Diabetes Flashcards
Define Diabetes [3]
Diabetes Mellitus is a set of metabolic disorders [1] in which defects in insulin secretion and/or action leads to Hyperglycaemia [1] and disturbances in carb/protein/fat metabolism [1]
What are the types of Diabetes? [5]
Type 1 (Insulin Dependant DM) Type 2 - (Insulin Independant DM)
Maturity Onset Diabetes in the Young (MODY)
Secondary DM
Gestational Diabetes
Describe criteria for clinical diagnosis and investigations for childhood onset diabetes [3]
4Ts:
- Tired
- Thinner
- Thirsty
- Toileting more (incl return to day or bed wetting)
Then test with a finger prick glucose test
If suspected refer to a specialist for a same day review
How does diabetes affect the lifespan and mortality rate?
Whats the most common cause of death in diabetics?
Diabetics have a 5-10 yr reduced life expectancy and twice the mortality rate (5.4% annually)
MIs are the most common cause of death
Long term complications of hyperglycaemia
Describe large vessel disease and its relationship with DM [2]
Describe arteriolar disease with reference to small vessel disease in DM and which organs this affects [2]
Large vessel disease
DM accelerates atherosclerosis [1] leading to CAD, MIs & Stroke [1]
Small vessel disease
- Arteriolar disease - narrows > ischemia [1] > kidney, peripheral tissues, eyes, arterioles supply nerves [1]
Explain the mechanism behind which Diabetes accelerates Atheroma [3]
Excess Glc attaches to LDL
LDL can no longer bind to receptors and be cleared in the liver
Hyperlipidaemia occurs
Explain the mechanism by which diabetes causes arteriolar disease? [4]
Normally molecules flux between the blood and subendothelial space.
In DM the high glucose glycosylates Subendothelial collagen and basal lamina proteins resulting in: [1]
1) Collagen binds albumin preventing it from fluxing back [1] out the subendothelial space
2) Basal lamina proteins cross link and accumulate [1]
This causes a build up of proteins in the wall known as the hyaline change [1]
A diagnostic test for people with diabetes require showing they are hyperglycaemic, but what is intermediate hyperglycaemia?
What risks are these group of people vulnerable to? [2]
Intermediate hyperglycaemia is where glucose/HbA1c levels are raised but don’t meet the threshold for diabetes [1]
These people are considered high risk for diabetes, CVD and associated complications
What is MODY? [3]
Autosomal dominant genetic syndrome.
A single gene leads to impaired B-cell function.
Either Glucokinase or Transcription Factor mutations.
What are the sub-types of MODY? [2]
Describe them in terms of onset, glycemic levels, treatment and likelihood of complications
Depends on the kind of mutation:
Glucokinase mutations # Onset at Birth # Stable hyperglycaemia # Treated with diet # Rare complications
Transcription Factor Mutations # Adolescent onset # Progressive Hyperglycaemia # Treated with diet, oral hypoglycaemics and insulin # Frequent complications
What is Secondary Diabetes Mellitus?
DM brought on by:
- Drugs e.g. CCS
- Pancreatic destruction/removal
- Genetic syndromes
- Endocrine disorders e.g pheochromocytoma, cushings or acromegaly
What is the aetiology of Gestational diabetes? [3]
Insulin resistance brought on by 2nd/3rd trimester of pregnancy.
Its associated with a family history of Type 2 DM
Patient’s are commonly overweight and inactive
Fetal complications of GDM [3]
- Foetal Macrosomia (big baby)
- Neonatal Respiratory arrest
- Neonatal Hypoglycaemia
What causes Type 1 diabetes? [2]
Autoimmune condition in which lymphocyte infiltration of Islets of Langerhans causes insulitis, destroying B cells and compromising the ability to absorb Glc from blood.
Describe the genetic component of Type 1 Diabetes? [2]
Human Leukocyte Antigen (HLA) genes Class 1 & 2
HLA molecules help T cells recognize self from non-self
