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Sem 1 - MEH > 14 - Diabetes Mellitus > Flashcards

14 - Diabetes Mellitus Flashcards

1
Q

What is type 1 diabetes?

A
  • Absolute insulin deficiency by autoimmune destruction of B-cells
  • Mainly in the young
  • Rapidly fatal if not treated
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2
Q

What is type 2 diabetes?

A
  • Slow progressive loss of beta cells along with issues of insulin secretion and tissue resistance to insulin
  • May be present for long time before diagnosis
  • May not need treatment initially
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3
Q

What will blood results from a type 1 diabetic show?

A
  • HLA markers
  • Autoantibodies
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4
Q

What is the staging of type 1 diabetes?

A
  1. HLA and autoantibodies in blood with no insulin or glucose issues
  2. Impaired glucose tolerance
  3. Diabetes
  4. Insulin dependent
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5
Q

What is the staging of type 2 diabetes?

A
  1. Insulin resistance
  2. Impaired glucose tolerance
  3. Diabetes
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6
Q

How is type 2 diabetes initially treated?

A
  • Diet
  • Tablets
  • Insulin
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7
Q

What is diabetes?

A
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8
Q

What are the two different mechanisms of diabetes?

A
  • Inability to produce insulin due to beta cell failur

and/or

  • Insulin production adequate but insulin resistance prevents insulin working effectively
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9
Q

What is the genetic predisposition of type 1 diabetes?

A

- Genetic marker: HLA DR3 and HLA DR4

  • Strong seasonal variation suggesting link with viral trigger
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10
Q

What is the classic picture of type 1 diabetes?

A
  • Lean young person

- Triad of symptoms: polyuria, thirst, weight loss

  • Glycosuria
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11
Q

Why do the triad of symptoms occur in type 1 diabetes?

A

- Polyuria: not all glucose reabsorbe so less water reabsorbed in the nephron

- Thirst: excess water loss in urine

- Weight loss: fat and protein metabolised by tissues because insulin absent

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12
Q

Why does diabetic ketoacidosis occur and how can it be spotted?

A
  • Excess beta oxidation of fats in liver and low insulin/glucagon ratio stimulates ketogenesis
  • Large amount of ketones produced and H+

Features: prostration, hyperventilation, nausea, vomiting, dehydration, abdominal pain, fruity breath

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13
Q

Why is it essential to diagnose type 1 diabetes quickly?

A

Prevent ketoacidosis which is fatal

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14
Q

At diagnosis of type 2 diabetes where are the beta cells at?

A
  • Around 50% functioning and progressively less as time goes on
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15
Q

What are some typical symptoms of type 2 diabetes?

A
  • Triad of symptoms
  • Tiredness, weakness, lethargy and weight loss due to inadequate energy utilisation
  • Blurring of vision
  • Persistent infections, mainly genitalia thrush and feet
  • Slow healing
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16
Q

How do you diagnose diabetes?

A
  • Symptoms PLUS
  • Random venous plasma glucose conc >11.1 mmol/L
  • Fasting plasma glucose conc > 7mmol/L
  • Plasma glucose >11.1 mmol/L 2 hours after 75g anhydrous glucose in OGTT

(don’t use finger prick test for diagnosis)

17
Q

How is type 1 diabetes treated?

A
  • Exogenous insulin subcutaneous several times per day
  • Educate patients for times and doses, exercise and diet

- Finger prick BM stick and reader to check sugar levels

18
Q

When might you change a type 1 diabetic’s insulin dosage?

A
  • Patient suffered trauma or infection need to increase dosage to prevent ketoacidosis
19
Q

What are some drugs used in the treatment of type 2 diabetes and what else can be used in management of this disease?

A

- Sulphonylureas: increase insuline release from remaining B cells and reduces insulin resistance

- Metformin: Reduces gluconeogenesis

  • Diet and exercise
20
Q

How can you prevent type 2 diabetes?

A
  • Diet
  • Exercise
  • Prevent obesity
21
Q

What is HbA1c?

A
  • Glycated Hb
  • Glucose in blood will react with terminal valine of Hb to form glycated Hb
  • Healthy 4-6% HbA1c, diabetics 10%
22
Q

What is the issue with glycation of plasma proteins?

A
  • Glucose reacting with free amino acids to form stable covalent linkages
  • Changes net charge and 3D structure of protein so affects function
23
Q

What are the differences in the urine of type 1 and type 2 diabetics?

A

Type 2 have no ketones in urine

24
Q

What are some macrovascular complications of diabetes?

A
  • Increased risk of stroke
  • Increased risk of MI
  • Poor circulation to peripheries
25
Q

How can diabetes lead to oxidative stress in the body, what tissues are most susceptible and why?

A

- Peripheral nerves, eye and kidney most susceptible as do not require insulin to uptake glucose

  • During hyperglycaemia glucose conc in these tissues increases so glucose is metabolised by aldose reductase
  • Reaction uses NADPH and accumulation of sorbitol causes osmotic damage to cells
26
Q

What are some microvascular complications of diabetes and why?

A

- Diabetic eye disease: osmotic effects of glucose, so cataracts, or retinopathy damaging blood vessels causing them to leak and alow protein exudates to form on retina

- Diabetic kidney disease: Poor blood supply or damage from infections of urinary tract, protein in urine

- Diabetic neuropathy: peripheral nerve damage, loss of sensation due to alternation of ANS

- Diabetic feet: poor blood supply, damage to nerves and increased risk of infection

27
Q

What is dyslipidemia?

A
  • Increased VLDL and LDL
  • Decreased HDL
28
Q

What is metabolic syndrome?

A

A group of symptoms associated with central adiposity

  • Insulin resistance
  • Dyslipidaemia
  • Glucose intolerance
  • Hypertension
29
Q

What is the WHO requirements for metabolic syndrome?

A
  • Hip ratio >0.85 women >0.9 men
  • BMI > 30kgm2
  • Blood pressure > 140/90 mmHg
  • Triglycerides > 1.7 mmol/L
  • HDL <0.9mmol/L men and <1mmol/L women
  • Glucose fasting or 2h after glucose load >7.8mmol/L
30
Q

What can metabolic syndrome be a risk factor for?

A
  • Type 2 diabetes
  • Cardiovascular disease
  • Obesity
31
Q

Why is the use of BMI in metabolic syndrome questioned?

A

Does not allow for large muscle bulk and it is central fat, not fully body fat, associated with insulin resistance and fatty liver

32
Q

What groups is obesity more prevalent in?

A
  • South Asians then Europeans then African-carribbeans
33
Q

Why does type 1 diabetes have to be treated immediately?

A

Can lead to ketoneacidosis which can put someone into coma

34
Q

What are the signs of untreated Type 1 diabetes?

A
35
Q

What are some quick tests you can do to diagnose untreated type I diabetes?

A
36
Q

When treating type 1 diabetes what should you teach the patient?

A
37
Q

What are the differences between type 1 and type 2 diabetes?

A
38
Q

What is the treatment ladder for type 2 diabetes?

A

Sem 1 - MEH (22 decks)

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