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Samenvatting Deel Diabetes - Metabolism & Hormones 2

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Samenvatting Deel Diabetes - Metabolism & Hormones 2 Lessen hierin - Definitie en diagnose - Acute complicaties - Chronische microvasculaire complicaties - Chronische macrovasculaire complicaties - Diabetische voet - Behandeling T1 insuline - Behandeling T2 oraal - Behandeling T2 ...

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  • 4 januari 2025
  • 54
  • 2024/2025
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METABOLISM & HORMONES 2
Diabetes




1

,Table of Contents
1 Diabetes: definitie, classificatie en diagnose................................................................................................ 6
Definitie.................................................................................................................................................................6
Epidemiologie.......................................................................................................................................................6
Risicoinschatting...................................................................................................................................................6
Diagnose...............................................................................................................................................................6
Types.....................................................................................................................................................................7
Zwangerschapsdiabetes.......................................................................................................................................7
Monogenetische vormen......................................................................................................................................7
Andere vormen.....................................................................................................................................................7
Type 1....................................................................................................................................................................8
LADA.................................................................................................................................................................8
Genetisch..........................................................................................................................................................8
Pathogenese.....................................................................................................................................................8
Symptomen.......................................................................................................................................................9
Verschillen type 1 en type 2..................................................................................................................................9
Type 2....................................................................................................................................................................9
8 features (pathogenese)..................................................................................................................................9
Samengevatte kenmerken type 2...................................................................................................................10

2 Diabetes: acute complicaties..................................................................................................................... 11
Hypoglycemie.....................................................................................................................................................11
Symptomen.....................................................................................................................................................11
Soorten coma’s...............................................................................................................................................11
Ernst................................................................................................................................................................12
Risico...............................................................................................................................................................12
Prevalentie bij antidiabetica...........................................................................................................................12
Effecten...........................................................................................................................................................12
Counterregulatoire mechanismes..................................................................................................................13
Behandeling....................................................................................................................................................13
Diabetische keto-acidotische coma....................................................................................................................14
Wanneer ketonen monitoren?.......................................................................................................................14
DKA metabole gevolgen.................................................................................................................................15
Symptomen ernstige decompensatie.............................................................................................................15
Urgentiemaatregelen......................................................................................................................................15
Complicaties...................................................................................................................................................15
Opvolging........................................................................................................................................................16
Euglycemische keto-acidose bij SGLT-2 inhibitoren............................................................................................16
Euglycemische ketoacidose - waarom ketonen?............................................................................................16
SGLT2-i in type 1 en 2.....................................................................................................................................16
Wanneer ketonen monitoren.........................................................................................................................16
SGLT2-1 in type 1............................................................................................................................................17
Hyperosmolair non-ketotisch hyperglycemisch coma (dehydratatie)................................................................17
Hyperglycemisch coma...................................................................................................................................17

2

, Symptomen.....................................................................................................................................................17
Labo................................................................................................................................................................17
Behandeling....................................................................................................................................................17
Complicaties...................................................................................................................................................17

3 Diabetes: chronische microvasculaire complicaties....................................................................................18
HbA1c..................................................................................................................................................................18
Prevalentie..........................................................................................................................................................18
Pathogenese.......................................................................................................................................................19
Risicofactoren.................................................................................................................................................19
Retinopathie.......................................................................................................................................................19
Prevalentie......................................................................................................................................................19
Pathogenese...................................................................................................................................................19
Symtomen.......................................................................................................................................................20
Onderzoek......................................................................................................................................................20
Behandeling....................................................................................................................................................20
Nefropathie.........................................................................................................................................................20
Prevalentie......................................................................................................................................................20
Stadia..............................................................................................................................................................20
Pathogenese...................................................................................................................................................21
Complicaties nefropathie...............................................................................................................................22
Behandeling....................................................................................................................................................22
Neuropathie........................................................................................................................................................23
Definitie..........................................................................................................................................................23
Prevalentie......................................................................................................................................................23
Risicofactoren.................................................................................................................................................23
Pathogenese...................................................................................................................................................24
Symptomen.....................................................................................................................................................24
Diagnose.........................................................................................................................................................24
Chronische symmetrische polyneuropathie...................................................................................................25
Acute symmetrische polyneuropathie...........................................................................................................25
Assymetrische polyneuropathie.....................................................................................................................25
Preventie.........................................................................................................................................................25
Behandeling....................................................................................................................................................25
Autonome neuropathie..................................................................................................................................26

4 Diabetes: chronische macrovasculaire complicaties...................................................................................27
Epidemiologie.................................................................................................................................................27
Hart- en vaatziekten.......................................................................................................................................27
Huidcomplicaties............................................................................................................................................28
Tandcomplicaties............................................................................................................................................28
Infecties..........................................................................................................................................................28
Diabetische voet.............................................................................................................................................28
Vroegtijdige diagnose van belang...................................................................................................................29

5 Diabetes: diabetische voet........................................................................................................................ 29
Epidemiologie.....................................................................................................................................................29
Pathofysiologie...................................................................................................................................................29
Neuropathie....................................................................................................................................................30

3

, Orthopedische abnormaliteiten.....................................................................................................................30
Angiopathie....................................................................................................................................................31
Infectie............................................................................................................................................................31
Classificatie.........................................................................................................................................................32
Behandeling........................................................................................................................................................32
Neuropathie....................................................................................................................................................32
Orthopedische problemen.............................................................................................................................32
Angiopathie....................................................................................................................................................32
Infectie............................................................................................................................................................33
Preventie.............................................................................................................................................................33

6 Diabetes: behandeling T1 insuline............................................................................................................. 34
Insuline................................................................................................................................................................34
Geschiedenis...................................................................................................................................................34
Insuline bij niet-diabetici................................................................................................................................34
Insulinetherapie..................................................................................................................................................34
Soorten...........................................................................................................................................................34
Actieprofielen.................................................................................................................................................34
Therapeutische doelen...................................................................................................................................34
Insulineabsorptie............................................................................................................................................34
Bolus insuline......................................................................................................................................................35
Nieuwe ultrasnelwerkende insulines.............................................................................................................35
Basale insuline....................................................................................................................................................35
Voordelen.......................................................................................................................................................35
Langere werking.............................................................................................................................................36
Ideale basale therapie....................................................................................................................................36
Tweede generatie...........................................................................................................................................36
Nieuwe mogelijkheden.......................................................................................................................................36
Gglucosemonitoring.......................................................................................................................................36
Insulinepomp..................................................................................................................................................37
Targets................................................................................................................................................................37

7 Diabetes: behandeling T2 orale anti-diabetica...........................................................................................38
Doelen.................................................................................................................................................................38
Mogelijkheden....................................................................................................................................................38
Metformine.........................................................................................................................................................40
Sylfonylurea........................................................................................................................................................41
Glinidines: NovoNorm.........................................................................................................................................41
Thiazolidinedionea: glitazones...........................................................................................................................42
Incretines............................................................................................................................................................42
DPP4-inhibitoren:................................................................................................................................................42
SGLT2-inhibitoren................................................................................................................................................43

8 Diabetes: behandeling T2 injecteerbare anti-diabetica...............................................................................44


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