diabetes principles Flashcards
what is diabetes?
An elevation of blood glucose above a diagnostic threshold
what are the thresholds for diabetes diagnosis?
fasting plasma glucose=7mmol/l
2hr plasma glucose=11.1mmol/l
HbA1c=48mmol/mol
what is a normal HbA1c?
41mmol/mol and below
what is the difference between gestational diabetes and diabetes?
in diabetes threshold levels are set by retinopathy risk and in gestational the threshold is set by the risk to foetus
how is the level of insulin that beta cells are secreting measured?
by measuring the C peptide level (C-peptide is co-secreted with insulin and is not part of injected insulin – so if c-peptide is present in the blood it must be coming from the person’s beta-cells)
can diabetes be caused by a pure disorder of the beta cells?
yes
is type 1 a disorder of insulin action?
no-its a disorder of insulin secretion
what are the disorders of insulin secretion?
diabetes T1
genetic disorders (MODY, neonatal diabetes)
pancreatic diseases (pancreatitis, cancer)
pure disorders of insulin action are rare-true or false?
true
what are some disorders of insulin action?
Donohue Syndrome
Rabson-Mendenhall Syndrome
Familial Partial Lipodystrophy
Congenital Lipoatrophy
Acquired Lipoatrophy
cushings syndrome
acromegaly
can be steroid induced
is type 2 diabetes an insulin secretion or insulin action disorder?
mixed-ranging from predominant beta cell deficiency to predominant insulin resistance
what is T1 diabetes?
autoimmune destruction of the pancreatic beta cells resulting in beta cell deficiency
what % of people with T1 have pancreatic autoantibodies in the blood at diagnosis?
95%
what are the features of T1 diabetes?
onset in children and young adults
not associated with overweight
autoimmune
requires insulin treatment
what are the features of type 2 diabetes?
onset in middle aged and elderly
associated with obesity and sedentary lifestyle
not autoimmune
may require insulin but can usually be managed with lifestyle changes
can diabetes be asymptomatic?
yes
what are the symptoms of high blood glucose?
polyurea
thirst and polydipsia
blurred vision
genital thrush
fatigue
weightloss
what other diseases are driven by chronic hyperglycaemia?
retinopathy
neuropathy
nephropathy
what is HbA1c?
glycated haemoglobin
is the amount of glycation measured in Hb1Ac proportional to glucose level?
Yes
how many days of glucose exposure does Hb1Ac measure?
90 days
what are diabetes emergencies?
diabetes ketoacidosis
hyperosmolar hyperglycaemic state
what are the main aims of diabetes management?
treat symptoms
prevent microvascular complications
prevent CV complications
screen for complications early while treatable eg eye disease
how much weight loss can result in T2 diabetes remission?
10-15%
by how much do lifestyle interventions lower the odds of developing T2 diabetes
50%
what is the HbA1c target in those who have T2?
7% (53mmol/mol)
