs CVAs Dementia CT examine Carotid Dopplers Treat chance components Carotid sidestep surgery CVD

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Angina MI Silent infarct CCF ECG Cardiac compounds Troponin I Exercise stretch test Echocardiography Angiography Angioplasty/CABG CAD

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Neuropathy PVD Charcot Arthropathy Ulceration MRI Angiography Diabetic Foot

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Background DR Pre-proliferative DR Proliferative DR Maculopathy Fluroscein angiography Laser Blood Pressure Lipids Glucose Retinopathy

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Diabetic glomerulosclerosis Microalbuminuria <300mg/l Proteinuria >300mg/l Nephrotic >3g/l Abnormal creatinine Glycaemic control BP control CAPD Transplantation Nephropathy

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BMI>30 Age >50 Ethnic minorities Family history GDM Urinalysis FBG Random glucose OGTT Cost/advantage examination Screening

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Diabetes is preventable by way of life adjustment Da Quing (Chinnese)31-46% diminishment Finnish (Europeans)58% decrease DPP (North Americans) 58% lessening STOP –NIDDM Trial Acarbose Lancet 2002;359: 2072-2077. JAMA 2003;290: 486-494 TRIPOD Study Pioglitazone

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DCCT Trial(Type1) Diabetes 1996;45: 1289-1298 NEJM 1993;329;977 UKPDS study (Type 2) Lancet 1998;352:837-853 DIGAMI (CCU) BMJ 1997;314:1512-1515 Lancet 2002:259; Lancet 2000; 355: 733-777 ICU patients NEJM 2001;345:1359-1367 WOSCOPS; 4S; ASCOT Lancet 2003;361;1149-1158 (Statin) HOPE (ACE-I) NEJM 2000;342:145-153 ALL-HAT (ACE-I) JAMA 2002;288:2981-2997 LIFE SCOPE (ARB) CARDS Study (Lancet August 2004) DIGAMI 2 ponder (in press). Writing