Diabetes

Question 1

Define diabetes mellitus

Answer 1

Characterised by chronic hyperglycaemia

Question 2

What are the two types of diabetes ?

Answer 2

Type 1 and type 2

Question 3

What is type 1 diabetes ?

Answer 3

An autoimmune condition in which the production of lymphocytes , macrophages and auto-antibodies attack and progressively destroy pancreatic beta cells. This results in the inability to produce sufficient amounts of insulin.

Thought to be caused by a genetic predisposition mixed with ana environmental trigger

Question 4

Type 1 diabetes is most common in what age groups ?

Answer 4

The young

It is usually diagnosed between the ages of 18-20 years

Question 5

What are the triad of symptoms present in a person with type 1 diabetes?

Answer 5

1. Polyuria
2. Weight loss
3. Polydipsia

Other symptoms include lethargy , tiredness and weakness due to inadequate energy utilisation.

Question 6

What is Polyuria and why does it develop in people with type 1 diabetes ?

Answer 6

The increased concentration of glucose in the urine would create a gradient whereby more water would want to be drawn into the urine.

Question 7

What is polydispia and why does it develop in people with type 1 diabetes a.

Answer 7

Excessive thirst

This would develop because we are excreting large amounts of water

Question 8

Why does excessive weight loss develop in people with type 1 diabetes ?

Answer 8

The absences of insulin means glucose cannot be used as an energy source ,so the body metabolised fat and protein instead.

This is because insulin allows cells in the muscles , liver and fat to take up this glucose and use it as a source of energy so they can function properly. Without insulin , cells are unable to use glucose as fuel.

Question 9

How is type 1 diabetes diagnosed ?

Answer 9

1. Measuring fasting plasma glucose concentration.
2. Measuring HbA1C %

You need symptoms AND one abnormal test to diagnose. OR 2 diagnostic tests to be abnormal if the person is asymptomatic.

Question 10

How to treat type 1 diabetes ?

Answer 10

THERE IS NO CURE FOR TYPE 1 DIABETES

treatment of type 1 diabetes is exogenous insulin - this is given subcutaneously several times per day.

Question 11

What is type 2 diabetes mellitus?

Answer 11

It is generally caused by insulin resistance - where receptors that detect insulin can longer no detect insulin. This is could be due to a decrease in affinity of the receptor or problems with the post-receptor outcome.

Insulin resistance is often compensated with the pancreas increasing insulin production , however over time pancreatic beta cell function decreases and the patient suffers hyperglycaemia due to inability of the pancreas to compensate for insulin resistance.

Question 12

What age range of patient are usually diagnosed with type 2 diabetes ?

Answer 12

Typically older patients who are usually overweight. ( eg 40 years or older )

90% of patients are overweight.

Question 13

Symptoms of patients with type 2 diabetes

Answer 13

Will also present with the classic triad of symptoms ( weight loss , polyuria , polydipsia) but will also present with other symptoms such as lack of energy , persistent infection ( genital thrush) , slow healing of minor skin and visual problems

Question 14

How can type 2 diabetes be managed ?

Answer 14

Managed by diet and exercise ALONE , but sometimes this is not the case and drugs such as metformin and sulfonylureas are used,

Question 15

What are acute complications of type 1 diabetes ?

Answer 15

Diabetic ketoacidosis

Question 16

What is diabetic ketoacidosis

Answer 16

Due to the low insulinlevels / absence of insulin as enhanced lipolysis occurring ,

ketone production is activated. Which means that large quantities of ketones are produced incl acetoacetate , acetone , 3-beta-hydroxylbutyrate

Acetone is a volatile substance and is therefore breathed out and smelled on a patients breath.

Symptoms of ketoacidosis incl : hyperventilation , nausea , vomiting , dehydration , abdominal pain , prostration

Question 17

How to monitor type 1 diabetes ?

Answer 17

Requires frequent blood glucose measurements.

A small amount of blood from a finger prick is sufficient to measure blood glucose using a BM stick and reader.

Question 18

What are chronic problems with diabetes ?

Answer 18

Macro vascular complications : STROKE , Increased risk of myocardial infarction and poor circulation to periphery ( eg feet)

2. micro vascular complications : Retinopathy , kidney disease , neuropathy , foot disease

Question 19

What is retinopathy ?

Answer 19

Micro vascular complication of diabetes. Also known as diabetic eye disease. This occurs where the blood vessels in the retina are damaged due to hyperglycaemia. The damaged blood vessels may leak and form protein exudate on the retina , or rupture - this could cause bleeding to the eye.

Question 20

Why does diabetic foot disease develop ?

Answer 20

An accumulation of poor blood supply, damage to nerves and increased risk of infection means that damage to the feet is increased .

Question 21

Compare the speed of onset of diabetes type 1 and diabetes type 2

Answer 21

Speed of onset of type 1 diabetes is much sudden than diabetes type 2

Question 22

What is metabolic syndrome ?

Answer 22

It is commonly found in patients with type 2 diabetes.

It is defined as a group of symptoms incl insulin resistance , dyslipidaemia ( abnormal amount of lipids in the blood ), glucose intolerance and hypertension

It is associated with central obesity.

BMI above 30kg/M2
BP above 140/90mmHg
Glucose fasting is above 7.8mmol/L
HDL less than 0.9mmol/L in men and less than 1mmol /L in women.

It is present with 80% of type 2 patients