1. Diabetes mellitus- classification, diagnosis, complications Flashcards
what’s the classification of diabetes ?
1) type 1 diabetes
b cell destruction through :
autoimmune
or idiopathic
2) type 2 diabetes
range from = insulin resistance with slight insulin deficiency
or
insulin secretory defect with slight insulin resistance
3) other specific types :
genetic defects in b cell function
HNF-1A diabetes
glucokinase diabetes
diseases of exocrine pancreases =
pancreatitis
cystic fibrosis
hemochromatosis
endocrinopathies : acromegaly cushing syndrome pheochromocytoma hyperthyroidism somatostatinoma
drugs :
nicotinic acid
glucoorticosteroids
thiazides
infections :
rubella
cytomegalovirus
genetic : down syndrome klienfeter syndrome turner syndrome wolfram syndrome friedriech ataxia prader willi syndrome huntington chorea
4) gestation diabetes
4) MODY diabetes onset is under 35 mutation in autosomal dominant genes impaired inulin secretion MINIMAL OR NO INSULIN RESISTANCE
what is the complications of type 2 diabetes ?
macroangiopathy
arthresclerotic cardiovascular disease
cerebral perfusion disorder
micorangiopathy: diabetic retinopathy = there is non proliferative = first appearing proliferative = later on appearing rupture very easily
diabetic nephorpathy = end stage renal disease
thickening of basal membrane and nodular glomerulocscleorisis
kimmel stiel wilson
diabetic neuropathy
affecting distant regions
Hyperosmolar hyperglycemic state
what is the aetiology of type 2 diabetes ?
genetic
=decreased insulin secretion
environmental obesity hypertension low physical activity smoking = receptor defects
patients without diabetic retinopathy should be advised what ? and with ?
annual dilated fundus examination
how do we diagnose diabetic nephropathy ?
progression of protein urea
from microalbuminurea 30-300mg/g creatinine in a spot urine sample
to macroalbuminurea / clinical albuminuria - nephrotic syndrome more than 300mg / g creatine
urine albumin excretion varies over time so two or more urine specimen collected within 3-6 month period to show rise in albumin and diagnose nephropthay
azotemic stage = nitrogen in blood
diabetic neuropathy can be what types ?
Peripheral neuropathy affects the feet and legs numbness tingling or burning sensations extreme sensitivity to touch insensitivity to hot and cold temperatures sharp pain or cramping
autonomic neuropathy
cardiovascular = tachycardia , orthoststaic hypotension
urogenital = urinary retention , inconteneice
GIT = reflux , constipation , diarrhea
proximal neuropathy only affects one side hips, buttocks, or thighs. muscle pain recovers
Focal neuropathy,
damage to one specific nerve or group of nerves, causing weakness in the affected area
hand , heard or torso
goes away
pain, numbness, tingling in fingers
an inability to focus
double vision
aching behind the eyes
how can we diagnose diabetic neuropathy ?
bedside sensory test
vibration = tuning for
pin prink on neurotics
light touch wisp of cotton
cold - cold tuning fork
what are the methods of diagnosis ?
venous blood is taken
random glucose test
glucose value is equal more than 11.1mmol/l
normal = 4.4 - 7.8 mmol/l
fasting of 8 hours glucose test
normal less than 5.6 mmol/l
impaired glucose tolerance = 5.6-6.9 mmol/l
diagnosing diabetes = >7mmol/l
------- oral glucose tolerance test = normal food and no excessive activities for 3 days = fating 10-14 hours before test not allowed to smoke or stand up and taken 75G OF GLUOSE
blood taken 2 hours after
normal <7.8 mmol/l
impaired glucose tolerance 7.8-11.1 mmol/l
diabetes more than 11.1 mmol/l
Hb1ac
pre diabetes = 5.7- 6.4
diabets = 6.5 percent or more
what is the diagnosis of MODY ?
mild to moderate hyperglycaemia
persistence of low insulin requirement less than 0.5u/kg/day = past the usual honeymoon period in type 1 diabetes
absence of obesity and metabolic syndromes
what is the difference between hyperosmolar hyperglycemia state and diabetic ketoacidosis ?
clinical findings polyuria and polydipsia in both nausea and vomiting in both dehydration in both but in hyperosmal is very pronounced altered mental status in both
hyperventilation only in DKA
fruity breath only in DKA
severe abdominal pain only in DKA
the onset in DKA rapid less than 24 hrs
while in hyperosmolar hyperglycaemic state its insidious
diagnostic
glucose
DKA = less than 33mmol/
more than that HHS
bicarbonate
less than 18mmol
more than that in HHS
anion gap
elevated in DKA
normal in HHS
Serum β-hydroxybutyrate
Elevated - elevated in DKA
Normal - HHS
Blood gas
pH < 7.30 - DKA
pH > 7.30 - HHS
Serum osmolality
Normal - DKA
Elevated - HHS
