Diabetes Mellitus and DKA

Question 1

What is Diabetes Mellitus

Answer 1

A lack or insufficiency of insulin

Question 2

What does insulin do?

Answer 2

It facilitates cellular uptake of glucose

Question 3

How is DM classified?

Answer 3

Type 1 = insulin dependent, Type 2 = non-insulin dependent
Gestational diabetes, post-pancreatectomy, Cushing’s syndrome related, CF related, LADA, MODY, post infection

Question 4

What is T1DM?

Answer 4

Complete insulin deficiency, autoimmune, usually onset in youth, normal BMI, family history

Question 5

Aetiology of T1DM

Answer 5

Autoimmunity which attacks beta cells - associated with genetic factors e.g. genes with the human leukocyte antigen (HLA) (50%), the gene that codes for insulin

Question 6

Aetiology of T1DM - Viruses

Answer 6

Rubella infection & enteroviruses - molecular mimicry (immune response activated against self-antigens that resemble viral agents due to overlap of amino acid chains)

Question 7

Aetiology of T1DM - diet & gut microbiome

Answer 7

Early introduction of cow’s milk (contains protein similar to one in beta cells)

Question 8

Pathogenesis of T1DM

Answer 8

Development of auto-antigens> processed & presented by antigen presenting cells > T-helper cells activated> autoantibodies activate and attack beta cells > decreased insulin secretion > glucose in circulation cannot be taken into cell

Question 9

Initial symptoms of T1DM

Answer 9

Excessive urination (high levels of glucose cause kidneys to excrete more), thirst, dehydration, weight loss, weakness, fatigue, nausea, emesis, ketoacidosis

Question 10

Chronic symptoms of T1DM

Answer 10

Eye damage, nerve damage, feet problems, kidney problems, heart disease, hypoglycaemia (inappropriate treatment)

Question 11

T1DM Diagnosis?

Answer 11

Random + Fasting Glucose level (normal range for fasting is 4-5.9 mmol/l, post prandial is less than 7.8 mmol/l). Oral Glucose Tolerance Test- 75g glucose + blood sugar levels are monitored afterwards, HbA1c gives idea of the long term glucose trend (diabetic is 48> mmol/mol)

Question 12

T1DM Treatment

Answer 12

Insulin- three types - short acting insulin(action in 30 min), rapid acting(action in 1-3 hrs), intermediate and long lasting have a retardant to slow release insulin i.e zinc. Injection of insulin between fatty and muscle layer in upper outer thigh, upper buttock. Insulin pumps are less frequently used but these administer insulin automatically.

Question 13

T1DM Monitoring?

Answer 13

Home blood testing kits available to measure glucose levels.

Question 14

What is Diabetic Ketoacidosis (DKA)?

Answer 14

High serum glucose due to lack of insulin - body produces ketones due to cellular starvation of glucose.

Question 15

Roughly how many T1 Diabetics develop DKA?

Answer 15

around 4%

Question 16

What is the fatality risk of DKA with timely medical intervention?

Answer 16

up to 5%

Question 17

What are the main symptoms of DKA

Answer 17

Increased urine rate, thirst, abdominal pain, laboured breathing and coma.

Question 18

What are the causes of DKA

Answer 18

Having pre-existing T1DM, not adhering to monitoring and treatment regime, infectious illness (pneuomia, flu, COVID, gastroenteritis, or UTI), having a heart attack or stroke, cocaine cause.

Question 19

How is DKA diagnosed?

Answer 19

Measurement of blood pH (Acidosis), serum bicarbonate levels, serum glucose levels, measuring ions like sodium and potassium, measuring body’s electrolyte/water balance to check for increased osmolarity which happens when you’re dehydrated.

Question 20

What is the treatment for DKA

Answer 20

fluid replacement via IV Drip, Infusion of Insulin, monitor ions, glucose, pH, bicarbonate and osmolarity every 1-2 hours

Question 21

Gestational Diabetes

Answer 21

~Occurs in (late) pregnancy - usually heals after birth
~Impaired glucose tolerance - Beta cell dysfunction & chronic insulin resistance
~15% pregnancies -risk factors:overweight,PCOS, geriatric pregnancy (≥34), family history
~No cure

Question 22

Gestational Diabetes Diagnosis

Answer 22

OGTT & serum glucose levels

Question 23

T2DM Statistics

Answer 23

~ 10% of people >50 in ROI - 5.5% pre-diabetic
~ Economic burden
~ 87% increase in OPD visit, 52% hospital admissions, & 32% ED visists

Question 24

Symptoms T2DM

Answer 24

Polyuria, polydipsia, lethargy, irregular menstruation, increased hunger,dark patches in skin folds, weight loss, yeast infection

Question 25

T2DM

Answer 25

~Insulin resistance - initially causes and increased insulin production to maintain homeostasis - insulin production decreased due to increased stress on beta cells
~>45 years old - increase prevelance in youth
~ Linked with adipokine dysfunction (health regulators e.g. appetite, satiety, inflammation)
~abnornalities of gut microbiota
~Obesity
~Production of glucagon-like peptides (upregulate serum glucose conc.)

Question 26

T2DM Risk Factors

Answer 26

Age, obesity, pre-diabetic, gestational diabetes, high BP, High cholesterol and triglycerides, low HDL, steroid use, history of heart disease, PCOS, heritage (Asian, Hispanic, Afro-Caribbean, travelling community)

Question 27

T2DM pathogenisis

Answer 27

Insulin resistance due to beta cell dysfunction:
~Compensatory increase in insulin production (homeostasis)
~beta cells change - unable to maintain homeostasis - hyperglycaemia
~Increased abdominal visceral fat promotes insulin resistance due to inflammation and release of free fatty acids

Question 28

T2DM effects on body parts

Answer 28

Liver: insulin resistance and increased hepatic glucose output
Pancreas: decreased insulin secretion, increased beta cell apoptosis, decreased beta cell mass, hyperglucogonaemia
Muscles: insulin resistance
Gut: impaired incretion effect
Adipocytes: increased in fatty acids circulating, hyperlipidaemia

Question 29

T2DM diagnosis

Answer 29

Same as T1DM
HbA1c and serum glucose monitored

Question 30

T2DM treatment

Answer 30

LIFESTYLE CHANGE - improved diet, less alcohol, no smoking, weight loss, more activity
~Some medicine uses e.g. insulin to reduce blood glucose- risk of hypoglycaemia

Question 31

Diabetic Foot Syndrome

Answer 31

-Neuropathy occurs as a result of T1DM in eyes, ears and extremities
~Ulcers form- gangrene occurs as a result of deepening of ulcers
~Amputation