Diabetes Mellitus

Question 1

What is the definition of Diabetes Mellitus?

Answer 1

A group of metabolic disorders which cause an elevated blood glucose concentration (hyperglycaemia) which over time leads to damage of the small and large blood vessels causing premature death from cardiovascular diseases

Question 2

What is Type 1 diabetes Mellitus?

Answer 2

Absolute insulin deficiency secondary to autoimmune destruction of pancreatic Beta cells

Question 3

What is type 2 diabetes?

Answer 3

A long term metabolic disorder that is characterised by hyperglycaemia which is caused by:

-insulin deficiency (Beta cells not producing enough insulin)
-insulin resistance (cells dont respond to insulin properly so don’t get unlocked to glucose)

Question 4

How does diabetes Mellitus present?

Answer 4

Symptoms of hyperglycaemia = Polyuria, Polydipsia, blurring of vision, Urogential infections

Symptoms of inadequate energy utilisation = tiredness, weakness, lethargy and weight loss

Question 5

What are the 3 most common symptoms of diabetes Mellitus?

Answer 5

Polyuria
Polydipsia (thirst)
Weight loss

Question 6

What tests are done to Diagnose Diabetes?

Answer 6

Fasting plasma glucose (over 7mmol/L)
Oral glucose tolerance test
HbA1C (glycated haemoglobin levels)
Random venous plasma glucose over 11.1mmol/L

Question 7

How do you diagnose diabetes?

Answer 7

You need symptoms and 1 abnormal test
Or
2 abnormal tests if asymptomatic

Question 8

How does Type 1 diabetes present?

Answer 8

Rapid onset weight loss, Polyuria and Polydipsia

Vomiting due to ketoacidosis

Question 9

Why are ketones present in the blood in a patient with Type 1 diabetes?

Answer 9

Insulin inhibits lipolysis
No insulin means uncontrolled lipolysis occurs leading to ketone production

Question 10

What is the definition of Ketoacidosis?

Answer 10

The triad of:
Hyperglycaemia
Ketonaemia
Acidosis

Question 11

What sign is present in a patient with Type 1 diabetes but not Type 2 and how can this be measured?

Answer 11

Ketonuria (ketones in urine)

Measured using Ketostix

Question 12

How is Type 1 diabetes treated?

Answer 12

Exogenous insulin
(Subcutaneous injection)

Question 13

In Type 2 diabetes what causes insulin resistance to develop?

Answer 13

Central obesity
Physical inactivity
Genetic influences
Muscle and liver fat deposition
Elevated circulating free fatty acids

Question 14

How can type 2 diabetes be diagnosed?

Answer 14

Symptoms: Polyuria, Polydipsia, weight loss
No urinary ketones

Question 15

How do you treat type 2 diabetes?

Answer 15

WEIGHT LOSS!!!!
Lifestyle
Non insulin therapies (sulphonylureas)
Patient education
Try and addresss other vascual risk factors - high BP, Lipids, smoking exercise and diet

Question 16

What are the acute complications of diabetes in terms of Hyperglycaemia and Hypoglycaemia?

Answer 16

Hyperglycaemia - diabetic ketoacidosis (type 1), hyperosmolar non-ketoacidosis syndrome (type 2)

Hypoglycaemia- coma due to hypoglycaemic therapy (brain not getting glucose)

Question 17

What are the chronic complications of Diabetes?

Answer 17

Macrovascular complications
Micro vascular complications

Question 18

What are the Macrovascular complications of chronic diabetes?

Answer 18

Cerebrovascular, cardiovascular and peripheral vascular diseases

Includes stroke, heart attack intermittent claudication and gangrene (diabetic foot)

Question 19

What are the Microvaecular complications of chronic diabetes?

Answer 19

Retinopathy, nephropathy, neuropathy

Blindness, Erectile dysfunction, foot ulceration, painful peripheral neuropathy

Question 20

Give an example of a peripheral vascular disease caused by chronic hyperglycaemia caused by diabetes?

Answer 20

Diabetic foot
Ischaemic feet
May be painful or non painful
Non painful if neuropathy since nerves are dead in foot

Question 21

What is a metabolic syndrome?

Answer 21

A cluster of the most dangerous risk factors associated with cardio as disease: diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and BP

Question 22

How can you say somebody has a Metabolic syndrome?

Answer 22

-Waist measurement > 94cm men. > 80cm women
-and any 2 of the following:
Raised triglycerides
Reduced HDL cholesterol
Raised BP
Raised fasting blood glucose

Question 23

What causes metabolic syndrome?

Answer 23

Insulin resistance
Central obesity
Genetics
Physcial inactivity
Ageing

Question 24

How can uncontrolled Diabetes Mellitus lead to reduced peripheral sensation?

Answer 24

Chronic hyperglycaemia can cause micro vascular complications affecting small vessels (arteries and arterioles)
Which can lead to peripheral neuropathy since the nerves get damaged if they have no oxygen