14. Diabetes Flashcards
What is diabetes?
When your blood glucose is too high and over years leads to damage of small and large blood vessels causing premature death from cardiovascular diseases
Why does blood glucose rise?
Inability to produce insulin due to beta cell failure and/or insulin production adequate but insulin distance prevents insulin working effectively and invariably linked to obesity
What is type 1 diabetes due to?
Autoimmune beta cell destruction
Autoantibodies made are directed against the beta cells and insulin producing cells are destroyed
Mostly genetic predisposition
How does diabetes present?
Typical symptoms of hyperglycaemia - polyuria, poly dips is
Symptoms of inadequate energy utilisation - weight loss
Severity of symptoms will depend upon rate of rise of blood glucose as well as absolute levels of glucose achieved
How is diabetes diagnosed?
Laboratory confirmation Fasting glucose Oral glucose tolerance test HbA1c Need symptoms and 1 abnormal test or 2 if asymptomatic
What are the symptoms of type 1 diabetes?
Rapid onset weight loss, polyuria and polydipsia
Late presentation there may be vomiting due to ketoacidosis
What is the treatment of type 1 diabetes?
Exogenous insulin
Given by subcutaneous injection several times per day
What causes insulin resistance to develop?
Obesity Muscle and liver fat deposition Elevated circulating free fatty acids Physical inactivity Genetic influences
What are the symptoms of type 2 diabetes?
May have polyuria, polydipsia, weight loss
May be asymptomatic
How should we manage type 2 diabetes?
Weight loss
How to treat type 2 diabetes?
Lifestyle
Non-insulin therapies
Insulin
What are the acute complications of diabetes?
Acute complications of hyperglycaemia:
- massive metabolic decompensation - diabetic ketoacidosis in type 1, hyperosmolar non-ketotic syndrome in type 2
Acute complications of hypoglycaemia:
- coma
What are the chronic complications of diabetes?
Macrovascular or large vessel disease - stroke, heart attack, intermittent claudication, gangrene
Micro vascular or capillary disease - retinopathy, nephropathy, neuropathy
What is metabolic syndrome?
Cluster of most dangerous risk factors associated with cardiovascular disease - diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and BP
What causes the metabolic syndrome?
Insulin resistance and central obesity
Genetics
Physical inactivity
Ageing
