Diabetes mellitus

Question 1

What is diabetes?

Answer 1

Hyperglycaemia

over years

Question 2

What are the groups of symptoms of diabetes mellitus?

Answer 2

Symptoms due to hyperglycaemia

Symptoms due to inadequate utilisation of glucose

Question 3

What are the symptoms due to hyperglycaemia?

Answer 3

Polyuria

Polydipsia

Blurring of vision

Urogenital infections - thrush

Question 4

What are the symptoms of inadequate utilisation of glucose?

Answer 4

Lethargy

Weight loss

Question 5

What is polyuria?

Answer 5

Increased urine

Question 6

How does diabetes cause polyuria?

Answer 6

Blood glucose rises above renal threshold 10mM
glucose in urine
draws water out of cells
gives increased volume of urine

Question 7

What is polydipsia?

Answer 7

Increased thirst

Question 8

How does diabetes cause polydipsia?

Answer 8

Increased urine production leads to dehydration

Question 9

How does diabetes cause urogenital infections?

Answer 9

Increased glucose in urine

predisposes to infection

Question 10

How does diabetes cause lethargy, weight loss?

Answer 10

Not able to use glucose from diet

Have to mobilise energy stores

Question 11

What do the severity of the symptoms of diabetes depend on?

Answer 11

Rate of rise of blood glucose

Absolute levels of blood glucose achieved

Question 12

How is diabetes diagnosed?

Answer 12

Fasting glucose - raised (above 7mM)

Oral glucose tolerance test

HbA1c - raised (above 6.5%)

Symptoms + 1 abnormal test
Asymptomatic + 2 abnormal tests

Question 13

What is HbA1c a measure of?

Answer 13

How much glucose is attached to red blood cells

Question 14

How can diabetes be prevented?

Answer 14

Lifestyle changes

• eating healthier
• increased exercise

Question 15

Which type of diabetes is seen in younger people?

Answer 15

Type 1

Question 16

What causes type 1 diabetes?

Answer 16

Autoantibodies against pancreatic beta cells

destruction of beta cells

Question 17

What are insulin levels in type 1 diabetes?

Answer 17

Absolute lack of insulin

Question 18

How does type 1 diabetes present?

Answer 18

Onset of polyuria, polydipsia, weight loss over a few weeks

Elevated ketone bodies in blood

Vomiting due to ketoacidosis

Question 19

How is the presence of ketones confirmed?

Answer 19

Presence of ketones in urine

measured by ketostik

Question 20

How is type 1 diabetes treated?

Answer 20

Exogenous insulin
given via subcutaneous injection
dose and type depends on many factors

Question 21

What type of diabetes has increased over the past few years?

Answer 21

Type 2

Question 22

What is the age range for type 2 diabetes?

Answer 22

Most patients are older than 40

Question 23

What group of people is type 2 diabetes increasing in?

Answer 23

Younger people

children

Question 24

Most patients with type 2 diabetes are..?

Answer 24

Overweight or obese

Question 25

What causes type 2 diabetes?

Answer 25

Cells are resistant to insulin

Question 26

What causes insulin resistance in type 2 diabetes?

Answer 26

Abdominal obesity in Fat deposition in muscle and liver Elevated circulating free fatty acids Physical inactivity Genetic influences

Question 27

What are the symptoms of type 2 diabetes?

Answer 27

May be asymptomatic May have weight loss, polyuria, polydipsia

Question 28

Are ketone bodies synthesised in type 2 diabetes? Why?

Answer 28

No | because have high enough levels of insulin to inhibit ketone body synthesis

Question 29

How is type 2 diabetes treated?

Answer 29

Changes in lifestyle Non-insulin therapies Insulin Lower other risk factors e.g. hypertension, hyperlipidaemia, smoking Surveillance for chronic complications

Question 30

What are some examples of non-insulin therapies?

Answer 30

Biguanides e.g. metformin GLP1 analogues SGLT2s

Question 31

Why is insulin given in later stages of type 2 diabetes?

Answer 31

Beta cells in pancreas die eventually

Question 32

How is type 2 diabetes prevented?

Answer 32

Maintain healthy body weight BMI = 18.5 - 24.9kg/m2 Exercise

Question 33

What happens if type 2 diabetes is untreated?

Answer 33

Worsening of symptoms Develop complications of diabetes

Question 34

What are the acute complications of hyperglycaemia?

Answer 34

Type 1 - ketoacidosis

Question 35

What are the acute complications of hypoglycaemia?

Answer 35

Coma

Question 36

How does diabetes affect blood vessels?

Answer 36

Damages endothelial lining of blood vessels

Question 37

What are the complications of damage to the endothelium?

Answer 37

Atherosclerosis Thrombosis

Question 38

What are the chronic complications of diabetes?

Answer 38

Vessel disease Capillary disease

Question 39

What are the different types of vessel disease? What do they each lead to?

Answer 39

Cerebrovascular disease - stroke Cardiovascular disease - angina, MI Peripheral vascular disease - gangrene

Question 40

What are the different types of capillary disease? What do they each lead to?

Answer 40

Retinopathy - blindness Nephropathy Neuropathy - foot ulceration because can't feel pain in it

Question 41

What is metabolic syndrome?

Answer 41

Group of risk factors | associated with cardiovascular disease

Question 42

What are some of the risk factors that lead to cardiovascular disease in metabolic syndrome?

Answer 42

Diabetes High fasting plasma glucose Hypertension High cholesterol Abdominal obesity

Question 43

What is measured to confirm metabolic syndrome? How many does a person need to have to be diagnosed with metabolic syndrome?

Answer 43

Waist measurement - large Triglyceride - raised HDL - raised Blood pressure - raised Blood glucose - raised Three

Question 44

What factors can lead to metabolic syndrome?

Answer 44

Physical inactivity Abdominal obesity Genetics - runs in families Insulin resistance