Makindo Medical Notes

Related Subjects: Type 1 DM |Type 2 DM |Diabetes in Pregnancy |HbA1c |Diabetic Ketoacidosis (DKA) Adults |Hyperglycaemic Hyperosmolar State (HHS) |Diabetic Nephropathy |Diabetic Retinopathy |Diabetic Neuropathy |Diabetic Amyotrophy |Maturity Onset Diabetes of the Young (MODY) |Diabetes: Complications

⚖️ Blood pressure targets in diabetes: • <140/80 mmHg (general target) • <130/80 mmHg if renal, eye, or vascular disease present (NICE 2015) 🩺 Alongside this: stop smoking, exercise, lose weight, reduce salt, limit alcohol, and start statins if indicated.

Diabetes is a chronic disorder of hyperglycaemia due to impaired insulin secretion, insulin action, or both. Hypertension commonly coexists with diabetes, multiplying cardiovascular and renal risk. Managing both together is essential to prevent complications.

🧩 Types of Diabetes

• Type 1 Diabetes:
  • Autoimmune destruction of beta cells.
  • Usually presents in childhood/young adults.
  • Lifelong insulin required.
  • BP treatment threshold: >135/85 mmHg; if albuminuria/metabolic syndrome → >130/80 mmHg. First line: ACEi/ARB.
• Type 2 Diabetes:
  • Insulin resistance + relative insulin deficiency.
  • Linked with obesity, sedentary lifestyle, genetics.
  • Treated with lifestyle, oral agents, sometimes insulin.
  • BP target: <140/80; <130/80 if renal/eye/vascular disease. First line: ACEi/ARB (or + thiazide). Afro-Caribbean origin: CCB first line.

⚠️ Causes & Risk Factors

• Type 1: autoimmune (HLA-linked), viral triggers.
• Type 2: obesity, poor diet, inactivity, family history.
• Both: share risk factors with hypertension → endothelial dysfunction, vascular damage.

🔍 Symptoms of Diabetes

• Polydipsia, polyuria, polyphagia.
• Unexplained weight loss (T1DM especially).
• Fatigue, blurred vision.
• Slow wound healing, recurrent infections.

🧪 Diagnosis of Diabetes

• Fasting glucose ≥7.0 mmol/L.
• 2-hour OGTT ≥11.1 mmol/L.
• HbA1c ≥48 mmol/mol (6.5%).
• Random glucose ≥11.1 mmol/L + symptoms.

💊 Treatment of Diabetes

• Lifestyle: diet, exercise, weight loss, smoking cessation.
• Medications:
  • T1DM → insulin therapy.
  • T2DM → metformin first line, add SGLT2i, GLP-1 RA, SU, or insulin depending on control/comorbidities.
• Monitoring: glucose checks, HbA1c every 3–6 months, screen for complications.

🫀 Relationship Between Diabetes & Hypertension

• Shared risk factors: obesity, inactivity, poor diet.
• Insulin resistance → endothelial dysfunction → ↑BP.
• Combined = much higher cardiovascular and renal risk.

💥 Combined Effects

• 💔 CV disease: MI, stroke, peripheral vascular disease.
• 🩺 Renal: diabetic nephropathy + hypertensive nephrosclerosis → CKD.
• 👁️ Eye: retinopathy, maculopathy, vision loss.
• 🧠 Nerves: peripheral neuropathy, autonomic neuropathy.

🛠️ Management Strategies

• Lifestyle: low-salt diet, exercise ≥150 min/week, weight loss, alcohol moderation, smoking cessation.
• Antihypertensives: ACEi/ARB first line; add thiazide or CCB if needed. CCB first line in Afro-Caribbean patients (unless proteinuria).
• Antidiabetics: optimise glycaemic control to HbA1c <48–53 mmol/mol if safe.
• Statins: indicated in most adults with diabetes for CV risk reduction.
• Monitoring: BP and glucose logs, annual kidney, eye, and foot checks.
• Education: empower patients with knowledge + peer support groups.

📚 Teaching Pearls

• Diabetes + hypertension = leading cause of end-stage renal failure in the UK.
• ACEi/ARB protect against proteinuria → first line even if normotensive in microalbuminuria.
• BP control often gives greater reduction in complications than tight glucose control (UKPDS trial).
• Always individualise targets (e.g., frail elderly may tolerate higher BP).

🔗 References

• NICE NG136: Hypertension in adults
• NICE NG17: Type 1 Diabetes
• NICE NG28: Type 2 Diabetes