9. Clinical aspects of Diabetes Mellitus and Complications Flashcards
Diagnosis of Diabetes mellitus
Diabetes mellitus is a group of metabolic disorders characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both.
The chronic hyperglycaemia is associated with long- term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels.
Diagnosis of DM? Glycated Haemoglobin Fasting blood glucose 2hr blood glucose Random blood glucose
Glycated Haemoglobin ≥48mmol/mol
Fasting blood glucose≥ 7.0mmol/L
2hr blood glucose≥ 11.1mmol/L following OGTT
Random blood glucose≥ 11.1mmol/L in presence of symptoms
Different classifications of DM? (4)
Type 1 diabetes ( ß cell destruction) (10%)
Type 2 diabetes (85%)
Insulin resistance with relative insulin deficiency
Secretory defect with insulin resistance
Other types (5%) Genetic (MODY etc) Pancreatic disease Endocrine disease Drugs
Gestational diabetes
Pathophysiology of T1DM?
Autoimmune disease
B cell destruction
- Symptoms when 80% cell mass lost
- Environmental factors e.g viral infection
Autoantibodies present in T1DM?
islet cell
Insulin
GAD (GAD65)
tyrosine phosphatases
Typical T1DM history?
Hyperglycaemia... Thirst Polyuria Nocturia Weight loss 2stone Osmotic lens change
Clinically dry
Blood sugar 44mol/L
Urine ketones ++
How does a diabetic diet compare to a typical british diet?
Higher protein
Higher complex carbs
Lowers fat
Higher fibre
Options of glucose monitoring?
Blood glucose monitoring
Libra device (patch on arm which detects interstitial glucose). Requires education
Use of diasend in diabetic control?
Information from monitoring device sent to pc to monitor blood sugar fluctuations.
Aids assessment of problems with control
What is HbA1c?
Glycated haemoglobin
Who is insulin dependent?
Type 1 DMs
MDI vs CSII for insulin management?
Both example of “intensive” regimes for insulin management.
In which the basal [background] and bolus [meal] insulin doses are given separately. Intensive insulin therapy has been shown to reduce risk of complications.
It can be delivered as:
1. Multiple daily dose insulin injections (MDI) including long acting basal insulin with boluses of rapid acting insulin given pre-meal,
2. Continuous subcutaneous insulin infusion [CSII] via an insulin pump. CSII delivers the “basal” component of the insulin regime via a slow infusion, and the patient can deliver “boluses” as and when required in addition to this.
MDI?
multiple daily dose insulin injections (MDI)
CSII?
Continuous subcutaneous insulin infusion [CSII]
Genetic and environmental factors of T2DM?
Genetic factors:
defect of cell
insulin resistance
Environmental factors:
Obesity
Stress
Reduced physical activity
Who is insulin dependent?
Type 1 DMs
MDI vs CSII for insulin management?
Multiple daily dose insulin injections (MDI)
MDI?
multiple daily dose insulin injections (MDI)
CSII?
Continuous subcutaneous insulin infusion [CSII]
Genetic and environmental factors of T2DM?
Genetic factors:
defect of cell
insulin resistance
Environmental factors:
Obesity
Stress
Reduced physical activity
In diabetic ketoacidosis, signs?
Hyperglycaemia Dehydration Tachycardia Hypotension Clouding of conciousness
Acidosis
Air hunger (Kussmaul’s respiration)
Acetone on breath Abdominal pain
Vomiting
PLUS
Features related to precipitating factors (e.g. sepsis)
Ketone body metabolism
Muscle breakdown to give: Amino acids, leucine, lysine
Adipose tissue breakdown to give: FFAs
Breakdown products sent to the liver which generates…
KETONE BODIES
H+
Acetone
Products all then sent to end organ
Mechanism of diabetic ketoacidosis?
Insulin deficiency ---> -Hyperglycaemia -Glycosuria -Osmotic diuresis \+ -Ketosis -Acidosis -Gastroparesis
Leading to..
Volume depletion + renal hypoperfusion
–> Impaired excretion of H+ and ketone bodies
Chronic complications of DM?
Microvascular
- Eyes, Kidneys, Nerves (Feet)
Macrovascular
- Heart, Brain, (Feet)
