Investigations
What are the 4 common blood glucose laboratory tests used to screen for diabetes?
Fasting blood glucose
Random blood glucose
Oral Glucose Tolerance Test
HbA1c
A physical examination of a patient with suspected diabetes typically may show these signs
Obesity/increased weight circumference, dehydration, ancanthosis nigricans
What is DKA?
A life-threatening complication of diabetes that occurs when the body lacks enough insulin to use blood sugar for energy, it switches to using fats for fuel which creates ketones causing the blood to be acidic.
What is the diabetes annual cycle of care?
An annual cycle of care is a checklist designed to help a patient & their healthcare team stay on top of diabetes management & reduce the risk of diabetes related complications
What investigation is used to determine T1 diabetes
Positive result for autoantibodies (e.g. GAD) suggests autoimmune β-cell destruction in Type 1 diabetes mellitus.
Repeat testing is usually needed for the diagnosis of diabetes. When is it NOT needed?
When patient has classic symptoms and unequivocal hyperglycemia
Who gets DKA?
People with newly diagnosed type 1 diabetes - often leads to diagnosis
People with known type 1 diabetes experiencing stress or illness - increased insulin needs
People missing insulin doses
People with diabetes and begin taking medications that affect blood sugar, i.e steroids
List 3 checks that are a part of the diabetes cycle of ASIDE from blood glucose levels & HbA1c
BP
Cholesterol
Eye health
Foot care
Kidney health
What investigations are commonly used together to diagnose diabetic ketoacidosis (DKA)?
Blood glucose, ketones and blood gas
What are the specific glucose thresholds used in laboratory diagnosis of diabetes in fasting plasma glucose, HbA1c, Oral glucose tolerance test and the random plasma glucose?
Fasting plasma glucose ≥ 7.0mmol/L
HbA1c ≥ 6.5%
Oral glucose tolerance test: 2-hour plasma glucose ≥ 11.1mmol/L
Random plasma glucose ≥ 11.1 mmol/L
List 3 symptoms of DKA and why they occur?
Nausea, vomitting, stomach pain - build up of ketones causing systemic acidicity which irritates the GIT system
Deep, rapid breathing - in attempt to compensate, the body is trying to expel as much CO2 as possible
Fruity breath - ketones are sweet smelling
Excessive thirst - severe dehydration due to extreme high blood sugars & your kidneys can't reabsorb all the glucose and then water then follows glucose into filtrate causing large volumes of urine
Fatigue, confusion, dizziness - brain cells starving :(
What is the cycle of care guidelines regarding foot care? How often should a patient be doing self checks, how often should they be seeing a podiatrist & what does it involve?
Self check everyday, a podiatrist at least once a year. Involves checking for changes to skin, calluses, foot ulcers, infections & nerve damage
What does ACR measure and what is it used for?
Urine albumin-to-creatinine ratio - Used to detect diabetic nephropathy by measuring albumin relative to creatinine.
Why is urine glucose alone NOT diagnostic?
Renal threshold varies
What are 2 major complications of DKA & why do they occur?
Hyperkalemia - insulin normally drives K+ into cells, without it, K+ accumulates in cells. Osmotic gradient, high blood sugar creates osmotic gradient that pulls water out of cells & K+ follows. Cells also are taking up H+ to fix pH and they pump out K+ to maintain electroneutrality
Dehydration - kidneys can't absorb glucose so glucose stays in filtrate, water follows, also nausea & vomitting
AKI - decreased blood flow to kidneys due to kidneys
What are the 3 major eye complications that should be screened for regularly with diabetes?
cataracts, glaucoma, retinopathy
What is C peptide and what is it used for?
Substance that is released when endogenous insulin is produced and helps assess residual pancreatic function.
Why do you die from DKA?
cerebral edema - most common in children
cardiovascular collapse - fatal arrhythmias
dehydration leading to hypovolemic shock
What are the LDL, HDL & triglyceride goals for someone with diabetes
LDL - <2mmol/L
HDL - >1mmol/L
triglycerides - <2mmol/L