Diabetes Mellitus Flashcards
What is diabetes?
Chronic hyperglycaemia
At levels able to cause specific microvascular complications
How many people have diabetes in Wales?
3 million people live in Wales
150,000
5%
Diabetic 2hr/random glucose
GTT (glucose tolerance test)
> 11.1 mmol/L
Diabetic fasting plasma glucose
> 7 mmol/L
Symptoms of diabetes
Polydipsia Polyuria Blurred vision- changes in lense due to osmotic affect of high sugar - rectified when glucose is controlled Thrush Weight loss in T1
Diabetic random HbA1c
> 6.5%
Doesn’t work in sickle cell or anaemia
Impaired glucose tolerance
Fasting b g 7
Random 7.8-11.1
Cardiovascular risk
Impaired fasting glycaemia
F b g 6.8
Types of diabetes
T1- damages Beta cells- can’t make insulin- immune mediated
T2- insulin resistance- have insulin, doesn’t work too well. Sometimes can’t make it too we’ll either.
Other- MODY, exocrine pancreas disease, pancreatitis, endocrineopathies (eg Cushing’s), drugs, genetic syndromes
Gestational - hormonal pressure of pregnancy- more insulin resistance- come out of it after placenta is delivered
Autoimmune cause of diabetes
T cells destroy Beta cells
Anti GAD, IA2, ZnT8, islet cell Abs
Genetics of diabetes
Caucasian
HLA DR3
Lots of genes involved- all contribute
HLA has the biggest effect
All genes (bar 1) are to do with the immune system
Affects insulin expression in THYMUS gland
Clinical features of T1
Slim Age 0.5-70 Median age is around 12 Present with weight loss Rapid onset (pathogen exist goes on for a long time though) Ketoacidosis prone Absolutely insulin dependant - can reduce dose if not eating but NEVER stop 85% have no family history
What causes type 2 diabetes?
Insulin resistance
Lipotoxicity? Affect of FA?
Adipokines made by fat?
Liver fat deposition :( liver becomes insulin resistance
Affects liver function- insulin goes to liver first
Genetic predispositions
Non Caucasians
Genes that increase weight
FTO
Genes that increase insulin resistance
PPARG
2 things required to get T2 diabetes
Insulin resistance &
Impairment of insulin production
Key clinical feature of T2 diabetes
BMI >25 (usually >30) Family history Asian/afrocarribean Asymptomatic (70%) Diet controlled initially- red glucose & red weight Can be reversed by marked weight loss
Why can someone with T2 look thin?
Lipodystrophy
Large livers stuffed with fat
Treatment of diabetes
Diet- carb input (T1), red calories (T2)
Exercise (especially T2) - protect against CV disease
Insulin sensitising agents- T2 only: metformin, (glitazones)
Insulin secreting agents - T2 only: sulphonylureas, incretin mimetics
Calorie intake reduction agents
Insulin
Problem with glitazones
Weight gain
Name a sulphonylurea
Gliclazide
Drugs that treat diabetes by reducing calorie intake
Orlistat…
Additional treatments to lower CV risk
Statins
BP tablets
Stop smoking