8.2 - The Patient With Diabetes

Question 1

How does diabetes mellitus present?

Answer 1

• typical symptoms of hyperglycaemia: polyuria, polydipsia, blurring of vision, urogenital infection e.g thrush
• symptoms of inadequate energy utilisation e.g. tired, weak, lethargic, weight loss (type 1)
• the severity of these symptoms will depend on the rate of rise in blood glucose as well as the absolute levels of glucose achieved.

Question 2

How is diabetes diagnosed?

Answer 2

• fasting glucose
• oral glucose tolerance test
• HbA1c
• you need symptoms and 1 abnormal test or 2 if asymptomatic

Question 3

How does type 1 diabetes present?

Answer 3

• rapid weight loss, polyuria and polydisplasia
• late presentation, there may be vomiting due to ketoacidosis
• patient is usually young, below 30
• elevated venous plasma glucose with presence of glucose

Question 4

What’s the treatment of type 1 diabeties?

Answer 4

• exogenous insulin
• given by subcutaneous injection several times per day
• amount and type of insulin given are dependant on Many factors

Question 5

What are the acute complications of hyperglycaemia?

Answer 5

• Massive metabolic decompensation
• Diabetic ketoacidosis in type 1
• hyperosmolar non- Ketoacidosis syndrome in type 2
• multiple causes of the above complications

Question 6

What are the acute complications of hypoglycaemia?

Answer 6

• coma
• brain needs glucose
• caused by hypoglycaemic

Question 7

What are the chronic complications of diabetes?

Answer 7

Large vessel disease

• cerebrovascular, cardiovascular, peripheral vascular
• stroke, heart attack, intermittent claudication gangrene

Microvascular or capillary disease

• retinopathy, neuropathy, nephropathy
• blindness, need for renal replacement therapy, erectile dysfunction, food ulceration, diarrhoea, constipation, painful peripheral neuropathy

Question 8

What is metabolic syndrome?

Answer 8

A cluster of the most dangerous risk factors associated with CV disease, diabetes and high raised fasting plasma glucose, abdominal obesity, high cholesterol and blood pressure.

• together = increased CV risk
• raised triglycerides
• reduced HDL cholesterol
• raised fasting blood glucose

Caused by insulin resistance and enrol obesity, genetics, physical inactivity and ageing