Diabetes Mellitus Flashcards
Where is insulin produced?
produced in ß-cells of the islets of Langerhans of pancreas; they also produce glucagon and pancreatic polypeptide
- auto-immune destruction of B-cells
- may be triggered by viral infection (dependent on HLA gene subtype)
What is diabetes mellitus?
- deficiency of insulin
- resistance to effects of insulin
What is diabetes insipidus?
- deficiency of antidiuretic
What are the acute consequences of insulin deficiency?
- hyperglycaemia (to much glucose in the blood steam)
- ketosis (produced by break down of fat, makes you sick and in high concentrations can kill you )
- acidosis
- hyperosmolar state
What are the chronic consequences of insulin deficiency?
- cardiovascular disease
- nephropathy
- neuropathy
- retinopathy
In type 2 diabetes what are the causes of it?
- peripheral insulin resistance
- B-cells response to glocise delayed or absent
What is gestational diabetes?
- triggered by hormonal changes in pregnancy
- genetic predisposition
- resolves with delivery
What are the risk factors for gestational diabetes?
- maternal age (as you get older)
- family history of DM type 2
- African or North American native
- previous gestational diabetes
- previous baby over 4kg
- smoking
What are the dangers of gestational diabetes?
mother - greater risk of DM type 2 in later in life - hypertension - pre-eclampsia or eclampsia - obstructed labour Child - risk of DM type 2 later in life - risk of obestity later in life - macrosomia - neonatal hypoglycaemia - neonatal jaundice - respiratory distress syndrome
What can secondary diabetes mellitus?
- chronic pancreatitis
- cystic fibrosis
- pancreatic surgery
- haemachromatosis ( inherited iron deficiency)
- endocrine disease eg. Crushing syndrome
- Drug therapy eg. steroids
What are the symptoms of diabetes mellitus type 1 ?
- polyuria
- polydipsia
- hunger
- weight loss
- can be seen in type 2 but often camouflaged by other symptoms
Why do we get polyuria in type 1 diabetes?
- normal for glucose to be secreted into the urine
- high concentrations lead to glycosuria
- gycouria leads to osmotic polyuria
- polyuria leads to polydipsia
What are the diagnosistic test results for diabetes mellitus?
- fasting plasma glucose level at or above 7.0mmol/l
- plasma glucose at or above 11.1mmol/l two hours after a 75g oral glucose load
- random plasma glucose at or above 11.1mmol/l
What is ketoacidosis?
- rapid breakdown of fat and protein releases ketones and acids into bloodstream
- normally in type 1
- can lead to coma and death
What is hyperosmolar nonketotic state?
- severe dehydration
- seen in type 2
- can lead to coma and death
What can diabetic foot lead to ?
generalised sepsis and death
What is hypoglycaemia?
- insulin overdose, generally accidental
- it can present in misleading ways. brain not being given enough glucose, confusion - can lead to brain damage
- can lead to coma and death
What are the chronical presentations of diabetes?
- ischaemic heart disease
- stroke
- peripheral vascular disease
- retinopathy
- neuropathy
- nephropathy
- cataract
What is diabetic retinopathy?
- proliferation of blood vessels in the retina
- retinal haemorrhages
- fluid exudation into retina
- can cause them to go blind
What is diabetic neuropathy?
- peripheral numbness or tingling
- occasional neuropathic pain
- muscle weakness
- autonomic neuropathy ( vomiting, diarrhoea, constipation, male impotence, incontinence, anorgasmia, postural hypotension)
- damage to kidney as glomerulus cant filter out all of the glucose
- Infections can occur in diabetic patients. such as more likely to get?
- osteomyelitis
- septicaemia
- post op infections
- rectal abscess
- pyelonephritis (infections in the kidney)
