Diabetes Mellitus Flashcards
Diabetes mellitus
a group of metabolic disorders characterized by chronic hyperglycemia due to insulin deficiency or insulin resistence or both.
type 1 diabetes?
cause?
a genetic predisposition ot the disease interacts w/ envorionmetsl trigger to produce immune activation
this leads to the production of killer lymphocytes and macrophages and antibodies that attack & pregressively DESTROY B CELL (autoimmune process)
(the genetic predisposition is assciated with the genetic markers HLA DR3, HLA DR4
what r the major symptoms of diabetes Type 1?
when do they occur?
Rapid onset (usually weeks) !
what causes weight loss in diabetes type 1?
even tho theres a lot of glucose in the blood, it cant get into cells> this leaves cells staved for energy!> so adipose tissue starts breaking down its fat and muscle breaks down as protein
what is polyphagia? why does it develop in type 1?
feeling of hunger!>> bc their body is breaking down fat and protein for energy!
what causes Polyuria?
when large quantities of glucose in the blood r filtered by the kidneys, not all of it is reabsorbed! this extra glucose remains in the kidney tubule and pulls water with it>>pee alot! and can cause dehydration!!
what is and causes polydypsia?
thirsty!>> due to polyuria and osmotic effects of glucose on thirst centres!
Diabetes diagnosis
- random= 11.1 mmol/L
- fasting plasma glucose= 7.0mmol/L
- Two hour plasma G more than or = to 11.1mmol/L after 75g anhydrous glucose in an oral glucose tolerance test (OGTT)
HbA1c is not appropriate or diagnoses of diabetes in patients of any age suspected of having type 1 diabetes
Type 2 diabetes?
cause?
insulin is still being made but….
either the body isnt producing enough insulin!
or insulin isnt working properly in the body
what is insulin resistance?
The cells in your body do not use insulin properly, the cells in your body become resistant to normal levels of insulin.
This means that you need more insulin than you normally make to keep the blood sugar (glucose) level down.
what causes insulin resistence to develop?
- Obesity – in particular central obesity
- Accounts for 85% of the risk for developing diabetes • Muscle and liver fat deposition
- Elevated circulating Free fatty acids
- Physical inactivity
- Genetic influences
Age onset btw the 2?
Type 2: older
- Most are over 40 years of age
- Increasing seen in younger people and children
- 90% are overweight or obese
- no KETONES PRESENT
Type 1:
• Usually, but not always, young < 30 years
URINARY KETONES PRESENT
A level of _________ or more in the blood sample indicates that you have diabetes
11.1 mmol/L
A fasting glucose level of ______ or more indicates that you have diabetes.
7.0 mmol/L
what is the HbA1c blood test?
what r abnormal levels?
If you have diabetes, your HbA1c level may be done every 2-6 months by your doctor or nurse. This test measures your recent average blood sugar (glucose) level.
above 6.5%!
The test measures a part of the red blood cells. Glucose in the blood attaches to part of the red blood cells.
This part can be measured and gives a good indication of your average blood glucose over the previous 2-3 months.
Extra info: GLucos**e in the blood reacts with the terminal of valine of Hb to make GLYCATED Hb (HbAc1)
what should be done at every follow up for type 1 diabetes in GP
At every review appointment–> SHAMB
- HbA1c measure
- BMI
- Assess for depression, anxiety & eating disorders
- Smoking status check
- Monitor neuropathy & complications – erectile dysfunction, neuropathic pain, autonomic neuropathy, gastroparesis
Once a year
- Check infection sites
- Ensure screening for
- Retinopathy
- Nephropathy
- Diabetic foot problems
- CVS risk factors
- Thyroid disease
Be alert for the possibility of the development of other autoimmune disease:
o Coeliac disease
o Addison’s disease
treatments of type 1?
no treatment.
manage with insulin injecitons! (subcutaneous)
they must measure their blood glucose frequently via fingerprick and BM stick and reader
treatments/managments of type 2?
sulphonylureas & metformin
what do sulphonylureas do?
managed by diet or oral Hypoglycemic drugs! such as
Sulphpnylureas
inhibit the Atp -voltage gated K+ channels>
to treat diabetes type 2, blocks K+ channels > memebrane is more easily depolarized, more Ca2+ comes in>> more insulin released!….YAAAAY
what is Insulitis ?
Insulitis - inflammation of the islets
Chronic inflammatory mononuclear cell infiltrate consisting of T-lymphocytes and macrophages is found associated with the islets of newly diagnosed type-1 diabetics
pic
cool
BMI values
which typre r more at risk in getting diabetic keto-acidosis and why?
most common cause of DKA?
Type 1
due to severe or abosulte deficiencyof insulin!
or
they havent been diagnosed earlier enough
or their demand of insulin increased!
Infection or missed insulin dose (pump failure)
normally what happens in ur fat cells when u have just eaten a meal? (glucose levels rise)
when ur eating, glucose levels in the blood goes up>>insulin levels goes up>>and insulin mediated entry into the fat cells (GLUT 4) help in the synthesisif glycerol and eventually synthesis of TAG
ketone bodeis formation
Diagnosis criteria of DKA?
- must do VBG, urine dip. glucose measure
- PH= less than 7
- Glucose= 11mmol/L
- ketones= +3mmol/L or ++urinary ketones
Metabolic syndrome?
what causes it?
cluster of the most dangerous risk factors associated w/ CVS disease > diabetes, raised plasma G, abdominol obesity, high cholestrol, high Bp
Insulin resistance and central obesity, genetics, physical inactivity, ageing
in type 1, how can insulin deficiency lead to DEATH?
explain the consequences in untreated diabetes type 1!
managment of type 2 in order…
ok
what r some chronic complication of diabetes?
Metabolic consequences of persistent hyperglycemia?
some tissues do not require insulin for the uptake of glucose, ex: peripheral nerves, eyes, kidenys.
Glucose is metabolised via aldose reductase into Sorbitol, accumalation of sorbitol causes osmotic damage to cells!
this reaction depletes the cells NADPH!>>
leading to increased disulfide bond formation in pretiens> altering their structures and functions!
Also, peresistne thyperglycemia is assosicated w/ increased Gylcation
how do u get diabetoic eye disease?
damage to BV in the retina can leak and form protein exuadate, also new vessels can from (proliferative retinopathy) which r very weak and can bleed easily!
what is happening in Diabetic nephropathy
there is damage to the glomeruli and the blood vessels supplying it!.
an early sign of nephropathy is an increase in the amount of protein in the urine! (microalbuminuria)
diabetic foot causes?
poor blood supply to the nerves supplying the arteries of the foot “vasa nervorum” >> increased risk of infection>> Gangrene
diabetic neuropathy?
results in demyelinating effect>> effects shwann cells>>
u get thickening of the cessel wall that supplies the nerve!
What should be considered when there is acute painful neuropathy after rapid improvement of blood G control?
- Acute painful neuropathy can result from rapid improvement of BG control. This is a self-limiting condition that improves symptomatically over time
- Tx aim to make symptoms tolerable until the condition resolves. They may not relieve pain immediately & may need to be taken regularly for several weeks to be effective
- Simple analgesics (paracetamol, NSAIDs) and self-care measures (bed cradle – frame that attaches to beef to keep sheets & blankets from touching or rubbing the body) can relieve symptoms
- If this does not work, treat as neuropathic pain
- DO NOT RELAX BLOOD GLUCOSE DIABETES CONTROL IF THIS CONDITION IS IDENTIFIED
List the classic triad of symptoms you would expect to see in a patient with Type 1 diabetes mellitus
Polyuria (excess urine production)
Polydipsia (excessive thirst)
Weight loss as protein and fat are metabolised due to absense of insulin
what r the feautures of diabetic ketoacidosis?
how do u test for it in someone w/ diabetes?
prostration, hyperventilation, nausea, vomiting, dehydration and abdominal pain
urine)
why does insulin have to be injected and cannot be taken orally in pill form?
Insulin is a peptide hormone so would be broken down in the GI tract to its consituent amino acids
Metformin has been widely used to treat type 2 diabetes in the UK since the 1950’s. What is the mode of action of metformin?
Metformin inhibits hepatic gluconeogenesis. This would act to lower plasma glucose which is the desired effect in a patient with Type 2 diabetes
DKA oathophysilogy
What is reactive hypoglycemia
Or sugar crash,
describes recurrent episodes of symptomatic hypoglycemia
(postprandial hypoglycemia) refers to low blood sugar that occurs after a meal — usually within 4 hours after eating
u ate so many carbs mara wa7da, goom il pancreas yi6ala3 wayid insulin and cause HYPOGLYCEMIA
Causes of diabetes
(vit C seive)
Pamcreatitis, pamcretectomy, cushings, heamacromatosis, cystic fibrosis,
DRUGS>> steroids, B blockers, thiazide
tumor>> pancreatic carcinoma
Metabolic>>acromegaly
trauma
What is HONK
Hyperglycaemic hyperosmolar non-ketotic coma is a dangerous condition brought on by very high blood glucose levels in type 2 diabetes (above 33 mmol/L).
Hyperglycaemic hyperosmolar non-ketotic coma is a short term complication requiring immediate treatment
Causes of hyperglycaemic hyperosmolar non-ketotic coma may include undiagnosed type 2 diabetes that has been developing over a number of years.
What is Hypo unawareness
Patient will not notice hypoglycemia bc he will no longer develop symptoms of hypogylcemia and that will happen due to the, having frequent hypoglycemic episodes
or having stress and alcholol makes it worse
improved by kncreasing glucose concentration
MUST NOT DRIVE
In type 2 diabetes when is it necessary to add a second drug to in addition to meatformin
If hbac1 is more than 58mmol per L
Type 2 diabetes bp target
with and without end organ damage
Type 2 diabetes blood pressure target
- no organ damage: < 140 / 80
- end-organ damage: < 130 / 80
What is maturity-onset diabetes of the young (MODY) characterized by?
is characterised by the development of type 2 diabetes mellitus in patients < 25 years old.
It is typically inherited as an autosomal dominant condition.
Over six different genetic mutations have so far been identified as leading to MODY.
Name some causes that
Lower-than-expected levels of HbA1c and vise versa
What is a important complication of fluid resuscitation in DKA
Cerebral edema
comfusion and slurred speech
How is insuloma diagnosed
This is diagnosed by Whipple’s triad:
- Symptoms and signs of hypoglycemia
- Plasma glucose < 2.5 mmol/L
- Reversibility of symptoms on the administration of glucose
GP
type 1 diabetes advice plan
Provide information on
o Communicating with the diabetes specialist team
Manage lifestyle issues o Diet
o Exercise
o Alcohol intake
Provide-up-to-date information on diabetes support groups
o Diabetes UK
How often should blood sugar self monitoring be in type 1?
this increases in certain situations, name some?
At least 4x day , before meals and bed
more frequent testing in periods of illnesses, hbacI1 not acheived, driving
Referrel in type 1 (gp)
Offer a structured education programme of proven benefit – DAFNE (dose-adjustment for normal eating programme)
- Offer this 6-12 months after diagnosis or at any time that is clinically appropriate and suitable for the person, regardless of duration of type 1 diabetes – this is because in the first months of taking insulin, the pancreas responds by producing insulin so there is little benefit in dose adjusting insulin during this period as insulin levels fluctuate
- o Explain to the patient that structured education is an integral part of diabetes care
When is C-peptide measured?
Consider measuring C-peptide after initial presentation if there is difficulty distinguishing type 1 diabetes from other types of diabetes.
Target blood glucose levels in type 1 vs type 2
What are the targets for cholesterol, TAGS and Bp in diabetic individuals?
- Cholesterol – <4mmol/l
- Triglycerides – <2mmol/l
- Blood pressure –
o Type 2 diabetes - <140/80mmHg (or 130/80 if there is nephropathy, retinopathy, or cerebrovascular damage)
o Type 1 diabetes – <135/85 (or 130/80 if albuminuria or greater than 2 features of metabolic syndrome)
