Diabetes Flashcards
What is diabetes mellitus (DM)?
Inability to regulate blood glucose levels (impaired glucose metabolism) – glucose levels consistently too high.
what are the 3 commonest types of diabetes
Gestational – pregnancy – mother cannot effectively respond to extra blood glucose levels from foetus. Usually resolves after birth. But higher risk of developing type II later in life.
Type I – Autoimmune disorder – B cells in Islets of Langerhans destroyed. Decreased insulin production.
Type II – Metabolic disorder – Body ineffective at using insulin it’s produced or doesn’t produce enough. Advanced stages of Type II can turn into Type I.
Who in the population would you expect to suffer from DM? (All types)
Type I – onset before 40
Type II - >40?
Gestational – pregnant women
What are the risk factors?
Type I – uncertain – genetic component small (Mother 2%, Father 8% - both 30%). Thought to be genetic plus an environmental trigger like a virus.
Type II – Obesity – BMI >30. (Waist measurement >31inch women, > 37 inch men). Genetic component – 1 parent = ~15-20% risk. Both parents = 75% risk. Lack of physical activity. Smoking. High Blood Pressure & Cholesterol. Ethnicity (African-American, Asian, Hispanic, Middle Eastern.
Gestational – pregnancy + previous pregnancy that resulted in baby over 10lbs weight.
What are the symptoms? (All types)
Increased thirst, hunger, tiredness, unexplained weight loss, itchy skin, cuts & sores that don’t heal, increased infections e.g. genital thrush, blurry vision, more frequent urination especially at night.
How would you treat it? (All types)
Type I – insulin via subcutaneous injection (into subcutaneous fat) or pump – common injection sites = stomach, back of arm, inner thigh. ~6% adults use pump vs 19% children.
Type II – lifestyle changes – quit smoking, weight reduction, low carbohydrate and fat diet, increase physical activity. Then oral medication e.g. Metformin. Advanced stages – insulin injections. (~40% type II diabetics are on insulin).
Gestational – diet mainly – drugs not encouraged due to risk of harming foetus
Pancreas transplants – only offer temporary solution to type I diabetics due to autoimmune condition and only offered for those with very severe symptoms or needle phobias.
What complications can arise from it (short term)? (All types)
Hyperglycemia – sugar levels dangerously high. Body tries to expel excess levels by increasing urination = dehydration.
Hypoglycemia – sugar levels dangerously low. Symptoms can include sweating, anxiety, feeling weak and fatigued.
Ketoacidosis – When body has insufficient insulin to allow enough glucose to be metabolised effectively it switches to an alternative fuel – fatty acids. The breakdown products of burning fatty acids produce acidic ketones and reduce pH = dangerous environment.
These conditions can lead to seizures and eventually coma if not treated quickly.
What complications can arise from it (long term)? (All types)
Excess glucose in blood contributes (along with high blood pressure and high cholesterol) to vascular disease – endothelium breaks down, LDL cholesterol enters vessel wall, inflammation etc. Oxygen delivery compromised. Following conditions result…
Peripheral vascular disease – feet, hands, genitalia (extremities where blood flow is already low) end stage = gangrene & amputation.
Retinopathy – swelling/ destruction / overgrowth of vessels particularly on surface of retina = blurry vision
Nephropathy – kidney filters out substances from blood vessels – if blood vessel walls are damaged this requires more effort – kidney fatigue and build up of waste products.
Neuropathy – cell death due to lack of oxygen delivery can also cause cell death of nerve cells = decreased sensastion again usually at the periphery – hands, feet etc.
Cardiovascular disease – large vessels become atherosclerotic – fatty plaques form which can physically obstruct vessels e.g. coronary artery disease or break off and cause heart attacks & strokes.
Skin Conditions – e.g. dry skin. Diabetics lose more moisture through the skin – especially if skin is damaged due to lack of blood supply. Cut & sores take longer to heal. Pigmentation can also be affected.
