D9 - Causes and diagnosis of blood glucose disorders Flashcards
What is the clinical impact of diabetes mellitus?
- diabetic retinopathy (50%)
- diabetic nephropathy (35%)
- stroke
- cardiovascular disease (45%)
- diabetic neuropathy (40%)
What is the percentage of type 1 vs type 2 diabetic patients?
In Hungary:
- type 1: 6%
- type 2: 94%
What are the clinical features for diagnosing diabetes?
- classical symptoms: polyuria, polydypsia, weight loss (1 + 1 abnormal value)
- fasting (10hrs) glucose >7mmol/l
- random glucose >11 mmol/l - without classical symptoms: fasting glucose two times > 7mmol/l (2 abnormal values)
What is normal fasting glucose?
≤ 6mmol/l
What is the normal postprandial glucose?
≤ 7.8 mmol/l
What is the fasting glucose in impaired fasting glucose?
6.1-7.0 mmol/l
What is the postprandial glucose in impaired fasting glucose?
< 7.8mmol/l
What is the fasting glucose in impaired glucose tolerance?
≤ 7 mmol/l
What is the postprandial glucose in impaired glucose tolerance?
7.8 - 11.1 mmol/l
What is the fasting glucose in diabetes mellitus?
≥ 7mmol/l
What is the postprandial glucose in diabetes mellitus?
≤ 11.1mmol/l
What are the classic symptoms of diabetes mellitus?
- polyuria
- polydipsia
- weight loss
Apart from the classic symptoms, what are other symptoms of diabetes mellitus?
- blurred sight
- weakness
- reoccurring
- infections (UTI, skin)
What is the lab criteria for diagnosing diabetes mellitus II. ?
- random glucose value ≥ 11.1mmol/l
- fasting glucose ≥ 7mmol/l
- 2 hour OGTT ≥ 11.1 mmol/l
What is OGTT?
- oral glucose tolerance test
- after 10-12 hours of fasting
- 75g glucose in 2-3dls water is consumed under 2-3 minutes
- fasting and 120 minute postprandial glucose values are the only ones of diagnostic importance
- usually at 7:00-8:00 am, without previous diet
What are some diseases associated with type 1 diabetes?
autoimmune diseases: thyroid, coeliakia, vitiligo
What are some diseases associated with type 2 diabetes?
- frequently a part of metabolic syndrome (obesity, hypertension, hypercholesterolemia)
- cardiovascular disease
What are the classifications of diabetes mellitus?
I. type 1
IA. autoimmune mechanism
IB. idiopathic
II. type 2
- insulin resistance
- relative insulin deficiency
III. gestational
IV. other specific types
What is type 1A diabetes mellitus?
T cell mediated autoimmune disease; rapid progression
What are the characteristics of T1 diabetes mellitus?
- classical clinical symptoms
- ketonuria
- (lack of obesity)
- low C-peptide
- presence of autoantibodies
- presence of other organ specific autoimmune disorders (thyroid, celiac, Addison)
- family history of T1 DM (predisposing HLA haplotypes)
What is type 2 diabetes?
- former names: adult onset, non-insulin dependent DM
- due to insulin resistance or insufficient insulin
What is insulin resistance?
- a normal amount of insulin is produced but there is subnormal/insuffient reaction
- results in type 2 diabetes mellitus
What are the causes of insulin resistance?
- obesity (25%)
- passive lifestyle (25%)
- genetics (50%, ethnicity)
- age
- nutrition (CH↑, fat ↓, cytokine production ↓)
What are the risk factors of type 2 diabetes mellitus?
- positive anamnesis in family
- overweight/obesity (90% patients are overweight)
- old age
- sedentary lifestyle
- pregnancy (gestation DM)
What is LADA?
- latent autoimmune diabetes in adults
- slowly progressing type 1 DM
- type 1.5 DM
When to consider LADA?
- diagnosis during adulthood (>30 yrs)
- type 2 diabetic patients without obesity
- family history negative for T2DM
- slow progression
- insulin treatment is necessary later on, but start with diet change (easily manageable)
- low C-peptide level
- antibody positivity
- diabetic ketoacidosis in type 2 DM patients
