Diabetes Flashcards
What causes type II diabetes
Repeated exposure to glucose and insulin makes the cells in the body become resistant to the effects of insulin. It therefore requires more and more insulin to produce a response from the cells to get them to take up and use glucose.
Overtime the pancreas (beta cells) become fatigued and damaged (damaged by lipotoxicity and glucotoxicity) from producing so much insulin and they start to produce less.
A continued onslaught of glucose on the body in light of insulin resistance and pancreatic fatigue leads to chronic hyperglycaemia.
What are the diagnostic tests for diabetes
Blood Glucose
HbA1c
Oral glucose tolerance test (OGTT
What is genetics of type II diabetes
Identical twin 90-100% risk
One parent 15%
What range of impaired fasting glucose is considered intermediate hyperglycaemia
Impaired fasting glucose 6.1-7 mmol/l
What decides what the diagnostic criteria are for diabetes
Diabetes diagnostic criteria are selected because above those criteria there is a significantly increased premature mortality and increased risk of microvascular and cardiovascular complications
What is intermediate hyperglycaemia
When someone has an impaired fasting glucose or impaired glucose tolerance.
People are identified a group at higher risk of future diabetes and adverse outcomes such as cardiovascular disease
What is secondary diabetes
Diabetes caused by something else:
Drug therapy e.g corticosteroids
Pancreatic destruction
Recognised genetic syndromes-
Rare endocrine disorders
What are found on examination of type 1 diabetes presentation
Ketones on breath
Dehydration
May have increased respiratory rate, tachycardia, hypotension.
Low grade infections, thrush / balanitis
What is a diagnostic level of HBA1c for type 2 diabetes
HbA1c ≥ 48 mmol/mol.
What rare endocrine disorders can cause secondary diabetes
Cushings syndrome,
Acromegaly,
Pheochromocytoma
What are the genetics of type 1 diabetes
Monozygotic twins 30-50% concordance
If both parents have Type 1: 30% risk
What is pre-diabetes
Pre-Diabetes is an indication that the patient is heading towards diabetes. They do not fit the full diabetic diagnostic criteria but should be educated regarding diabetes abd implement lifestyle changes to reduce their risk of becoming diabetic. They are not currently recommended to start the treatment.
What are diagnostic levels of fasting and random glucose levels
fasting 7.0 mmol/l,
random 11.1 mmol/l
What is the diagnostic levels of HbA1c for Pre-diabetes
HBA1C >42-47mmol/mol
What is gestational diabetes
Hyperglycaemia of pregnancy
Increasing insulin resistance in pregnancy
When can’t you use HBA1C (x8)
All children and young people.
Pregnancy—current or recent (< 2 months).
Short duration of diabetes symptoms.
Patients at high risk of diabetes who are acutely ill
Patients taking medication that may cause rapid glucose rise; for example, corticosteroids, antipsychotic drugs (2 months or less).
Acute pancreatic damage or pancreatic surgery.
Renal failure.
HIV
What are Diagnostic glucose levels (venous plasma) for type II diabetes
Fasting 7.0 mmol/l,
Random 11.1 mmol/l
When do you diagnose someone with diabetes
ONE diagnostic lab glucose plus symptoms
TWO diagnostic lab glucose or HbA1c levels without symptoms.
What is a Diagnostic HbA1c for diabetes
Diagnostic HbA1c ≥ 48 mmol/mol.
What age do people get type II diabetes
Incidence increases with age, maxing at 60 then declining – aging population
What is the diagnostic levels of IFG for Pre-diabetes
Impaired fasting glucose – 6.1-6.9 mmol/l
When do you diagnose someone with type II diabetes
Should consider Diagnosis of diabetes if there are are 2 Risk factors present
ONE diagnostic lab glucose plus symptoms
TWO diagnostic lab glucose or HbA1c levels without symptoms.
Why do patients get diabetic ketoacidosis
When there is no insulin driving glucose into the cells the body thinks it is starving. It starts producing ketones as a temporary fuel for the brain. The body does not need this however, and the Ph of the blood starts to rise. Initially this is buffered by bicarbonate but eventually this runs out and the PH increases lots.
What is MODY
Autosomal dominant
? 5% of people with diabetes
Impaired beta-cell function
Single gene defect
How is an oral glucose tolerance test taken
Oral glucose tolerance test is performed in the morning prior to having breakfast. It involves taking a baseline fasting plasma glucose result, giving a 75g glucose drink and then measuring plasma gluose 2 hours later.
What is Impaired glucose tolerance
Body struggles to cope with processing a carbohydrate meal.
What happens if someone is hyperglycaemic acutely
polydipsia, polyuria, blurred vision, weight loss Infections
What are presenting symptoms of type 1 diabetes
Short duration of:
Thirst Tiredness Polyuria / Nocturia Weight loss Blurred vision Abdominal pain
What are the risk factors for type II diabetes
Family history
Over age 30 years if Maori ⁄ Asian (Indian subcontinent)⁄ Pacific Island descent
Over age 40 years if European
Previous history of diabetes in pregnancy (Gestational Diabetes)
Inactive lifestyle, lack of exercise
Previous high blood glucose ⁄ impaired glucose tolerance
Overweight
What are symptoms included in the diagnostic criteria for diabetes
Polydipsia, polyuria, blurred vision, weight loss, infections (candida)
What is the screening test for type II diabetes
Hba1C – easy screening test
What is impaired fasting glucose
Body struggles to get their blood glucose levels into normal range even after a prolonged period without eating carbohtdrates.
Define Diabetes
A group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
What are signs of type II diabetes
Not ketotic
Usually overweight but not always
Low grade infections, thrush / balanitis
In type 2 DM may have micro vascular or macrovascular complications at Dx
What range of HbA1c is considered intermediate hyperglycaemia
HbA1c 42-47mmol/mol
What range of impaired glucose tolerance is considered intermediate hyperglycaemia
Impaired glucose tolerance 2h glucose ≥7.8 and <11mmol/l
What are other types of diabetes (apart from I and II)
Recognised genetic syndromes : MODY
Gestational diabetes
Secondary diabetes
What is the diagnostic levels of IGT for Pre-diabetes
Plasma glucose at 2 hours 7.8 – 11.1 mmol/l on a OGTT.
What are symptoms of type II diabetes
May have no symptoms
Thirst
TirednessPolyuria / nocturia
Sometimes weight loss
Blurred vision
Symptoms of complications e.g. CVD
What can be a trigger for diabetes
viral infection
- Coxsackie B virus
- Enterovirus
What happens if someone is hyperglycaemic chronically
Microvascular issues -retinopathy,
- neuropathy,
- nephropathy,
Macrovascular
- stroke,
- MI,
- PVD
