Diabetes Flashcards
When we say diabetes what type do we usually mean
diabetes mellitus
what is the difference between diabetes mellitus and diabetes insipidus
mellitus = abnormality of GLUCOSE regulation
insipidus = abnormality of RENAL function (lack of ADH)
Why is testing for diabetes hard
it’s a group of symptoms, you need to know circumstances before you take a blood sample
How do they test for diabetes
- fasting sugar sample + test following fixed amount of sugar
- Random plasma glucose (RPG) on 2 occasions >11.1mmol/L is diagnostic of diabetes
why do complications arise in diabetes
prolonged time with high levels of sugar
What is the different diagnoses you can get when diagnosing diabetes
- normal
- impaired fasting glucose/impaired glucose tollerance
- diabetes
how is diabetes mellitus classified now
Type 1 - insulin deficiency
Type 2 - insulin resistance (can progress to deficiency)
What causes type 1 diabetes
immune mediated pancreatic B cell destruction
What happens if you don’t treat type 1 diabetes
- unable to manage glucose because of autioimmune disorder
- cells not getting enough glucose as need insulin to move glucose into cells
- metabolise ketones instead
- get ketoacidosis
Why do people develop type 1 diabetes
genetic and environmental triggers
What are the differences between adult and child onset of type 1 diabetes
Childhood
- more common
- severe decompensation
Adult
- GAD associated
- variable period until insulin required
- latent autoimmune diabetes in adults
- less weight loss, less ketoacidosis
symptoms of type 1 diabetes
- polyuria
- polydipsia
- tiredness
- acute presentation
- hyperglycaemia with diabetic symptoms
- ketoacidosis
- usually require insulin from diagnosis
is type 1 or 2 more common
2 (90% of all cases)
what is strongly associated with type 2 diabetes
obesity and inactivity
Do type 2 patients get ketoacidosis
rarely
what is the family concordance like in type 2 diabetes
strong (100% in identical twins)
How can type 2 diabetes arrise
- defect in insulin resistance
- defect in insulin secretion
- basal hepatic glucose output increased
- insulin simulated muscle glucose uptake is reduced
What are the effects of type 2 diabetes
- impaired glucose tolerance
- hyperinsulinaemia
- hypertension
- obesity with abdominal distribution
- dyslipidaemia
- procoagulant epithelial markers
- early and accelerated atherosclerosis
What do type 2 diabetic people usually present with
- gradual onset
- retinal damage
- polyuria, polydiipsia, tiredness
- unusual infections
- diabetic complications (CVS)
What can protect from and even reverse type 2 diabetes
strict diet and exercise
Compare features of type 1 and type 2 diabetes
Type 1
- younger
- thin
- ? family history of type 1
- ? family history of autoimmune disease
- diabetic symptoms
- easily get ketosis
Type 2
- older
- obese
- strong family history
- diabetic symptoms?
- present with complications
- rarely get ketosis
How is diabetes managed
- education
- targets
- management tools (drugs/insulin - basal-bolus v split-mixed control)
- nutrition
- exercise
- monitoring
Describe the differences between 2 options of insulin regimes
- twice-daily soluble and isophane insulin regime (Short and medium acting taken together which over the day will keep insluin where you need it to be. Can only eat just after having injection)
- basal-bolus (slow acting plus short acting ones depending on what your day is going to look like - gives more flexibility for patient)
Type 1 management
insulin subcutaneously is best (can be inhaled too)
- different regimes for each individual
