Diabetes Flashcards
define
chronic, metabolic disease characterised by elevated levels of blood glucose which overtime leads to serious damage to heart, blood vessels, eyes, kidneys and nerves
why does diabetes develop?
when there is insufficient insulin to maintain glucose homeostasis
classification of diabetes
mellitus (insulin resistance/lack)
insipidus (lack of ADH)
define T1DM
AI disorder with T lymphocyte infiltrate that causes destruction of pancreatic beta cell
presentation of T1DM
polyuria increased thirst malaise severe weight loss acute onset ketonuria +/- metabolic acidosis
autoimmune markers of T1DM
islet cell autoantibodies
autoantibodies to GAD65
HLA association with DQA DQB genes
markers of T1DM
ketones (only type 1)
C-peptides (plasma)
define LADA
late onset type 1 diabetes that is commonly mis-diagnosed as T2DM
what age does T1DM present?
preschool
peri-puberty
late 30s
consider LADA
typical type 2 diabetes mellitus presentation
middle-aged/elderly usually obese pre-diagnosis duration 6-10 years/ insidious onset evidence of microvascular disease managed with diet and tablets initially
classification of diabetes
T1DM
T2DM
gestational diabetes mellitus (GDM- type 3)
specific types
define GDM
diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation
examples of specific types of diabetes due to other causes
- monogenic diabetes syndromes e.g. neonatal diabetes and MODY
disease of the exocrine pancreases e.g. CF, haemochromatosis and pancreatitis - endocrine disease e.g. Cushing’s, acromegaly, phaeochromocytoma or glucagonoma
- drug or chemical induced diabetes e.g. glucocorticoids, diuretics, beta blockers, treatment of HIV/AIDs or after organ transplantation
- genetic diseases e.g. CF, myotonic dystrophy and Turner’s syndrome
define fasting
no calorific intake for at least 8 hours
describe the results seen in positive diabetes
- HbA1c= 48m/m or above
- fasting= 7.0mmol/L or above
- 2-hr glucose OGTT= 11.1mmol/L or above
- random glucose= 11.1mmol/L or above
describe the results seen in impaired/pre-diabetes
- HbA1c= 42-47mmol/mol
- fasting= 6.1-6.9mmol/L
- 2-hr glucose in OGTT= 7.8-11.0mmol/L
normal results in diabetes testing that signify no diabetes
HbA1c= 41m/m or below
fasting= 6.0mmol/L or below
2hr-fasting glucose in OGTT= 7.7mmol/L or below
what is the glucose drink made of?
75g anhydrous glucose dissolved in water
what does diagnosis of diabetes require in terms of testing samples?
two abnormal test results from same sample or two separate test samples
who should testing be considered in?
- overweight or obese (BMI >25 or >23 in Asian Americans)
- first degree relative with diabetes
- high risk race/ethnicity e.g. African American, Latino, Native American, Asian American, Pacific Islander
- history of CVD or hypertension
- HDL cholesterol <35mg/dL (0.9mmol/L) and/or triglycerides level >250mg/dL (2.82mmol/L)
- women with PCOS
- physical inactivity
- other conditions associated with insulin resistance e.g. severe obesity, acanthosis nigricans
how often should those with “pre-diabetes” be tested?
yearly
follow-up for GDM
6-week post natal check
lifelong testing at least every 3 years
what does HbA1c show?
measure of glucose control over the past 2-3 months and control reduces complications
macrovascular disease
TIA stroke angina MI HF peripheral vascular disease
