Diabetes Flashcards
What is Diabetes and another name of it?
An elevation of blood glucose above a diagnostic threshold
AKA Diabetes Mellitus
Diabetes is—– disease
endocrine/hormones
How to diagnose diabetes?
Thresholds for Diagnosis of Diabetes: (having symptoms)
* Fasting Plasma Glucose = 126mg/dl = 7mmol/L
* 2 hr plasma glucose = 200mg/dl = 11.1 mmol/L
* HbA1c = 5.8% = 48 mmol/mol
If asymptomatic a repeat confirmatory test is required
Random or 2 hr (after 75g Oral Glucose) glucose >=11.1.
OR
A fasting glucose of >=7.0mmol/L
OR
An HbA1c >= 48mmol/mol
Gestational Diabetes criteria
Threshold levels are NOT set by retinopathy risk but rather by risk to the foetus/neonate
NB:the G level’s mother is down to 5mmol/mol
Hormones control G?
Glucagon- releases from alpha cells in low G
Insulin- releases from beta cells when G is high. to tell the organs absorb more G
c-peptide
is the endogenouse of level of insulin in liver
Type 2 Diabetes is the most common one . T/F
T
90% of ppl with T2DM have IR.
T
People in their 60s and 70s have higher risk of T2DM. T/F
T
Diabetes is one of the sig signs of pancreatic disease. T/F
T
What happens in Diabetes?
- Diabetes can be caused by a pure disorder of beta cells
- Diabetes can be caused by increased Insulin resistance, with an inability to compensate by increasing beta-cell function
Define T1DM?
- Onset in Children and Young adults
- Not associated with overweight
- T cell mediated Autoimmune (autoimmune destruction of beta cells = insulin deficiency)
- Requires insulin treatment – can be fatal if untreated
Diagnosis of T1DM?
Measuring pancreatic autoantibodies in the blood
Define T2DM?
*95% of diabetes
* Onset in middle aged and elderly
* Insulin resistance+beta cell dysfunction=relative insulin deficiency
* Associated with obesity and sedentary lifestyle
* Not Autoimmune destruction of beta cell
* Mostly do not need insulin but usually managed with lifestyle modification and non-insulin treatments
* No known cause
Symptoms and Presentation of Diabetes?
- Often asymptomatic – esp. Type 2 diabetes
- Symptoms of high blood glucose
Polyuria
Thirst and polydipsia
Blurred vision
Genital Thrush
Fatigue
Weight loss - Symptoms/signs of complications (rarely)
Loss of vision/retinal bleed or retinal changes found by optician
Presentation with Diabetes Emergencies?
Diabetic Ketoacidosis (mainly in T1D)
Hyperosmolar Hyperglycaemic State
2 main causes of diabetes?
- Diabetes can be caused by a pure disorder of beta cells
- Diabetes can be caused by increased Insulin resistance, with an inability to compensate by increasing beta-cell function
Disorders of insulin secretion?
- Type 1 Diabetes
- Genetic disorders
MODY
Neonatal Diabetes - Pancreatic disease (the first signs of pancreatic disease is diabetes)
Alcohol and chronic pancreatitis
Acute pancreatitis
Pancreatectomy
Pancreatic cancer
Cystic Fibrosis (Genetic)
Haemochromatosis (Genetic)
Disorders of insulin actions?
Pure disorders are rare and mostly genetic
Donohue Syndrome Rabson-Mendenhall Syndrome Familial Partial Lipodystrophy Congenital Lipoatrophy Acquired Lipoatrophy
- Insulin Resistance
Feature of Obesity, Type 2 Diabetes,
NAFLD - Endocrinopathies
Cushings Syndrome, Acromegaly, Phaeochromocytoma, Glucagonoma - Steroid induced
i.e. exogenous glucocorticoids
How to diagnose distinguish T1DM and T2DM?
Why treat diabetes?
- To prevent the acute symptoms and life-threatening illness
- To reduce the ‘burden of diabetes’ such as :
1. Microvascular Complications
“Diabetes Specific”
Largely driven by chronic hyperglycaemia
e.g. Retinopathy, Neuropathy, Nephropathy
2.Macrovascular
Increased risk in all diabetes
Due to hyperglycaemia, high blood pressure and dyslipidemia e.g. Myocardial Infarction/ACS, Stroke, Peripheral Vascular Disease
What is HbA1c?
*Blood glucose varies continuously in response to meals, exercise, so it is not informative. therefore we use HbA1c.
* Glycated Haemoglobin
Haemoglobin exposed to glucose becomes glycated
The amount of glycation is proportional to the glucose
* As a red blood cell survives for ~90 days the HbA1c gives a measure of glucose exposure over the last 90 days
* Caution in conditions of increased or reduced red cell turnover e.g. haemolytic anaemia; Haemoglobinopathies may give spurious (false) results
Unit and conversion of HbA1C?
Each 1% increase is an 11mmol/mol increase
Summary of this lecture
Diabetes is a diagnostic label defined by hyperglycaemia above a fasting glucose of 7 mmol/L – a threshold set in relation to the risk of diabetic retinopathy
There are many different causes for diabetes – that can be due to impaired insulin secretion, impaired insulin action or both
Type 1 diabetes results from an autoimmune destruction of the pancreatic beta-cells and can occur at any age
Type 2 diabetes is a mixed bag – what is left after ruling out other causes
Diabetes can present with ‘osmotic symptoms’ although often is only diagnosed at incidental blood testing or screening
Treatment aims to reduce the blood sugar and cardiovascular risk factors to minimize micro and macrovascular disease
Diabetes is monitored using HbA1c
