Diabetes (bad notes- go to LOs for detail) Flashcards
Epidemiology of diabetes
T2DM- 90%
T1DM- 8% (high % of these are Caucasian)
Rarer types of diabetes- 2%
1/6 people in a hospital bed have diabetes
what is diabetes mellitus
- body has trouble moving glucose from blood into cells hyperglycaemia
- insulin secreted by beta cells at the centre of islets of Langerhans
- insulin exerts its effects by binding to insulin receptors on the plasma membranes of various cells e.g., muscle and adipose tissue
Different factors, including genetics and some viruses, may contribute to type 1 diabetes. Although type 1 diabetes usually appears during childhood or adolescence, it can develop in adults.
pathophysiology of T1DM
Type 1 diabetes mellitus
Can’t make enough insulin following a type 4 cell mediated hypersensitivity reaction to beta cells in the pancreas.
Many type 1’s are +ve for HLA-DR3 and HLA-DR4
type 1 diabetes is also known as
insulin dependant diabetes
Symptoms of uncontrolled diabetes:
Polyphagia- high hunger
Glycosuria- presence of glucose in urine
Polyuria- weeing a lot
Polydipsia- thirsty, people wee so much
Weight loss- body has to break down adipose tissue and protein
treatment for T1DM
Insulin- usually subcutaneous but may be IV
complications for T1DM
- Ketoacidosis- lipolysis generates free fatty acids- liver converts these to ketone bodies (include ketoacids) - ketone bodies used for energy but also make blood more acidic
Even with people on medication - stress (e.g., infection)- adrenaline- glucagon -tip scale –> ketoacidosis
- KUSSMAUL respiration- deep and laboured breathing–> reduce co2 and acidity
- Hyperkalaemia- intracellular stores low
symptoms of ketoacidosis
- Nausea
- Fruity breath (acetone)
- Vomiting
- Mental status changes
- Cerebral oedema
treatment of dka
- Fluids for dehydration
- Insulin to lower blood glucose
- Electrolytes (e.g., K+)
- Often affects younger patients
- Associated with other autoimmune disorders:
- Hypothyroidism, coeliac disease, RA, addison’s disease
- Is sometimes first picked up in an emergency setting
- ALWAYS treated with insulin.
clinical diagnosis of ketoacidosis
- Clinical diagnosis in adults with hyperglycaemia
- HbA1c is not routinely used to diagnose T1DM
- Patients will also often gave one or more of:
- Ketosis
- Rapid weight loss
- Age of onset under 50 years
- BMI below 25 kg/m2
- Personal and or family history of autoimmune disease
type 2 diabetes mellitus
Makes insulin but doesn’t respond to it - resistance
Beta cell hyperplasia and size in an attempt to increase insulin. Beta cells eventually hyperplase and then die–> decompensated –> symptoms
Less likely to get diabetic ketoacidosis –> there is still SOME insulin left
Whats more likely is HYPEROSMOLAR HYPERGLYCAEMIC STATE (HHS) –> increased plasma osmolarity from dehydration. Glucose draws water out of cells. Some ketonaemia and acidaemia seen
risk factors for T2DM
- Obesity
- Lack of exercise
- Hypertension
- Genetics
subtypes of diabetes (2)
- gestational
pregnant women have increased glucose primarily in the third trimester
- drug induced
long term/ intense corticosteroids use
diagnosis of diabetes
Fasting glucose–>no food or drink for 8 hours
100-125 mg/dL - prediabetes
>126 mg/dL - diabetes
Non-fasting*** or ***random glucose
>200 –> diabetes
Oral glucose tolerance–> given glucose and measured at intervals (2 hour mark most important)
140-199 - pre-diabetes
>200 mg/dL - diabetes
HbA1C–> 5.7-6.4% is prediabetes
>6.5% is diabetes
C-peptide
Biproduct on insulin production –>therefore if this is low then that indicates that insulin production has dropped.
used in diagnosis
