Diabetes

Question 1

How does DM present?

Answer 1

polydipsia, (dehydration), polyuria (esp. night), rapid weight loss, lack of appetite, TATT, vision blur, thrush

Question 2

How to diagnose DM?

Answer 2

fasting glucose > 7mM
oral glucose > 11.1mM after 2 hours
HbA1c > 6.5%

Symptoms: 1 abnormal test, Asymptomatic: 2 abnormal test

Question 3

Describe type 1 DM

Answer 3

autoimmune beta cell destruction
normally young people with genetic predisposition
environmental as well

Question 4

How to detect type 1 DM? What is the treatment?

Answer 4

elevated venous plasma glucose
presence of ketones (breakdown product of fat) measured using ‘ketostik’ - absolute lack of insulin

treatment: exogenous insulin through subcutaneous injection given several times a day

Question 5

What is type 2 DM?

Answer 5

when insulin receptors do not work (don’t bind) OR not enough insulin is produced by body

develops later on in life due to lifestyle choices

Question 6

type 2 DM symptoms

Answer 6

polyuria, polydipsia, weight loss
no urinary ketones
may be asymptomatic at early stages

Question 7

Symptoms of hyperglycaemia

Answer 7

polyuria, polydipsia, blurring of vision, urogenital infections, (weight loss)

Question 8

Symptoms of inadequate energy utilisation

Answer 8

tiredness, weakness, lethargy, weight loss

Question 9

How do you manage diabetes?

Answer 9

change of diet (less fat & high sugars) & lifestyle (more exercise)
insulin injections as tablets won’t work - body enzymes break it down by liver - inject to blood

Question 10

How to monitor type 2 diabetes?

Answer 10

lifestyle
non-insulin therapies
insulin
look for vascular risk factors - BP, lipids, smoking, exercise, diet
surveillance for chronic complications (eyes, diabetes foot)

Question 11

How do you monitor type 1 diabetes

Answer 11

insulin injections

Question 12

What happens if treatment is not effective?

Answer 12

gradual worsening of symptoms
hyPERglycaemia
inadequate energy utilisation - ketones instead of glucose
worsening / onset of complications of diabetes - CV risks

Question 13

acute complications of diabetes

Answer 13

1. diabetic ketoacidosis (type 1) - blood become acidic due to fat metabolism producing ketones
2. hyperosmolar non-ketotic syndrome (type 2) - high blood sugar cause dehydration

Question 14

acute complications of hyPOglycaemia

Answer 14

coma - brain needs glucose ONLY

Question 15

chronic macrovascular complications of DM

Answer 15

large vessel disease:

1. cerebrovascular, cardiovascular, peripheral vascular disease
2. stroke, heart attack, intermittent claudication, gangrene

Question 16

chronic MICROvascular complications of DM

Answer 16

1. retinopathy, nephropathy, neuropathy
2. blindness, need for renal replacement therapy, erectile dysfunction, foot ulceration, diarrhoea, constipation, painful peripheral neuropathy

Question 17

Why does diabetes develop?

Answer 17

inability to produce insulin (beta cells)

insulin doesn’t bind to receptors (resistance)

Question 18

What are signs & symptoms of hypoglycaemia?

Answer 18

pale, weak, sweating, faint, confusion, headache, mood change (angry, violent), slurred speech, unconsciousness, coma –> death

lack of glucose for normal functioning of CNS - body’s response to stress