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MEH > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What is Diabetes Mellitus

What are the criteria for diagnosis

A

A group of metabolic diseases characterised by Chronic Hyperglycaemia and Elevated glucose in urine

  • Symptoms
  • Random plasma [glucose]> 11.1 mmol/L
    OR
    Fasting plasma [glucose]> 7.0 mmol/L
    OR
    2h after glucose in Oral Glucose Tolerance Test> 11.1 mmol/L
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2
Q

Differ between Absolute and Relative Insulin Deficiency

A

Absolute: Beta cells destroyed

Relative: Abnormally slow/ small secretory response of Beta cells

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3
Q

If a patient is symptomatic, how many tests must be abnormal for a diabetes diagnosis?

What if patient is asymptomatic

A

Symptomatic: 1 abnormal test

Asymptomatic: 2 abnormal tests

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4
Q

What is Type 1 Diabetes

It is caused by a mix of genetic and environmental factors, what 2 genetic markers are associated?

A

Absolute insulin deficiency due to autoimmune destruction of Beta cells

HLA DR3 and HLA DR4

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5
Q

What are 2 mechanisms of Type 2 Diabetes

A

Relative insulin deficiency

Insulin resistance

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6
Q

How does insulin resistance onset before 12 years, lead to type 2 diabetes

A

Initially;
- Beta cells increase insulin production to maintain normal blood glucose

Eventually;
- Beta cells unable to maintain increased insulin production

Finally;
- Beta cell dysfunction-> Relative insulin deficiency

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7
Q

What are the 2 groups of symptoms of Diabetes Mellitus?

Give 3 examples of each

A

Symptoms due to hyperglycaemia;

  • Polyuria (Excess urine)
  • Polydipsia (Thirst)
  • Blurred vision

Symptoms due to inadequate energy utilisation;

  • Tiredness
  • Weakness
  • Weight loss
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8
Q

Name 4 symptoms of Type 1 Diabetes

In late stage, what may be detected in urine?
What does this mean?

A
  • Weight loss
  • Polyuria
  • Polydipsia
  • If late presentation, vomiting due to Ketoacidosis (Fatal)
  • Ketones in urine, means lack of insulin
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9
Q

How is Type 1 diabetes treated?

If ketones are seen in urine, what do you do?

A

Exogenous insulin injected subcutaneously several times a day for life

Immediate insulin therapy

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10
Q

What are 3 characteristics of Ketoacidosis

A

Hyperglycaemia
Ketonaemia
Acidosis

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11
Q

What is Type 2 Diabetes

A

Long-term metabolic disorder characterised by Hyperglycaemia, insulin resistance, and relative insulin deficiency

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12
Q

Name 5 causes of insulin resistance

A
  • Obesity
  • Fat deposition in muscle and liver
  • Physical inactivity
  • Genetics
  • Elevated circulating free fatty acids
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13
Q

Are Type 2 Diabtes patients symptomatic?

Compare the rise in blood glucose to that of Type 1?

Name 2 drugs used to manage Type 2 diabetes, describe how they work

A
  • May be asymptomatic
  • Type 2: Slower rise in blood glucose than in Type 1
  • Sulphonylureas: Reduce insulin resistance and increase insulin release from remaining Beta cells
  • Metformin: Reduces gluconeogenesis
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14
Q

If symptomatic, name the symptoms of Type 2 Diabetics

Can ketones be found in urine?

A
  • May have Polyuria, Polydipsia, weight loss (Classical triad)
  • No ketones in urine
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15
Q

Other than Sulphonylureas and Metformin, suggest 2 management techniques for Type 2 Diabetes

A
  • Lifestyle changes

- Insulin

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16
Q

Describe 3 metabolic consequences of Persistent Hyperglycaemia

A
  1. Increased [Glucose} in cells;
    - NADPH depleted to make Sorbitol
    - Disulphide bonds-> Altered cell structure/ function
    - Sorbitol causes osmotic damage
  2. Increased glycation (Non-enzymatic glycosylation) of plasma proteins;
    - Altered function
  3. Formation of Glycated Hb (HbA1c)
17
Q

How much Hb is Glycated (HbA1c) in;

  • Normal healthy people
  • Poorly controlled diabetics
A

Normal: 4-6%

Poorly controlled Diabetics: 10% or more

18
Q

Identify 1 ACUTE complication each of Hyperglycaemia and Hypoglycaemia due to Diabetes

A
  1. Hyperglycaemia- Massive metabolic decompensation
  • Diabetic Ketoacidosis in Type 1
  • Hyperosmolar non-ketotic Syndrome in Type 2
  1. Hypoglycaemia- Coma due to hypoglycaemic therapy
19
Q

What are 2 groups of chronic complications of Diabetes?

Give 3 examples and 5 examples

A
  1. Macrovascular disease;
    - Stroke
    - Myocardial Infarction
    - Poor circulation to periphery
  2. Microvascular disease;
    - Diabetic eye disease (Lens change due to glucose’s osmotic effects)
    - Retinopathy (Damaged blood vessels in retina-> Blindness)
    - Nephropathy (Poor blood supply damages glomerulus)
    - Neuropathy (Peripheral nerve damage-> Sensation loss)
    - Diabetic feet (Poor blood supply, nerve damage, ulcers, increased infection risk)
20
Q

What is Metabolic Syndrome

A

A cluster of the most dangerous risk factors associated with Cardiovascular Disease;

  • Diabetes + Raised fasting plasma glucose
  • Abdominal/ Central obesity
  • High cholesterol
  • High Blood Pressure
21
Q

List 5 causes of Metabolic Syndrome

A
  • Insulin resistance
  • Central/ abdominal obesity
  • Genetics
  • Physical inactivity
  • Ageing
22
Q

What are the 5 criteria for having Metabolic Syndrome

A
  1. Waist measurement (> 94cm men/ >80 cm women)

Plus any 2 of;

  1. Raised triglyceride
  2. Reduced HDL
  3. Raised BP
  4. Raised fasting blood glucose
23
Q

What does Aetiology mean?

What are the 2 most important factors underlying the aetiology of Metabolic Syndrome?

A

Underlying cause of a disease

Insulin resistance
Central obesity

24
Q

Which change in DNA makes you more susceptible to Diabetes, Obesity and Cardiovascular disease in adult life?

A

DNA Methylation

MEH (20 decks)

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