Diabetes Flashcards
what is diabetes?
an elevation of blood glucose above a diagnostic threshold
what happens to average fasting plasma glucose as the age of patients increases?
it increases
what are the thresholds for diagnosis of diabetes based on?
the risk of developing diabetic retinopathy
what fasting glucose suggests normal glucose tolerance?
6.0mmol/L and below
what 2 hour glucose suggests normal glucose tolerance?
7.7mmol/L and below
what HbA1c suggests normal glucose tolerance?
41 mmol/mol and below
what fasting glucose indicates impaired glucose tolerance?
6.1 - 6.9 mmol/L
what 2 hour glucose indicates impaired glucose tolerance?
7.8 - 11.0 mmol/L
what HbA1c indicates impaired glucose tolerance?
42-47 mmol/L
what is another name for impaired glucose tolerance?
pre diabetes
what fasting glucose is diagnostic of diabetes?
7.0mmol/L and above
what 2 hour glucose is diagnostic of diabetes?
11.1mmol/L and above
what random glucose is diagnostic of diabetes?
11.1mmol/L and above
what HbA1c is diagnostic of glucose?
48 mmol/mol and above
aka 5.8% and above
what determines the thresholds for diagnosing gestational diabetes?
not based on the risk of retinopathy
determined by the risk to the foetus
what is gestational diabetes?
diabetes that comes on during pregnancy
which has higher thresholds - regular diabetes or gestational diabetes?
normal diabetes
values for diagnosis of gestational diabetes are much lower
what happens when plasma glucose is low?
alpha cells release glucagon to raise it again
what happens when plasma glucose is high?
beta cells release insulin to lower it
what can be measured to measure endogenous insulin secretion?
C-peptide
what does an insulin assay in a person receiving exogenous insulin show?
the injected insulin
how can C-peptide be used to measure endogenous insulin secretion?
C peptide is co-secreted with insulin, so if present in the blood it shows that a person’s beta cells are producing insulin
C-peptide not found with injected (exogenous) insulin
what determines blood glucose?
the balance between how much insulin is produced and how effective this insulin is
what are the two ways diabetes can occur?
beta cells not secreting enough/any insulin
insulin resistance
what is the main disease caused by deficiency of beta cell secretion?
type 1 diabetes
name two genetic disorders that involve deficiency of beta cell secretion
MODY
neonatal diabetes
how can pancreatic disease cause type 1 diabetes?
damage to the pancreas can impact insulin secretion
name some pancreatic diseases that can cause diabetes
pancreatitis
pancreatic cancer
cystic fibrosis
what is type 1 diabetes?
autoimmune destruction of the pancreatic beta cells resulting in beta cell deficiency
when does type 1 diabetes come on?
any age
classically thought of as a disease in children/young adults, but this is not the case
what is found in the blood of most type 1 diabetics at diagnosis?
pancreatic autoantibodies
how is type 1 diabetes treated?
life long insulin therapy
what type of diabetes is most common?
type 2
do people with type 2 diabetes require insulin therapy?
the majority do not, but some people benefit from it
how is type 2 diabetes usually managed?
lifestyle modification and non-insulin treatments
what type of diabetes can often be asymptomatic?
type 2
how can asymptomatic diabetes be picked up?
as part of a routine blood test
name some symptoms of high blood glucose
polyuria thirst blurred vision genital thrush fatigue weight loss
what are two possible diabetic emergencies?
diabetic ketoacidosis
hyperosmolar hyperglycaemic state
which type of diabetes is more commonly associated with DKA?
type 1
what type of diabetes is more commonly associated with HHS?
type 2
what are the two classes of diabetes complications?
micro vascular
macro vascular
What is the main driver for micro vascular complications?
Chronic hyperglycaemia
Name some micro vascular complications of diabetes
Neuropathy
Retinopathy
Nephropathy
What causes macro vascular complications in diabetes?
Hyperglycaemia
High blood pressure
Dyslipidemia
Name some macrovascular complications of diabetes
MI
Stroke
Peripheral vascular disease
What are two ways to monitor blood glucose over a long period of time?
Continuous blood glucose monitoring
HbA1c
What is HbA1c?
Glycated haemoglobin
How does haemoglobin become glycated?
When it becomes exposed to glucose
What does HbA1c provide a measurement of?
Glucose exposure over the last 90 ish days (as a red blood cell survives around 90 days)
