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Diseases of human systems > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What is the difference between diabetes mellitus and insipidus

A

DIABETES MELLITUS - abnormality of GLUCOSE regulation

DIABETES INSIPIDUS - abnormality of RENAL FUNCTION (WATER)

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2
Q

What percent of diabetes is type 1

A

8%

-90% type 2

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3
Q

What is type 1 diabetes

A

​

Autoimmune destruction of pancreatic Beta cells​

Usually diagnosed in children and young adults but can develop at any age​

Interplay between genetic and environmental factors

Rate of destruction determines the clinical presentation

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4
Q

Why can some patients with type 1 be diagnosed witb type 2 diabetes at first

A

Due to late presentation of the disease 80-95% of the pancreatic beta cells are destroyed at time of diagnosis

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5
Q

What does beta cell destruction subsequently cause

A

hyperglycaemia​

Ketoacidosis (Body cells cannot access glucose for metabolism so they start to metabolise fat which results in Ketones as end product)

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6
Q

Production of what substance is directly correlated to insulin levels

A

C-Peptide levels
Low C-peptide usually indicates low insulin secretion and can be used to detect diabetes

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7
Q

What antibodies are present in people with T1DM

A

GAD glutamic acid decarboxylase​

ICA Islet cell antibodies​

IAA insulin autoantibodies

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8
Q

What antibodies will be much higher than normal in patients with T1DM

A

ICA IAA

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9
Q

What are diabetic symptoms type 1

A

polyuria​

polydipsia​

Tiredness​

Unintentional weight loss​

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10
Q

What are some signs of acute diabetes

A

Hyperglycaemia with diabetic symptoms​

Ketoacidosis​

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11
Q

What are the symptoms of diabetic ketoacidosis

A

Symptoms include:​

Thirst​

Increased urination​

Confusion​

Blurred vision​

Stomach pain​

Nausea/ vomiting​

Sweet/ fruity smelling breath- (pear drops)​

Loss of consciousness

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12
Q

How is DKA (diabetic ketoacidosis) treated

A

Early signs of DKA can be treated with insulin and fluids​

If not treated early, pt will require URGENT hospital treatment

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13
Q

What does LADA stand for

A

Late autoimmune diabetes in adults

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14
Q

What are the features of LADA

A

GAD associated - generally lower AB levels​

less weight loss, less ketoacidosis​

may masquerade as ‘non-obese’ type 2​

variable period until insulin required

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15
Q

What is type 2 diabetes

A

MOST COMMON

Established type 2 diabetes is characterized by defective and delayed insulin secretion and abnormal postprandial suppression of glucagon

-over exposure to glucose leads to inneffective insulin secretion

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16
Q

What surgery is shown to improve T2D

A

Bariatric surgery has shown promising results in terms of remission of type 2 diabetes as most people go into partial or complete remission afterwards.

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17
Q

What is the pathogenesis of T2DM

A

usually IGT (impaired glucose tolerance) for some time​

often retinal damage at diagnosis (7-10yrs IGT)​

ability to secrete insulin falls with time

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18
Q

Signs/symptoms of T2DM

A

Rarely acute presentation​

polyuria, polydipsia, tiredness​
-But these are usually present!​

unusual infections​

diabetic complications e.g.Cardiovascular

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19
Q

How does insulin resistance occur in T2DM

A

Beta cell response to hyperglycaemia is inadequate​

elevated basal insulin levels ​

failure of gluconeogenesis suppression​

insulin stimulated glucose uptake is reduced

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20
Q

What are the effects of T2DM on the body

A

​

Impaired glucose tolerance​

Hyperinsulinaemia​

Hypertension​

Obesity with abdominal distribution​

Dyslipidaemia (High VLDL, Low HDL)​

Procoagulant epithelial markers​

Early & accelerated atherosclerosis

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21
Q

What medication can induce diabetes

A

Corticosteroids​

Immune suppressants – Cyclosporin, Calcineurin inhibitors (Tacrolimus, Serolimus)​

Cancer medication – Imatinib, Nilotinib​

Antipsychotic Medicines – clozapine, olanzapine, quetiapine​

Antiviral – protease inhibitors

22
Q

Why might medication induce diabetes

A

Interferes with the secretion of Insulin or Glucagon​

Alters tissue uptake of Glucose

23
Q

What are the investigations for diagnosis of diabetes

A

Random Plasma Glucose (RPG)​
-11.1mmol/L and above on 2 occasions is diagnostic of DIABETES​

GTT indicated if fasting sample indicates Impaired Fasting Glucose​
​

HbA1C(glycated haemoglobin)
-Blood test that shows average blood sugar levels for the last 2-3 months. Glycated Hb is when glucose sticks to haemoglobin in red blood cells. RBC lifespan is 2-3 months so readings taken quarterly. ​
-48mmol/mol and above (6.5%) diagnostic of diabetes​
-Does not require a fasting sample​
-Reliable measure of chronic hyperglycaemia/ how well diabetes is being controlled over time

24
Q

What is the glucose tolerance test

A

Patient fasts before test. During test they drink glucose solution which contains 75g of sugar

25
Q

What do the results of the GTT show

A

Before test (mmol/L) ​

FPG 6.0 and below Normal​

FPG 6.1-6.9 Impaired fasting glucose​

FPG 7.0 and above Diabetes​

2 hour plasma glucose (mmol/L)​

7.7 and below normal​

7.8-11.0 Impaired Glucose Tolerance (IGT)​

11.1 and above Diabetes

26
Q

What HbA1C level indicates diabetes

A

48mmol >

27
Q

What would a HbA1c result of 42-47 mmol show

A

Impaired or pre-diabetes

28
Q

What are the differences between type 1 and 2

A

1
younger
not overweight
short/acute onset
insulin deficient

2
older
overweight
gradual onset
insulin resistant

29
Q

How can diabetes be managed

A

Education - awareness
Healthy living advice - diet, exercise etc
Blood glucose management - set targets to maintain
Prevention from associated diseases - antiplatelet drugs, statins, antihypertensives (periodontitis)

30
Q

When is insulin prescribed

A

Type 1 - from diagnosis
Type 2 - with inadequate control on oral meds

31
Q

What type of route is insulin administered by

A

Subcutaneous injection

32
Q

Whar monitoring devices are available for insulin

A

Continuous glucose monitoring
Closed loop system

33
Q

What diet restrictions do people with T2DM have

A

avoid refined CHO​

encourage high fibre food​

reduce fat, esp. saturated

34
Q

What medications are available for T2DM

A

Biguanides - Metformin

DDP-4 inhibitors block the enzyme metabolising incretin

GLP-1 mimetics

Sulphonylureas

35
Q

How does Metformin manage T2DM

A

first line drug for T2DM​

enhance cell insulin sensitivity​

reduce hepatic gluconeogenesis​

preferred in the obese

36
Q

What do DDP-4 inhibitors do

A

block the enzyme metabolising incretin​

Improves insulin response to glucose​

Reduces liver gluconeogenesis and delays stomach emptying

37
Q

Why can GLP-1 mimetics help diabetes type 2

A

Increase the level of incretin
-injection daily/weekly

38
Q

What is a potential negative effect of sulphonylureas

A

can cause hypoglycaemia due to increasing pancreatic insulin secretion

39
Q

What are chronic complications of diabetes

A

Cardiovascular disease​

Peripheral Vascular disease​

Increased risk of infection​

Retinopathy​

Nephropathy​

Neuropathy

40
Q

What are potential acute complications of diabetes

A

Hypoglycaemia​

Hyperglycaemia​

Ketoacidosis

41
Q

What is hypoglyceamia

A

Blood glucose levels below 4mmol

42
Q

When does hypoglycemia occur

A

Type 1 DM​

Type 2 DM when taking sulphonylurea or insulin​

insulin/drug without food!

43
Q

How is hypoglycemia treated

A

Needs to be treated quickly​

Eat/drink something that will increase blood sugar​

If someone becomes unconscious- glucagon injection then food/drink when they regain consciousness.

44
Q

What are the oral manifestations of diabetes mellitus

A

Dry Mouth​

Burning Mouth​

Fungal Infections​

Enlarged Salivary glands​

Periodontal disease​

Impaired wound healing​

Halitosis​

Taste alteration

45
Q

What are some factors to remember when treating those with diabetes

A

Risk of acute medical emergencies- hypoglycaemia

Reduce stress- increases adrenaline which interferes with insulin activity and may precipitate a hypoglycaemic event. ​

Be aware of diabetic complications​
IHD, dehydration, neuropathy, eyes​

Infection risk​

Poor wound healing

Link between DM and periodontal disease

46
Q

What are macrovascular and micovascular complications of diabetes

A

Macrovascular​
-Coronary Artery Disease​
-Peripheral Ischemia- causes poor wound healing e.g diabetic foot ulcers​
-Stroke​
-Hypertension​

Microvascular/ Small vessel disease​
-nephropathy (renal disease)​
-eye disease- Cataracts, Maculopathy, Proliferative retinopathy​
-Peripheral neuropathy

47
Q

What cause diabetic ulcers

A

Peripheral neuropathy ​

Peripheral vascular disease ​

Delayed wound healing ​

Increased risk of infection

48
Q

What are cataracts

A

Lens of eye becomes clouded and allows less light in

49
Q

What nervous conditions can the affects of diabetes cause

A

General sensation​
-‘glove & stocking’​

Motor neuropathy​
-weakness and wasting of muscles​

Autonomic regulation​
-awareness of hypoglycaemia lost​
-postural reflexes​
-bladder & bowel dysfunction

50
Q

Would insulin requirements be increased or decreased when undergoing surgery with diabetes

A

Increased in T1DM due to more glucose production caused by hormone changes (epinephrine, cortisol,GH) and less muscle uptake so metabollic acidosis is more likely

T2DM may require insulin cover perioperatively

Diseases of human systems (8 decks)

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