Diabetes-Basic Principles Flashcards
what is diabetes?
an elevation of blood glucose above a diagnostic threshold
what do young girls tend to have as a fasting plasma glucose?
4 mmol/l
what is the threshold for diagnosing diabetes?
based upon the risk of developing retinopathy
what is retinopathy?
a specific complication only seen in diabetes
what is the fasting plasma glucose threshold?
7 mmol/l
what is the 2 hour plasma glucose threshold?
11.1 mmol/l
what is the HbA1c threshold?
5.8% or 48 mmol/mol
what is particular about diagnosing diabetes if the patient is asymptomatic?
must have a repeat confirmatory test
what is normal fasting plasma glucose?
6.0 mmol/l and below
what is a normal 2 hour plasma glucose?
7.7 mmol/l and below
what is a normal HbA1c?
41 mmol/mol and below
what is different about gestational diabetes?
threshold is risk to the foetus/neonate and not the risk of retinopathy
what cells secrete insulin?
beta cells in pancreatic islets
what cells secrete glucagon?
alpha cells in pancreatic islet
what is C-peptide useful for?
a way to measure endogenous insulin secretion
why do we need to measure C-peptide?
to find out how much insulin the body is producing on its own. if insulin levels are measured it includes exogenous insulin too.
what is C-peptide?
co-secreted with insulin and is then cleaved from insulin and remains in the blood
what is involved the diabetes balance?
insulin secreted from beta cells, insulin resistance (impaired insulin action)
what is the most common disorder of insulin secretion?
type one diabetes
what are the other two types of insulin secretion disorders?
genetic and pancreatic
which disorder is a mix between insulin secretion disorder and insulin action disorder?
type 2 diabetes
what is a key feature of type 1 diabetes?
autoimmune destruction of the pancreatic beta cells resulting in beta cell deficiency
what age group does type 1 diabetes occur in?
all age groups of similar incidences
how many people have pancreatic autoantibodies in. their blood at diagnosis?
95%
how is type 2 diabetes diagnosed?
diagnosis of exclusion
what type of disorder is type 2 diabetes?
consists of insulin deficiency and insulin resistance
which is the most common diabetes?
type 2 (90-95%)
is there autoimmune destruction of the beta. cells in type 2 diabetes?
no
what are common characteristics of type 1 diabetes?
onset in children and young adults, not associated with overweight, autoimmune, requires insulin treatment and can be fatal if left untreated
what are common characteristics of type 2 diabetes?
onset in middle age and elderly, associated with obesity and sedentary lifestyle, not autoimmune, may require insulin but usually can be managed with lifestyle modifications and non-insulin treatment
are diabetic patients commonly symptomatic or asymptomatic?
asymptomatic
is type 1 or 2 diabetes more commonly asymptomatic?
type 2
what are some common symptoms of diabetes
polyuria, thirst and polydipsia, blurred vision, genital thrush, fatigue, weight loss
what are some signs and symptoms of complications (rare)?
loss of vision/retinal bleed, retinal changes found by an optician
what are two diabetic emergencies?
diabetic ketoacidocis and hyperosmolar hyperglycaemic state
what diabetic emergency is more common in type 1?
diabetic ketoacidosis
what diabetic emergency is more common in type 2?
hyperosmolar hyperglycaemic state
why treat diabetes?
to prevent acute symptoms and life-threatening illness
what are some microvascular complications of diabetes?
retinopathy, neuropathy and nephropathy
what are microvascular complications largely driven by?
chronic hyperglycaemia
where does retinopathy affect?
back of the eye
where does neuropathy affect?
numbness in feet and pain in legs
where does nephropathy affect?
kidneys
what are some macrovascular complications?
MI, ACS, stroke, PVD
what are microvascular complications driven by?
hyperglycaemia, HBP and dyslipidaemia
how is HbA1c measured?
blood test
why is HbA1c measured?
to test how good someones blood sugar control is
what is special about testing the HbA1c?
gives a measure of the blood sugar levels over the last few months
what does the HbA1c test?
glycated haemoglobin in the blood
what forms glycated haemoglobin?
glucose in blood binds to haemoglobin
where should you be cautious measuring glycated haemoglobin?
conditions that cause increased red cell turnover e.g haemolytic anaemia and haemoglobinopathies
what is HbA1c called now?
IFCC HbA1c
what is HbA1c measured in?
mmol/mol not %age anymore
what does 1% equal in mmol/mol?
11
what is good control of blood sugar?
53-58mmol/mol or 7-7.5%
what is the first step of treatment in type 2 diabetes?
therapeutic lifestyle changes
what %age of weight loss can result in remission of type 2 diabetes?
10-15
what weight loss can improve health outcomes in a year?
5-10kg
