Diabetes Flashcards
Normal blood glucose level
Roughly 5mmol/L
Pancreatic cells
- Alpha cells produce glucagon
- Beta cells produce insulin
- Delta cells produce somatostatin
- Gamma cells produce pancreatic polypeptide
Is diabetes a syndrome?
Yes - Collection of symptoms and signs due to more than one condition/disease
75g OGTT (oral glucose tolerance test)
- Can be oral (OGTT) or IV (IVGTT)
- Blood glucose levels before and after 75g oral glucose load
- 2-hour post-glucose load >11mmol/l = impaired glucose tolerance (IGT) - diabetes
HbA1c criteria
higher HbA1c – more likely to have diabetes as less control of glucose
- 48mmol/mol (6.5%) = diabetes
Type 1 diabetes
- Autoimmune destruction of the insulin producing islet beta cells (Langerhans) - only beta cells are affected in the islets
Type 1 diabetes presentation
- rapid onset, weight loss (but may be obese), low energy, abdominal pain, often slim, may present with diabetic ketoacidosis (DKA)
Test for T1DM
- Insulin autoantibodies - GAD, IA-2
- Transporter autoantibodies
Type 2 diabetes
Inulin resistance - strong family history with weight and obesity. Usually high BP or high lipids
Symptoms of T2DM
minimal weight loss, complications such as vision loss or foot ulcers or fungal infection. State of Hyperosmolar Hyperglycaemia State (HHS) or HONK
Management of T2DM
- Exercise and diet
- Oral therapy = metformin
- Once a day insulin
Gestational diabetes
- Appears during pregnancy, resolves after pregnancy - risk of diabetes in later life
Diagnosis of Gestational diabetes
- OGTT after fasting - between 5.6 and 7.8 mmol
- Do not use HbA1c
- Criteria is lower glucose level as there is an increased risk to foetus
Consequences of Gestational diabetes
- short term = macrosomia, pre-eclampsia, still birth, neonatal morbidity
- Long term = obesity in child, T2DM in mother
Management of Gestational diabetes
- diet, limited oral option (metformin or glibenclamide), majority require insulin
Genetic diabetes
- Maturity onset diabetes in the young
- Maternal Inherited diabetes and deafness
- Wolfram syndrome
Diabetes secondary to pancreatic disorders
- Chronic/acute pancreatitis
- Calcific pancreatitis
- Pancreatectomy
- Pancreatic cancer
- Fibrosis of pancreatic duct
- Haemochromatosis
What is Haemochromatosis
- hereditary iron overload storage disorder) – accumulates in tissues- grey skin, damage pituitary, cardiomyopathy, pancreatic fibrosis and low testosterone.
- Blue staining of islet for iron
Counter regulatory hormones
Hormones that usually oppose the action of insulin
- Secreted as a result of stress response
- Release stimulated by glucose, ketones, vagal nerve stimulation
- Stimuli for inhibition = Sympathetic stimulation, alpha-adrenergic agents
Glucagon
- Counter regulatory hormone
- increase secretion of insulin (negative feedback) and growth hormone = increase glucose levels
Glucose homeostasis
- If hyperglycaemia, insulin released = lower levels
- If hypoglycaemia, Glucagon released. Sends ACTH to adrenal cortex to release cortisol = increase levels. Along with GH anf adrenaline/catecholamines
