Diabetes Flashcards
What is diabetes?
- A medical condition with high blood glucose levels
- Diabetic people also often have high BP and high cholesterol levels.
- a condition in which the blood glucose level drifts up: chronic hyperglycaemia
Where are the breakdown products of food and drink refined to glucose?
In the Liver
Where is ‘fuel’ stored?
In the liver and muscles as glucose and in fat cells.
Using the analogy of a car, what are the issues with to little or too much fuel?
To little - stalling
Too much - uneven engine performance
What is a normal blood glucose level?
5 mmol/l
Glucose is released from where in response to insulin?
The liver
Glucose is taken up to where in response to insulin?
Muscle tissue
What are the signs are symptoms of diabetes?
- Symptoms: thirst, polyuria, weight loss, tiredness
- Signs: dry mouth, weight loss, glycosuria, hyperglycaemia
How common is diabetes?
- Leeds 4% population
- Rising fast
- Associated with the rise in obesity and a reduction in physical activity
- High prevalence in certain ethnic groups: Asians, Afro-Caribbeans
How is diabetes diagnosed?
- Typical symptoms and high RANDOM blood glucose
- Fasting blood glucose >7mmol/l
- 75g OGTT
- HbA1c; 48 mmol/mol (6.5%)
What is the oral glucose tolerance test?
- Fasting, then 75g oral glucose load
- Blood glucose: fasting and at intervals
- Fasting: normal 7mmol/l
- 2-hour post-glucose load: diabetic >11 mmol/l
What is ‘borderline’ diabetes?
- Impaired fasting glucose: 6-7mmol/l
- Impaired glucose tolerance: two-hour glucose levels of 7.8 -11.0mmol/l, 140 to 199mg/dl on the 75-g oral GTT
What investigations are neccessary in diabetes?
- HbA1c
- Renal function
- Liver function
- Lipids
- Thyroid function
What are the features of type 1 diabetes?
- Autoimmune destruction of the insulin producing islet beta cells
- Insulin deficient: insulin dependent
- Usually young, but can be ANY age.
What autoantibodies may be present in TiDM?
- ICA
- IA2
- GAD
What is latent autoimmune diabetes in adults(LADA)?
- Older patients, often female
- Medical or family history of related conditions: type 1 diabetes, thyroid, PA, Addison’s, coeliac, vitiligo
- Presents often as ‘type 2’ diabetes
- Progressive deterioration in control, increasing therapy
What autoantibodies may be present in LADA?
- GAD
- ICA
- tTG
- TPO
What are the features of type 2 diabetes?
- Insulin resistant/deficient
- Not absolutely insulin dependent
- Strong family history
- Often obese or overweight
- Usually hypertensive and hyperlipidaemic
What are the features of TIIDM variant ‘ketosis-prone type 2’?
- Often obese, ethnic minority
- Ketosis when physically stressed with intercurrent illness
- Temporarily requites insulin
- Not insulin dependent
Which pancreatic disorders can cause secondary diabetes?
- Chronic or acute pancreatitis
- Calcific, tropical pancreatitis
- Pancreatectomy
- Pancreatic cancer
- Cystic fibrosis
- Haemochromatosis
Which drugs can induce diabetes?
- Diuretics
- Steroids
- Antipsychotics e.g. Olanzapine
- Psychiatric drugs: weight gain
Diabetes may be comorbid in which endocrine disorders?
- Acromegaly: high growth hormone levels cause diabetes
- Cushing’s syndrome: high cortisol levels cause diabetes
- Phaeochromocytoma
What are the ethnic variants of diabetes?
- J type diabetes: ‘Jamaican’ diabetes, Afro-Caribbeans
- Flatbush diabetes: US Afro-Americans
- MRDM: malnutrition- related diabetes, tropical diabetes
- Chronic calcific pancreatitis: secondary diabetes
- Z type diabetes
What are the features if J typr Jamaican diabetes?
- Ketosis prone
- Not particularly obese
- On and off insulin therapy
- Variable insulin requirements
- Also called Flatbush diabetes
