Diabetes mellitus Flashcards
What is Diabetes Mellitus (DM)?
DM is a syndrome characterized by chronic hyperglycemia due to an absolute or relative deficiency of insulin.
What is the primary cause of Type I Diabetes Mellitus?
Type I DM is primarily due to autoimmune destruction of pancreatic beta cells, resulting in an absolute insulin deficiency.
What distinguishes Type II Diabetes Mellitus from Type I?
Type II DM involves a combination of insulin resistance and a relative insulin deficiency rather than absolute deficiency.
What is the prevalence of diabetes in South Africa?
The prevalence is approximately 9.8%, with 7.7% in males and 11.8% in females.
What are the diagnostic criteria for diabetes based on fasting plasma glucose (FPG)?
FPG ≥ 7 mmol/L with symptoms indicates diabetes.
Name two acute complications of diabetes.
Diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic State (HHS).
List three chronic complications of diabetes.
Chronic complications include stroke (CVA), ischemic heart disease (IHD), and peripheral vascular disease (PVD).
What is diabetic neuropathy, and what are its two main types?
Diabetic neuropathy is nerve damage due to diabetes, divided into peripheral and autonomic neuropathy.
Describe a key aspect of the diabetic foot examination.
The examination includes inspection, checking pulses, assessing sensation, vibration, joint position, and reflexes.
Why is foot care critical for diabetic patients?
Proper foot care helps prevent diabetic foot ulcers and infections which can lead to serious complications like gangrene.
What is glycated hemoglobin (HbA1c), and what level indicates diabetes?
HbA1c reflects average blood glucose over 2-3 months; a level ≥ 6.5% indicates diabetes.
Why should diabetic patients rotate injection sites for insulin?
Rotating sites helps prevent lipodystrophy (dents or lumps) and ensures consistent insulin absorption.
What is the primary use of Metformin in diabetes management?
Metformin is used to improve insulin sensitivity and lower blood glucose levels in Type II DM.
What is the purpose of testing for urine glucose in diabetes management?
Testing for urine glucose helps monitor glucose control and detect hyperglycemia or hypoglycemia episodes.
What are the cardiovascular risk factors for diabetic patients?
Key risk factors include high blood pressure, elevated cholesterol, and increased triglycerides.
What lifestyle modification is strongly recommended for individuals at risk of developing Type II DM?
Regular physical activity and dietary changes to manage weight and improve insulin sensitivity.
Which test is used to diagnose diabetes by measuring glucose levels after a glucose load?
The Oral Glucose Tolerance Test (OGTT), where a blood glucose level ≥ 11.1 mmol/L 2 hours after a glucose load confirms diabetes.
What fasting plasma glucose (FPG) range indicates impaired fasting glucose (IFG)?
FPG between 5.6 and 6.9 mmol/L indicates impaired fasting glucose, a prediabetic state.
What role does the hormone glucagon play in diabetes?
Glucagon raises blood glucose by stimulating the liver to release glucose, counteracting insulin’s effects.
Name two macrovascular complications associated with diabetes.
Coronary artery disease and peripheral artery disease are major macrovascular complications of diabetes.
In diabetic retinopathy, what are the two main types of eye damage?
Non-proliferative retinopathy (with microaneurysms) and proliferative retinopathy (with new, abnormal blood vessel growth).
Why is the annual urinary albumin-to-creatinine ratio test important in diabetes?
It screens for early kidney damage (microalbuminuria), allowing for timely intervention to prevent kidney disease progression.
What is the significance of a “honeymoon period” in newly diagnosed Type I DM patients?
It’s a temporary phase where insulin needs decrease as some beta cell function briefly returns.
What type of diet is generally recommended for Type II diabetic patients?
A diet low in simple sugars and refined carbs and high in fiber, complex carbohydrates, and healthy fats.
Name a skin condition commonly associated with diabetes.
Acanthosis nigricans, characterized by dark, thickened patches of skin, usually in skin folds.
How often should HbA1c be checked in diabetic patients with stable glucose control?
Every 6 months, though high-risk or uncontrolled patients may need testing every 3 months.
What is the main goal of using insulin therapy in Type I DM?
To replace insulin the body cannot produce, helping to manage blood glucose levels effectively.
What is “hypoglycemia unawareness” in diabetic patients?
A condition where patients lose the ability to recognize the early symptoms of low blood sugar, increasing risk of severe hypoglycemia.
Which type of diabetes is strongly associated with obesity and metabolic syndrome?
Type II Diabetes Mellitus is commonly linked to obesity and metabolic syndrome, as both contribute to insulin resistance.
What are the key components of a diabetic foot examination?
The diabetic foot examination includes inspection, checking pulses, sensation tests, vibration perception, joint position sense, reflexes, and ankle joint assessment.
Why is foot inspection crucial in diabetic patients?
Diabetic patients are prone to neuropathy and reduced blood flow, which increases the risk of unnoticed injuries, infections, and foot ulcers, potentially leading to severe complications like gangrene.
What pulses should be checked during a diabetic foot exam?
The dorsalis pedis and posterior tibial pulses should be checked to assess blood flow to the foot.
How is sensation tested in a diabetic foot examination?
Sensation is tested using tools like monofilaments, which help detect reduced sensitivity that may indicate neuropathy.
Why is vibration perception important in a diabetic foot exam?
Vibration perception is tested to assess nerve function, as loss of this sensation is an early indicator of peripheral neuropathy in diabetic patients.
What does testing joint position sense reveal in diabetic patients?
Joint position sense tests proprioception, which can be impaired in patients with diabetic neuropathy, increasing their risk of falls and foot injuries.
How often should diabetic patients examine their feet?
Patients should check their feet daily for any signs of changes or injuries to prevent infections or complications.
What footwear recommendations are made for diabetic patients to protect their feet?
Diabetic patients are advised to wear supportive shoes and socks to prevent injuries and deformities; they may also benefit from custom orthotics if prescribed by a podiatrist.
What lifestyle habit is discouraged in diabetic patients to prevent foot complications?
Diabetic patients are advised to avoid smoking, as it can accelerate both macrovascular and microvascular complications, worsening blood flow issues in the feet.
What additional care is recommended for diabetic patients regarding foot hygiene?
Daily washing, careful nail trimming, and proper care for corns and bunions are recommended to reduce infection risks and maintain foot health.
A 55-year-old man with Type 2 diabetes presents with numbness and tingling in his feet. What complication is most likely responsible?
Diabetic neuropathy, a common complication affecting peripheral nerves due to prolonged hyperglycemia.
A 62-year-old woman with poorly controlled diabetes complains of frequent urination, thirst, and fatigue. What is the likely cause?
Hyperglycemia, leading to osmotic diuresis, which causes polyuria, polydipsia, and fatigue.
A 45-year-old diabetic patient is found to have poor dorsalis pedis pulses bilaterally. What could this indicate?
Peripheral vascular disease (PVD), a macrovascular complication common in diabetes due to atherosclerosis.
A 68-year-old man with diabetes presents with sudden vision loss in one eye. What complication should be suspected?
Diabetic retinopathy, which can lead to retinal hemorrhages and sudden vision changes.
A patient with diabetes presents with dry, cracked skin on their feet. Why is this a concern?
Dry skin can lead to cracks, which increase the risk of infections, particularly in diabetic patients with neuropathy.
A 40-year-old diabetic woman reports pain in her calves while walking, which resolves with rest. What is the likely diagnosis?
Claudication due to peripheral arterial disease, a common issue in diabetic patients with compromised circulation.
A 70-year-old diabetic man complains of episodes of sweating, tremors, and confusion after missing meals. What is the likely cause?
Hypoglycemia, potentially due to insulin or oral hypoglycemic medications without adequate food intake.
A diabetic patient has recurrent episodes of foot infections that are slow to heal. What could be contributing to this?
Poor blood glucose control can impair immune function, increasing the risk of infections and delaying wound healing.
A 50-year-old diabetic woman presents with loss of vibration sensation in her toes. What test might confirm this finding?
Tuning fork test, which can reveal diminished vibration sense, indicating peripheral neuropathy.
A patient with Type 2 diabetes reports chest pain and shortness of breath. What complication should be considered, even if they have minimal pain?
Silent myocardial infarction, as diabetic neuropathy can cause atypical presentation of cardiac ischemia.
A 65-year-old man with a history of poorly controlled diabetes presents with leg swelling, jugular venous distention, and decreased breath sounds. What complication is likely?
Diabetic cardiomyopathy or congestive heart failure, possibly due to longstanding diabetes leading to heart muscle dysfunction.
A diabetic patient complains of blurry vision but no pain. Fundoscopy reveals microaneurysms and dot hemorrhages. What stage of retinopathy does this indicate?
Non-proliferative diabetic retinopathy, characterized by microvascular changes like microaneurysms and hemorrhages.
A 58-year-old diabetic patient presents with a red, swollen foot but reports no pain. What underlying condition might this suggest?
Charcot foot, a severe complication of diabetic neuropathy, where repeated minor trauma goes unnoticed due to loss of sensation.
A diabetic patient presents with lightheadedness and nausea upon standing. What is the likely cause?
Autonomic neuropathy, which can cause postural hypotension due to impaired vascular regulation.
A diabetic patient reports frequent nocturnal sweating, nightmares, and morning headaches. What phenomenon could be responsible?
The Somogyi effect, where nocturnal hypoglycemia triggers a rebound hyperglycemia in the morning.
A patient with diabetes has been experiencing delayed wound healing on their lower extremities despite proper hygiene. Laboratory results reveal high triglycerides and low HDL cholesterol. What factor is likely contributing?
Dyslipidemia, common in diabetes, which can worsen vascular health and impede wound healing.
A patient presents with intermittent diarrhea, bloating, and abdominal discomfort. They have a longstanding history of diabetes. What condition might explain these symptoms?
Diabetic autonomic neuropathy affecting the gastrointestinal tract, leading to gastroparesis or diabetic enteropathy.
A 45-year-old diabetic patient has blood glucose levels within the target range but exhibits irritability, confusion, and dizziness. What could explain this?
Hypoglycemia unawareness, a condition where the patient does not recognize the early symptoms of low blood glucose, which can occur in longstanding diabetes.
A 62-year-old diabetic man has dry gangrene of the toes and diminished pulses. What is the primary mechanism behind this condition?
Peripheral arterial disease with ischemia, often due to atherosclerosis accelerated by diabetes.
A diabetic patient with high blood pressure and proteinuria on urinalysis is noted. What complication is developing, and how should it be managed?
Diabetic nephropathy; management should focus on blood pressure control, glycemic control, and potentially ACE inhibitors or ARBs to reduce kidney damage.
