Diabetes Miletus Flashcards
epidemiology of Diabetes Miletus
Diabetes mellitus can be Type 1 or Type 2
Type 2 = 8.3% of population western disease, increasing 2/3 of cases are primary DM. 1/3 of cases are secondary due to other illness. Females 4 : 1 Males
Type 1 = most common metabolic disease of childhood. About 1 in every 400-600 children and adolescents has type 1 DM. In adults, type 1 DM constitutes approximately 5% of all diagnosed cases of diabetes
M=W
Aetiology
A chronic multisystem disease of an
abnormal metabolic state, characterised
by hyperglycaemia due to inadequate
insulin action/production
Pathophysiology Type 1
Type 1
NO INSULIN produced
It is an autoimmune, Organ specific i.e. affects thePancreas.
disorder causing ANTIBODY
MEDIATED destruction of the Beta cells of the
Pancreas. Type 2 Hypersensitivity reaction.
It has a childhood or adolescent onset.
Usually affects thin people.
Patients of European extraction are most commonly affected.
90% of cases exhibit the antigenic markers HLA - MHC
Females = Males in the number of cases.
It has an acute/subacute onset.
Ketoacidosis is common (see notes).
Patients always require INSULIN therapy because
insulin levels are absent or very low.
Peak age of onset 10-13 years old.
The incidence in Europe has doubled over the past 20/30 years.
Type I Diabetes mellitus is not totally genetic but the incidence is increased if related people have.
Pathophysiology Type 2
Insulin resistance
Plasma levels of insulin may be normal or raised suggesting end organ resistance.
Nonautoimmune mechanism - involves varying degrees hepatic insulin resistance (causing an inability to suppress hepatic glucose production), peripheral insulin resistance (which impairs peripheral glucose uptake) in combination with a β-cell secretory defect.
Gradual onset. Usually subacute.
More common in obese people.
Ketoacidosis is rare.
The disease may present in a sub clinical form for several years.
The incidence of the disease is increased with increasing age and obesity.
The onset may be accelerated by pregnancy, drugs or concurrent illness.
Natural History
Type 2 can be subclinical for years
Symptoms Type 1
Young people often present with a 2/4 week history of a TRIAD of symptoms:
POLYURIA - due to osmotic diuresis that occurs when blood glucose levels exceed the renal threshold.
THIRST
due to resulting fluid and electrolyte loss
WEIGHT LOSS
due to fluid loss and increased
breakdown of fat & muscle tissue due to insulin
deficiency
Fatigue may also be a common feature
Ketoacidosis may be the presenting feature if
the early signs are not recognised and treated.
Ketoacidosis - in response the body switches to burning fatty acids and producing acidic ketone bodies that cause most of the symptoms and complications
Uncontrolled catabolism associated with insulin
deficiency.
Insulin deficiency is a precondition to cause
Ketoacidosis, however this is not the sole cause.
Other simultaneous causations include: excessive hormonal antagonists to insulin and fluid depletion
Increased Glucose Increased Ketones Hyperglycaemia Acidosis Glucosuria Osmotic Diuresis Vomiting
Fluid & Electrolyte Depletion
Renal Hypoperfusion
Impaired excretion of Ketones & Hydrogen Ions
In absence of insulin:
symptoms of Ketoacidosis
Hyperventilation Ketone Breath Nausea Vomiting Abdominal Pain Confusion
5% of patients present in a COMA
Marked dehydration/Hypothermia
symptoms type 2
polyuria, polydipsia, lethargy, boils, pruritus vulvae or with frequent, recurrent or prolonged infections. Blurred vision Lower-extremity paresthesias Yeast infections (eg, balanitis in men)
signs
type 1 - weight loss, dehydration, ketonuria and hyperventilation. Presentation of type 1 diabetes tends to be acute with a short duration of symptoms
type 2 - tends to be subacute with a longer duration of symptoms
complications
75% of people with type 2 die of heart disease and 15% of stroke.
peripheral neuropathy, nephropathy, and predisposition to infection
The mortality rate from cardiovascular disease is up to five times higher in people with diabetes than in people without diabetes.
Type 1
experience blindness, end-stage renal disease (ESRD),
Also ischemic heart disease, cerebral vascular disease, peripheral vascular disease with gangrene of lower limbs, chronic renal disease, reduced visual acuity and blindness, and autonomic and peripheral neuropathy
Prognosis
Type 1 - More than 60% of patients with type do not develop serious complications over the long term - lead health life if managed
Type 2 - The prognosis in patients with diabetes mellitus is strongly influenced by the degree of control of their disease
BUT leading cause of morbidity.
7th leading cause of death
CVC effects need to me managed.
