diabetes mellitus in clinical practice Flashcards
what is diabetes mellitus broadly speaking
A group of conditions characterised by
HIGH BLOOD GLUCOSE
and other metabolic and vascular derangements secondary to insufficient insulin action
name microvascular complications of diabtetes
retinopathy, nephropathy, neuropathy
what are macrovascular complications of diabetes
ischaemic heart disease, cerebrovascular disease, peripheral vascular disease
what is difference between type 1 type a DM vs type 1 type b DM
Type a: autoimmune
Type b: idiopathic (no markers of autoimmunity)
describe type 2 diabetes
combination of insulin deficiency and resistance sometimes more resistance than deficiency and vice versa
how might patients with diabetes present to healthcare
with severe hyperglycaemia emergency, symptoms of hyperglycaemia(osmotic symptoms), detected by screening, or symptoms of diabetes complications
what does absence of insulin do to stored lipids
Lipolysis
what does absence of insulin do to proteins
Proteolysis
why do tissues become glucose deprived in abscense of insulin
less uptake due to less transcription of glut protiens and recruitment to cell surface
name osmotic symptoms of diabetes
polyuria and thirst and polydipsia
what is polyuria
is excessive or an abnormally large production or passage of urine
what is polydypsia
is excessive thirst or excess drinking
why are diabetic people at greater risk of infection
hyperglycaemia facilitates pathogens
how can a diabetic person become hypotensive
because hyperglycaemic, causes glycosuria which causes osmotic diuresis, they become dehydrated, reduced blood volume causes hypotension
why do diabetics suffer from weight loss use key terms
proteolysis, lipolysis due to insulin being absent and dehydration
what causes nausea in diabetic patients
acidosis as a result of ketosis which originates from lipolysis
what causes hyperventilation
acidosis as a result of ketosis, body attempting to compensate
a patient with diabetes reports symptoms of tingling in hands and feet, numb, abnormal sweat, errectile dysfunction, postural dizzyness, gastroparesis, pain weakness, diplopia what is this likely to be considering the patient has diabetes
microvascular complication of neuropathy
how do you diagnose diabetes
clinical symptoms of hyperglycaemia, polyuria, polydipsia etc and hba1c or unequivocally random high blood glucose conc >11.1
to be diagnosed with dm what does hba1c have to be typically
HbA1c ≥ 48 mmol/mol
In the absence of typical symptoms how do you diagnose diabetes
On 2 separate occasions: • Abnormal blood glucose • Abnormally high amount of glucose on circulating proteins: • Glycated haemoglobin or HbA1c
what is prediabetes
high risk of getting diabetes .
HbA1c 43 – 47 mmol/mol (6.1-6.4%)
Impaired glucose tolerance
fasting venous plasma glucose < 7 and 2 hr ≥7.8 and
< 11.1 mmol/l
Impaired fasting glucose
fasting venous plasma glucose 6.1 - 6.9 mmol/l
what does glucose tolerance mean
how well body cells can absorb glucose
why is the sample that we test glucose conc from important
Glucose concentrations are
different in different samples
upon examination a patients shows hla markers, insulin deficiency, ketosis prone, the onset of diabetes peaked in teenage years and weight loss is this more likely type one or 2
type 1
describe clinical features of type 2 diabetes
insulin resistant & deficient • not ketosis prone • Polygenic • S Asians > Aficans & Caribbeans > Europids • Increases with ageing younger in ethnic groups with high prevalence • associated with obesity
what are the aims of diabetes management
remove symptoms of uncontrolled diabetes, prevent complications, prevent diabetic emergencies, avoid impact on quality of life
what diabetes complication risk factors are modifiable
Glycaemic control • Blood pressure / Hypertension • Lipid profile/ dyslipidaemia • Smoking(especially!!) • Exercise • Diet • Overweight/obesity
what Risk factors for long term diabetes
complications are non modifiable
Non-modifiable • Age • Gender • Family history • Ethnicity
what is a hard endpoint
outcome important to patients such as death, blindness, MI, amputation
what is a surrogate endpoint in a clinical trial
biomarker intended to
substitute for a hard endpoint
