Diabetes mellitus Flashcards
what percentage of all diabetes sufferers have diabetes type 1?
a) 5%
b) 10%
c) 50%
d) 100%
b) 10%
which gene is diabetes type 1 associated with?
HLA
what occurs to the pancreas in type one diabetes?
beta cell destruction
absolute insulin deficiency
how do DMT1 patients normally first present?
Diabetic ketoacidosis
Presenting symptoms of T1DM? (4)
Polyphagia
Polydipsia
Polyuria
Glycosuria
Pathophysiology of T1DM?
Destruction of b cells so less insulin released. This means that there is less glucose taken up from the blood into tissues. There is a high level of glucose in the blood causing many symptoms
What age does T1DM affect?
Before puberty
what 2 substances will be present in the urine of a patient with DMT1?
ketones
glucose
give 2 risk factors for diabetes type 1
family history
other autoimmune conditions
what enzyme is used in diagnostic antibody testing for DMT1?
Glutamate acid dehydrogenase
The level will be low because in T1DM» there are anti GAD antibodies that attack GAD
Main complication of T1DM and describe it
DKA
Adipocytes are not receiving enough food because of a lack of glucose in cells» lots of glucose in blood but not in cells.
Fats are metabolised by the adipocytes to form fatty acids.
Fatty acids are converted to ketones by the liver through ketosis.
Ketones are converted to keto acids which accumulate in the blood.
Blood acidity increases which causes many symptoms
Presentation of DKA? (4)
Kussmaul breathing
hyperkalaemia» tall tented t wave
Sweet breath
nausea and vomiting
Why does metabolic acidosis from DKA cause hyperkalaemia?
Because every cell needs at least H+ or K+ inside it.
In acidosis, there is lots of H+ in the blood so it’s pumped into the cells through the H+/K+ transporter so lots of K+ is pumped out of the cells into the blood» HYPERKALAEMIA
what will be present to smell on the breath of someone with DMT1?
ketones on breath
dx of T1DM (3)
Venous glucose is high on 2 measurements
Fasting glucose is >7
Urinalysis shows high glucose
Mx of T1DM? (4)
1) educate about glycaemic control
2) short acting and long acting insulin
3) Regular capillary blood glucose testing
4) Hba1c every 3-6 months
what would be first line treatment for a DKA and DMT1 in general?
insulin
why would you give potassium in treatment for a DKA?
to prevent rebound hypokalaemia in response to hyperkalemia in DKA
why don’t DMT1 patients get AKI as soon as expected in a DKA?
polyuria is a protective factor for the kidney
why does caution have to be exercised in giving fluids in a DKA?
to avoid cerebral overload as brain hydration is maintained
Define T2DM
Body is producing insulin but the receptors are insensitive to insulin»> blood glucose is very high as a result
Cause of t2dm?
Prolonged poor diet» too much sugar intake for a long time
App Ix of T2DM (4)
Fasting glucose
non fasting glucose
oral glucose tolerance test
Hba1c» greater than 6.5% is diabetes
Presentation of t2dm?
Polyuria
Polydipsia
Blurred vision
Complication symptoms» e.g. macro and microvascular
