Diabetes Mellitus

Question 1

Type 1 DM Pathology

Answer 1

Metabolic disorder characterised by hyperglycaemia due to absolute insulin deficiency

• Destruction of pancreatic beta cells
• DO NOT PRODUCE INSULIN

Question 2

Type 2 DM Pathology

Answer 2

Progressive disorder defined by deficits in insulin secretion and action that lead to abnormal glucose metabolism.
Preceded by pre-diabetes.
- INSULIN DESENSITISATION

Question 3

Type 1 DM Aetiology

Answer 3

Genetic predisposition + trigger?

• Autoimmune (FH)
• Viral infection

Idiopathic

Question 4

Type 2 DM Aetiology

Answer 4

• Older age
• Obesity
• Pregnancy
• FH
• Physical inactivity
• PMH: CVD, hypertension, stroke, PCOS

Question 5

Diabetes Mellitus Symptoms

Answer 5

• Polyuria
• Nocturia
• Polydipsia
• Weight loss
• Blurred vision
• Nausea + vomiting
• Abdominal pain
• Tachypnoea/cardiac
• Lethargy
• Coma
• Low grade infection: candida, skin, UTI
• Ketone breath, dehydration, hypotension (T1 only)
• Asymptomatic (T2 only)

Question 6

Diabetes Mellitus Complications

Answer 6

• Diabetic ketoacidosis (T1 only)
• Retinopathy
• Neuropathy
• Nephropathy
• Vascular disease
• Ulcers
• Charcot foot
• ED
• Depression

Question 7

Diabetes Mellitus Investigations

Answer 7

• Plasma glucose: random, fasting, 2-hour
• OGTT
• Plasma/urine ketones
• HbA1c (T2 only)

Question 8

Diabetes Mellitus Monitoring

Answer 8

• Acute: urine testing, capillary BG

- Chronic: BG, HbA1c, urine albumin

Question 9

Diabetes Mellitus Management

Answer 9

Insulin
Metformin
Complications: laser photocoagulation, ACEI’s, foot care

Question 10

Diabetic ketoacidosis (T1)

Answer 10

Triad

1. Hyperglycaemia
2. Ketonaemia
3. Metabolic acidosis

Investigations

• Venous blood gas
• Blood ketones
• Blood glucose and K+
• U&Es
• FBC

Management

• IV fluids
• Insulin
• Treat possible complications

Question 11

Maturity onset diabetes of the young (MODY)

Answer 11

Genetic (autosomal dominant) mutation resulting in impaired beta cell function
- Glucokinase mutation
- Transcription factor mutation
Management: diet, oral hypoglycaemics, insulin

Question 12

Secondary diabetes

Answer 12

Disease of the exocrine pancreas, endocrine and medication associated with development of diabetes

• CP
• Haemochromatosis
• CF
• Acromegaly
• Cushing’s
• Glucagonoma
• Phaeochromocytoma
• Steroids