Diabetes Mellitus Flashcards
What is the definition of Diabetes Mellitus?
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
What is Type 1 diabetes Mellitus?
Absolute insulin deficiency secondary to autoimmune destruction of pancreatic Beta cells
What is type 2 diabetes?
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)
How does diabetes Mellitus present?
Symptoms of hyperglycaemia = Polyuria, Polydipsia, blurring of vision, Urogential infections
Symptoms of inadequate energy utilisation = tiredness, weakness, lethargy and weight loss
What are the 3 most common symptoms of diabetes Mellitus?
Polyuria
Polydipsia (thirst)
Weight loss
What tests are done to Diagnose Diabetes?
Fasting plasma glucose (over 7mmol/L)
Oral glucose tolerance test
HbA1C (glycated haemoglobin levels)
Random venous plasma glucose over 11.1mmol/L
How do you diagnose diabetes?
You need symptoms and 1 abnormal test
Or
2 abnormal tests if asymptomatic
How does Type 1 diabetes present?
Rapid onset weight loss, Polyuria and Polydipsia
Vomiting due to ketoacidosis
Why are ketones present in the blood in a patient with Type 1 diabetes?
Insulin inhibits lipolysis
No insulin means uncontrolled lipolysis occurs leading to ketone production
What is the definition of Ketoacidosis?
The triad of:
Hyperglycaemia
Ketonaemia
Acidosis
What sign is present in a patient with Type 1 diabetes but not Type 2 and how can this be measured?
Ketonuria (ketones in urine)
Measured using Ketostix
How is Type 1 diabetes treated?
Exogenous insulin
(Subcutaneous injection)
In Type 2 diabetes what causes insulin resistance to develop?
Central obesity
Physical inactivity
Genetic influences
Muscle and liver fat deposition
Elevated circulating free fatty acids
How can type 2 diabetes be diagnosed?
Symptoms: Polyuria, Polydipsia, weight loss
No urinary ketones
How do you treat type 2 diabetes?
WEIGHT LOSS!!!!
Lifestyle
Non insulin therapies (sulphonylureas)
Patient education
Try and addresss other vascual risk factors - high BP, Lipids, smoking exercise and diet
What are the acute complications of diabetes in terms of Hyperglycaemia and Hypoglycaemia?
Hyperglycaemia - diabetic ketoacidosis (type 1), hyperosmolar non-ketoacidosis syndrome (type 2)
Hypoglycaemia- coma due to hypoglycaemic therapy (brain not getting glucose)
What are the chronic complications of Diabetes?
Macrovascular complications
Micro vascular complications
What are the Macrovascular complications of chronic diabetes?
Cerebrovascular, cardiovascular and peripheral vascular diseases
Includes stroke, heart attack intermittent claudication and gangrene (diabetic foot)
What are the Microvaecular complications of chronic diabetes?
Retinopathy, nephropathy, neuropathy
Blindness, Erectile dysfunction, foot ulceration, painful peripheral neuropathy
Give an example of a peripheral vascular disease caused by chronic hyperglycaemia caused by diabetes?
Diabetic foot
Ischaemic feet
May be painful or non painful
Non painful if neuropathy since nerves are dead in foot
What is a metabolic syndrome?
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
How can you say somebody has a Metabolic syndrome?
-Waist measurement > 94cm men. > 80cm women
-and any 2 of the following:
Raised triglycerides
Reduced HDL cholesterol
Raised BP
Raised fasting blood glucose
What causes metabolic syndrome?
Insulin resistance
Central obesity
Genetics
Physcial inactivity
Ageing
How can uncontrolled Diabetes Mellitus lead to reduced peripheral sensation?
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
