4.7 Diabetes Mellitus Flashcards
Which is more common: T1DM or T2DM?
T2DM (90% of cases)
Describe T1DM pathophys
- Immune mediated reduction of the insulin secreting capacity of beta cells of the pancreas
- Blunted/absent insulin response
Describe T2DM pathophys
- Body becomes resistant to normal levels of insulin
- Impaired release of insulin
- Blunted/absent insulin response
What are the effects of “incretin” hormones? Where are they released from?
- Promote release of insulin
- Released from duodenum and small intestine
What are the two incretin hormones? Which type of cells secrete them?
- Gastric inhibitory peptide (GIP): K cells (Dr K likes this one)
- Glucagon like peptide-1 (GLP-1): L cells (semaglutide is an L)
Why might insulin be higher from oral glucose than IV glucose?
- Oral glucose goes through the stomach
- This stimulates incretin hormones; much bigger insulin response
What is the final straw that causes frank diabetes?
- Failure of insulin secretion in response to increased resistance
- This leads to much higher blood glucose levels
What is C-peptide? Is it high or low in T1DM vs T2DM?
- Byproduct released during insulin secretion
- Low in T1DM
- Normal/high in T2DM
What’s the mech for how T1DM can cause diabetic ketoacidosis
- No insulin
- No suppression of Hormone-Sensitive Lipase
- More FFAs in blood
- Excess are converted into ketones; lowers pH; acidosis
What are the two most common precipitating factors for diabetic ketoacidosis
- Infection
- Deliberate insulin manipulation
Hyperosmolar hyperglycaemic syndrome (HHS) pathophys. Which type of diabetes is it associated with?
- Relative insulin deficiency
- Incr. gluconeogenesis
- Hyperglycaemia
- Diuresis
- Hyperosmolarity :(
- Primarily associated with type 2 diabetes
Precipitating factors for HHS
- Infection
- Infarction
What are the four tiers, in order, that the body uses to prevent hypoglycaemia as BGL lowers?
- Insulin suppression
- Glucagon + adrenaline
- Growth hormone
- Cortisol
List four autonomic symptoms of hypoglycaemia
- Palpitations
- Shaking
- Sweating
- Hunger
Basic treatment algo for hypoglycaemia
- If responsive/cooperative, give high-sugar foods like jelly beans
- If not, give IV glucose
What are the two classifications of chronic diabetes complications?
- Microvascular
- Macrovascular
What are the three categories of macrovascular complications of diabetes?
- Heart
- Brain
- Extremities
What are the three categories of microvascular complications of diabetes?
- Retino
- Nephro
- Neuropathy
How do you test for microvascular renal complications of diabetes?
- Urinalysis
- High albumin levels indicate protein leakage -> nephro referral
What are the three types of diabetic foot ulcers, as classified according to their causes?
- Neuropathic
- Ischaemic
- Neuroischaemic
What is the proposed link between DKA and pancreatitis?
- Elevated lipids
- Parenchymal inflammation
- Ischaemic damage of tissue
Proposed link between DKA and DVT
- DKA causes hypercoagulability
- Incr. DVT risk
Proposed link between DKA and resp. disturbance
- Acidosis
- Body tries to blow off CO2
- Kussmaul breathing
Proposed link between DKA and rebound cerebral oedema
- High BGL sucks fluid from brain via osmosis
- When insulin is given, there’s a rebound rush of fluid into the brain
