Diabetes

Question 1

What percentage of people in the UK do not know they have diabetes?

Answer 1

25%

1 million people

Question 2

Define insidious onset.

Answer 2

Slow onset, without obvious symptoms so often person does not know they have the disease

Question 3

List 10 long-term complications of diabetes

Answer 3

nephropathy
neuropathy
retinopathy
MI
ischaemic foot
Charcot foot (inflammation of bones/joints/soft tissue)
stroke
peripheral vascular disease
postural hypotension
impotence
erectile dysfunction

Question 4

Describe 4 typical cardiac symptoms of diabetic patients

Answer 4

pain on walking
SOB
chest tightness
fatigue

Question 5

How does Type 1 DM present?

Answer 5

Acutely with ketosis

Question 6

How does Type 2 DM present?

Answer 6

Insidious onset (spend months or years not knowing they have it)

Question 7

State 3 typical symptoms of Type 2 DM.

Answer 7

Tiredness, lethargy
Polyuria (at night) - intermittent
polydipsia - intermittent
assumed prostate trouble or waterworks infections

Often drink Lucozade or coke because of thirst
Glucose slowly rises further
Osmotic diuresis* causes loss of water and a rise in sodium in cells
EVENTUALLY the glucose is VERY high, as is the sodium Suddenly normalising can kill the patients

*increased urination due to non-reabsorbed solutes in tubular lumen (glucose etc.)

Question 8

(hyperosmolar state)

Osmolality = … + … + … + ….

Answer 8

Osmolality = cations + Anions  + glucose + urea
cations = Na + K
anions = Cl + bicarb

Question 9

Compare the osmolar state of Type 1 and 2 DM

Answer 9

Type 1 DM
acidotic (due to DKA)
hyperosmolar hyperglycaemic state (HHS)

Type 2 DM
no acidosis
HHS (increase glucose, urea, Na)
* HHS causes osmotic diuresis (increase urine output and rise in Na)

Question 10

What is the aetiology of Type 2 DM complications?

Answer 10

months/years of hyperglycaemia
slow damage to endothelium
micro and microvascular damage

Question 11

Summarise aetiology and order of microvascular complications of Type 2 DM

Answer 11

glycolysation of basement membrane leads to ‘leaky’ capillaries
In the order:
retinopathy -> nephropathy -> neuropathy

NB. if patients ignore polyuria, may present with complication

Question 12

Summarise aetiology and order of macrovascular complications of Type 2 DM

Answer 12

dyslipidaemia, HT, hypercholesterolaemia

ischaemic heart disease, peripheral vascular disease (gangrene, atherosclerosis), stroke, MI