Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathology > Diabetic Mellitus: diagnosis, clinical features & management > Flashcards

Diabetic Mellitus: diagnosis, clinical features & management Flashcards

1
Q

what is the definition of diabetes mellitus

A

a group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both. the chronic hyperglycaemia is associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidney, nerves, heart and blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is diabetes a group of metabolic diseases in

A

the endocrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is hyperglycaemia

A

raised blood glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is a defect in insulin secretion from

A

problems with the pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is a defect in insulin action

A

the tissues don’t receive the insulin properly or respond to it properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what can still occur even if diabetes is treated

A

long term damage, dysfunction, failure of various organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what do diabetes sufferers have a higher risk of

A

heart attack & stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does insulin lower

A

lowers blood glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how does insulin lower blood glucose level

A

by suppressing glycogenolysis and gluconeogenesis in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is gluconeogenesis

A

synthesis of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what does insulin stimulate

A

glucose uptake into skeletal muscle (and to a lesser extent, fat and cardiac muscle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what limits are blood glucose levels maintained within

A

narrow limits, 3.5 - 8.0 mmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what levels remains the least changed during the day

A

blood glucose levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what also goes up as well as blood glucose levels after having a meal and why

A

insulin production, to maintain homeostasis (they mirror each other)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which organ does the insulin act on in order for glucose to be taken up by the cells

A

the liver which breaks down glycogen into glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the most common group of diabetics

A

it is age related and people are living longer, so cases will rise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what do most healthcare costs of diabetes result from

A

complications requiring hospital admission and treatment e.g. coronary heart disease, cerebrovascular disease, microvascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how common is diabetes

A 
very common, 
England 5.1%
Northern Ireland 4.5% 
Wales 4.6%
Scotland 3.9%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the two classifications of diabetes

A

primary or secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how many new cases does secondary diabetes represent

A

1-2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how many new cases does primary diabetes represent

A

98%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what can cause secondary diabetes

A
  • pancreatic daises/cancer
  • drug induced - steroids which impacts cardiovascular metabolism
  • gestational diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is gestational diabetes

A

diabetes that arises during pregnancy (usually during 2nd or 3rd trimester) become normal after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what implications can gestational diabetes have on a woman

A

they can develop diabetes later in life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what can primary diabetes be classified as

A

type 1 - insulin dependent
or
type 2 - non insulin dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

in the UK, how many % of people have type 1 diabetes

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

in the UK, how many % of people have type 2 diabetes

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is type 1 diabetes due to

A

destruction of beta cells in the pancreas islets of langerhans by autoimmune attack
loss of insulin production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the autoimmune attack triggered by in type 1 diabetes

A

combination of genetic and environmental factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

how long can type 2 diabetes patients survive without insulin for after diagnosis

A

at least 6 months, put on another therapy to start off with

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is the underlying mechanism of type 2 diabetes

A

either due to:
- diminished insulin secretion (associated with increased insulin resistance = tissue not responsive to insulin)
or
- increased hepatic glucose output (decline is insulin & glycogen production, so will need to treat disease more aggressively over time)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is the onset of type 2 diabetes

A

slowly progressive disease with a decline in insulin secretion over several years resulting in deterioration of glycemic control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what are the diagnosis methods for diabetes set out by the WHO criteria

A
  • symptoms of diabetes plus casual (anytime of the ay without regard to time since last meal) venous plasma glucose > or = 11.1 mmol/l
  • fasting plasma glucose (no calorie intake for atleast 8 hours prior to measurement) > or = 7.0 mmol/l
  • 2 hour plasma glucose (give known amount of glucose usually 75g, dissolved in water & drink & measure blood glucose level 2 hrs later) > = or 11.1 mmol/l
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what diagnosis method is done when not eating during the night and test is carried out in the morning

A

fasting plasma glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is the HbA1c diabetes type 2 diagnosis

A

HbA1C = glycated haemoglobin
could be used as an alternative to standard glucose measures to diagnose type 2 diabetes amongst non pregnant adults
HbA1c measures the amount of glucose that is being carried by the red blood cells in the body
HbA1c levels of 6.5% (48 mmol/l) or above indicate that someone has type 2 diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the normal % of haemoglobin that is glycated/glucose attached

A

6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what happens to glycemic levels when your diabetic

A

more and more glycemic, as more glucose attaches to haemoglobin carried in red blood cells so the % goes up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what age is the peak incidence of type 1 diabetes

A

10-12 years but can effect any age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

how many % of all diabetics are type 1

A

5-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what difficulties can arise if someone is presented with type 1 diabetes later in life i.e. latent autoimmune diabetes

A

difficult to differentiate from type 2 diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what has there been an increase of with type 1 diabetes in recent decades

A

increased prevalence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what do 95% of type 1 diabetics carry

A

HLA DR3 and DR4 antigens (which are a particular component of the MHC protein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

how many % of all diabetics are type 2

A

85-95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the most common age to get type 2 diabetes

A

middle age 50-70 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

why do rich countries account type 2 diabetes as the disease of the poor

A

as poor people have unhealthy lifestyles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

why to poor countries account type 2 diabetes as the disease of the rich

A

as countries of people with more money can eat more & do less manual labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what has increased steadily in type 2 diabetes

A

prevalence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

where is the geographical prevalence of type 2 diabetes and by how much

A

people of asian or african ancestry but 3-4x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

which country has the highest population of diabetics

A

india

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what is the genetic chance of developing diabetes with an identical twin with the disease

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is the diabetogenic lifestyle

A

physical inactivity
high intake of saturated fat
obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what has there been a relationship in which has resulted in the increase of type 2 diabetes

A

number of fast food chains and type 2 diabetes

53
Q

what can a treatment of blood glucose result in, in type 2 diabetes

A

symptoms of type 2 diabetes

eg blurred vision

54
Q

list the epidemiology of type 1 diabetes

A
  • younger (usually < 30yrs)
  • usually lean (underweight as causes weight loss)
  • increased incidence in north european ancestry
55
Q

what is the pathogenesis of type 1 diabetes

A

autoimmune attack of beta cells in the pancreas, islets of langerhan

56
Q

what is the clinical implications of type 1 diabetes

A
  • insulin deficiency

- always need insulin (no alternative)

57
Q

what is the epidemiology of type 2 diabetes

A
  • older (> 30yrs)
  • often overweight
  • all racial groups (increased in again, african, polynesian)
58
Q

what is the pathogenesis of type 2 diabetes

A

insulin resistance (tissues not responding adequately to the insulin)

59
Q

what is the clinical implications of type 2 diabetes

A
  • partial insulin resistance (50% will eventually need insulin) (produced as lower level)
60
Q

what are the acute clinical presentations/symptoms of diabetes

A
  • polyuria (excessive urination)
  • thirst
  • sudden weight loss, fatigue and ketonuria (in type 1 patient < 30yrs)
  • obesity (in type 2)
61
Q

what are the sub-acute presentations of diabetes

A
  • lack of energy
  • blurred vision/refractive changes
  • candida infection
62
Q

what is the blurred vision/refractive changes in diabetes due to

A

excessive hyperglycaemia

63
Q

what is a symptomatic patient’s diagnosis based on

A

a single elevated plasma glucose of > 11 mmol/l

64
Q

what is an asymptomatic patient’s diagnosis based on

A

2 fasting plasma glucose levels > 7 mmol/l or two random values of > 11.1 mmol/l

65
Q

what HbA1c levels indicate a diabetic diagnosis

A

levels of 6.5% (48 mmol/l) or above

66
Q

what test id only needed for borderline diabetes cases

A

a glucose tolerance test

67
Q

what would be the next check for a person aged 40-74 without diagnosed to have existing cardiovascular disease

A

BMI

68
Q

what will be the next check required for a person with a BMI > 30 (or 27.5 if Indian, Pakistani or Bangladeshi, the asian or Chinese) or have a BP of 140/90

A

HbA1c - haemoglobin level
or
FPG+ - fasting blood glucose

69
Q

what are the steps for someone who is border line diabetic

A

may not put straight onto medication, instead advised to change lifestyle & diet e.g. stop smoking, change diet, if these don’t work, then must put on treatment/medication

70
Q

what are the aims of treatment for diabetes

A
  • alleviate symptoms ie stop feeling thirsty or going toilet
  • reduce risk factors, can be short term but is most important
  • prevent long term complications
  • manage long term complications (that are potentially life threatening)
71
Q

list the treatments for type 2 diabetes

A
  • achieving glycaemic control (can be via drug therapy that lowers blood glucose)
  • healthy lifestyle (lose weight, stop smoking, appropriate exercise)
  • control hypertension (blood pressure tablets)
  • control hyperlipidaemia (put on statins to lower cholesterol)
72
Q

when must hypertension tablets be given to diabetics

A

any case, even if their blood pressure isn’t high, as it reduces of cardiovascular events

73
Q

when must statins for hyperlipidaemia be given to diabetics

A

at a threshold lower than someone who isn’t diabetic

74
Q

list the three things required for treatment for type 2 diabetes

A
  • achieving glycaemic control by:
    controlling diet
    oral hypoglycaemic agents eg Metformin or Sulphonylurea (tablets which lower blood glucose)
    insulin (in atleast a third of type 2 DM i.e. HbA1c > 9%)
75
Q

name the oral hypoglycaemic agents taken to achieve glycaemic control in type 2 diabetes

A

Metformin or Sulphonylurea

76
Q

list the 4 types of insulin treatment

A
  • short acting insulin
  • intermediate acting insulin
  • long lasting insulin
  • mixtures of insulin
77
Q

what is short acting insulin

A

soluble insulin acts quickly and lasts for between 6 and 8 hours

78
Q

what is intermediate acting insulin

A

isophane insulin acts slightly slower and lasts for between 10 and 14 hours

79
Q

what is long lasting insulin

A

act slowly and lasts much longer, up to around 24 hours

80
Q

what are mixtures of insulin

A

mixed short and intermediate acting insulin

81
Q

what does the type of insulin required vary with

A

how quickly the insulin acts & how long the insulin will last so the aim is to achieve glycaemic control through day & night with a combination of different insulins to get the right blood glucose balance

82
Q

what can happen if the blood glucose becomes too low

A

px will go into a coma

83
Q

what are the majority of type 1 diabetic patients insulin injection frequency

A

majority are on 2x or 4x daily
eg 2-3 short acting insulins during the day and 1 medium acting insulin during the night
or
a medium acting insulin in the morning, short acting insulin midday and medium acting insulin a night

84
Q

how many insulin do some type 2 diabetics require per day

A

1 injection

85
Q

why must type 1 diabetics have to alternate their injection site

A

as they may get a reaction if its always at the same place

86
Q

what is the importance of glycaemic control by acquiring a narrow range of blood glucose levels as opposed to having a wide range of blood glucose, for a diabetic patient

A
  • reduced chance of diabetic retinopathy
  • reduced level of protein urea (protein in urine) measure for kidney function
  • reduced progression of clinical neuropathy
87
Q

what is the principle risk factor for developing myocardial infarction and stroke

A

hypertension

88
Q

what is the outcome for diabetics, for every 10mmHg increase in systolic BP

A
  • any diabetic complication increased by 12%
  • deaths related to diabetes increased by 11%
  • microvascular complications increased by 13%
89
Q

what does hyperlipidaemia increase

A

the propensity to microvascular disease

90
Q

what does smoking do for diabetics

A

exacerbates all complications

increases chance of a shorter life

91
Q

what do GPs test, for measuring diabetic control

A
  • urine tests
  • blood glucose testing
  • glycosylated haemoglobin
92
Q

what is a blood glucose monitor useful for

A

suspected hypoglycaemia

93
Q

what can hypoglycaemia lead to

A

diabetic coma

94
Q

how is the blood glucose monitoring carried out

A
  • using a spring loaded finger pricking device, and a blood glucose monitor with test strips
  • insert the blood glucose test strip
  • load finger pricker
  • prick the finger
  • apply blood to test strip
  • await results
95
Q

list what the annual screening program consists of for diabetics

A
  • weight/height BMI
  • BP
  • eye examination
  • foot examination
  • blood tests (HbA1c, lipid profile, creatinine)
  • urine tests (proteinuria)
  • smoking status
96
Q

why is a foot examination carried out in the annual screening program

A

to check for foot ulcers due to higher levels of ischemia for diabetes which can lead to amputation

97
Q

what is checked during the eye examination in the annual screening program

A

retinal screening for diabetic retinopathy, retinal photographs are taken only

98
Q

list the complications which can occur in the eye due to diabetes

A
  • proliferative retinopathy
  • retinal detachment
  • maculopathy
  • cataract
  • rubeosis iridis
99
Q

how many people does diabetic neuropathy effect with diabetics

A

50%

100
Q

which nerves does diabetics neuropathy effect

A

sensory & autonomic nerves

effects the peripheral nervous system

101
Q

why does neuropathy effect the sensory nerves

A

as these nerves need a blood supply which comes from smaller blood vessels and the underlying problem in diabetes is a problem with the smaller blood vessels (angiopathy)

102
Q

what does sensory neuropathy mainly effect

A

the lower limbs, less commonly the hands and causes initially pain followed by loss of sensation and numbness

103
Q

what does autonomic neuropathy cause damage to

A

both sympathetic and parasympathetic nerves leading to gastrointestinal problems, incontinence and erectile dysfunction

104
Q

what complications with cranial nerves can occur with diabetes

A

isolated cranial nerve palsies (however multiple nerves can also be effected i.e. any cranial nerve is at risk)

105
Q

which nerves are preferentially effected in diabetes

A

nerves to the extra ocular muscles

106
Q

which are the most common nerves effected

A

3rd, followed by 4th, 5th & 6th

107
Q

what does a third nerve palsy cause in diabetes

A

ptosis

108
Q

what is often spared with a third nerve palsy in diabetes

A

the pupil i.e. hey have a normally reactive pupil as opposed to a dilated one

109
Q

why is the pupil reflex spared in a third nerve palsy in diabetes

A

due to peripheral placement of the autonomic fibres

110
Q

what is the onset of cranial nerve palsies in diabetes

A

usually spontaneous, complete or partial resolution in 3-6 months

111
Q

what type of foot complications can occur in diabetes

A

foot ulceration and infection

112
Q

what are the principle causes of foot ulceration and infection

A

neuropathy and ischemia

113
Q

what does a combination of neuropathy and ischemia carry a high risk of

A

gangrene and may lead to amputation

114
Q

in how many people with diabetes does nephropathy occur

A

10-20%

115
Q

what are the early signs of nephropathy

A

proteinuria (protein in the urine)

116
Q

what can proteinuria cause

A

kidney complications

117
Q

what can happen if nephropathy is not treated

A

proteinuria increases and glomerular filtration rate progressively declines with subsequent renal failure

118
Q

what is nephropathy managed by

A

angiotensin converting enzyme inhibitors (ACE) and strict hypertension control

put on dialysis if they have kidney failure due to diabetes

119
Q

what type of diabetics carry a considerable risk of morbidity and mortality from cardiovascular, cerebrovascular and peripheral vascular disease

A

particularly type 2 diabetics & those with proteinuria

120
Q

how many % of diabetic deaths are caused by cardiovascular problems and why

A

75% as increases rick of heart attacks and stroke

121
Q

at what rate does diabetes increase the risk of myocardial infarction in males

A

doubles

122
Q

at what rate does diabetes increase the risk of myocardial infarction in females

A

quadruples

123
Q

what is required to reduce the risk of myocardial infarction in males and females

A

strict control of hypertension and blood lipids

124
Q

what is pregnancy in type 1 diabetes associated with

A

increased risk of congenital malformations

125
Q

what can pregnancy exacerbate in diabetes

A

retinopathy and nephropathy

126
Q

what is the control of essential during pregnancy

A

blood glucose

127
Q

what are all pregnant women screened for

A

gestational pregnancy

128
Q

when do most gestational diabetics return to normal blood glucose

A

after giving birth

129
Q

what do women who have had gestational diabetes have an increased risk of later in life

A

type 2 diabetes

Pathology (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions