Diabetes mellitus clinical Flashcards
Common symptoms of type 1/type 2 DM (7)
Polydipsia (excessive thirst) Polyuria (excessive urinating) Blurred vision Weight loss (unexplained) Fatigue Thrush/genital itching Increased vulnerability/recurrent infection
Diagnostic investigations of diabetes mellitus (4)
Fasting plasma glucose ≥ 7.0 mmol/l
Random plasma glucose ≥ 11.1 mmol/l
Oral glucose tolerance test 2hr after 75g oral glucose load ≥11.1 mmol/l
HbA1c ≥ 48 mmol/mol (type 2 only)
People with intermediate hyperglycaemia are at risk of what
future diabetes
If have the classic diabetes symptoms, how many diagnostic investigations needed
ONE LAB GLUCOSE
If no classic diabetes symptoms, how many/ what diagnostic investigations needed
TWO LAB GLUCOSE (e.g. random and fasting)
or
just HbA1c
What is HbA1c
Glycated haemoglobin
HbA1C gives an indication of BG levels over what time period
last 3 months
Does glucose reversibly or irreversibly bind to Hb
Irreversibly
When HbA1c can’t be used for diagnosis (6)
All children
If pregnant
Acutely ill
If have been on mediation that can cause rapid glucose rise <2 months
Acute pancreatic damage/ if had pancreatic surgery
Post-blood transfusion
Only hormone that lowers BG
Insulin
Summarise the factors which may contribute to beta cell damage and the eventual clinical presentation of type 1 DM (2)
Genetic factors
+
Environmental factors
-e.g. viral infection
What are ketones produced from + where
Free fatty acids
produced in liver
Symptoms (3)/signs (5) of DKA
Symptoms
- Nausea
- Vomiting
- Abdo pain/tenderness
Signs:
Ketones in breath (acetone breath)
Tachypnoea/kussmaul breathing (rapid deep breathing)
Tachycardia
Hypotension
Dehydration (fluid depletion) –> dry mucous membranes, sunken eyes
In type 2 DM, what is wrong with the beta cells
Due to insulin resistance, glucose persists in blood so beta cells compensate for this by increasing insulin secretion
However beta cells become damaged by lipotoxicity and glucotoxicity and eventually can no longer compensate –> hyperglycaemia
Summarise what type 2 DM is a result of (2)
insulin resistance and subsequent B cell dysfunction
Which type of DM may present with no symptoms
2
What sign of DM is present in type 1 but not type 2
Ketones in breath or urine
Risk factors of type 2 DM (5)
Overweight Family history of DM >40yrs old Gestational diabetes Sedentary lifestyle/lack of exercise
Other types of diabetes mellitus that are not type 1/2 (3)
Genetic syndrome
-maturity onset diabetes in the young (MODY)
Gestational diabetes
Secondary diabetes
What is maturity onset diabetes in the young (MODY)
Single gene defect resulting in reduced insulin production
Most are due to mutations of transcription factor genes
Maturity onset diabetes in the young (MODY) is a single gene defect of either … or … (2)
Transcription factor genes
- HNF-1a
- HNF-1b,
- HNF-4a
Glucokinase gene
Most common form of maturity onset diabetes in the young (MODY) is due to a single gene defect in what gene
HNF-1a (a transcription factor gene)
How does maturity onset diabetes in the young (MODY) due to a glucokinase mutation present
- normal function of glucokinase
- how it presents
- any treatment
Glucokinase helps the body to recognise how high the blood glucose level is so when it isn’t working properly, the body allows the level of blood glucose to be higher than it should be
typically only slightly higher than normal so don’t generally have symptoms
No medical treatment needed
How does maturity onset diabetes in the young (MODY) due to a HNF-1a (transcription factor) present
- age onset
- pathology
- any treatment
Usually in adolescence/ early 20s
Reduces insulin production by pancreas
Generally don’t need insulin therapy, but may take sulphonylureas
