DM Flashcards
What is diabetes
Group pf metabolic disorders characterised by presence of hyperglycaemia in the absence oc treatment
What is MODY
maturity onset diabetes of the young.Are autosomal dominantly inherited causes of diabetes resulting in defects in ẞ cells function rather than insulin action. It usually affects those below 25 years of age. Mutations can occur in the Glucokinase enzyme (MODY2) or in Hepatocyte Nuclear Factors 1 & 4 (MODY3 and MODY1).
pancreatic causes of secobdary diabetes
Pancreatitis, Haemochromatosis, Pancreatic surgery/trauma, Cystic Fibrosis
endocrine causes for 2ndary diabetes
Acromegaly, Cushing Syndrome, Pheochromocytoma
drug induced causes of diabetes
Glucocorticoids (steroids), thiazide diuretics, ẞ Blockers
infectious causes od diabetes
Congenital Rubella, Cytomegalovirus, Mumps
what should you check in all cases of hy[erglycaemia
ketones as shouldnt assume t2dm
features of t1d
occurs young weight loss common osmotic symptoms common dye to rapid onset ketosis v likely insulin absent or low
features od t2d
more likely in the obese weight loss less common Less common to have osmotic symptoms but cano occur if severe hyperglycaemia Ketosis less likely Insulin levels low or normal
How is glucose uptake into cels
Insulin is released by the β cells when glucose levels rise after a meal. Insulin acts upon glucose transporters (GLUTs) which are responsible for sensing and taking up glucose into the cells; GLUT2 is important for sensing glucose in βcells and GLUT4 is involved in insulin mediated glucose uptake in skeletal muscle and adipose tissue.
Function of insulin
Insulin anabolic effects result in glucose being converted to glycogen in muscle, glycogen and triglycerides in the liver and triglycerides in adipose tissue. Insulin also promotes glycolysis (breakdown of glucose to produce ATP) and inhibits gluconeogenesis (synthesis of glucose from stored substrates).
What happens during a fasted state
During a fasted state insulin production is down regulated and glucose stores are released through glucagon mediated gluconeogenesis therefore preventing a hypoglycaemic state in the body during periods of fasting.
What processes does body go through in absence of insulin due to t1d
In the absence of insulin (due to Type 1 diabetes) the glucose cannot be taken up into the cells effectively starving the cells of its most effective substrate to make energy. This signals gluconeogenesis, glycogenolysis and lipolysis as the body can no longer make use of the glucose that is available
What is DKA
hypeglucaemia in presence of acidosis and ketosis
What can precipitate e DKA
first diagnosis, infection or poor compliance, or MI/infarct
Why does diuresis occur
-consequences
Due to hyperglycaemia resulting in polyuria and polydipsia
-Can result in AKI with electrolyte disturbances (hypokalaemia and hyponatraemia)
Role of glucagon in DKA
its effects result in production of ketone Bodies from the conversion of FFA to acetoacetate and conversion of glycerol and amino acid to glucose leading to worsening hyperglycaemia
Why does breathlessness occur in DKA
What kind of breathing occurs
Acidosis nobody tries to remove co2
First rapid, then Kussmaul’s which is deep, labour breathing
What will blood gases in DKA show and why
Lactate?
Other signs of DKA
Acidosis due to bicarbonate consumption by acidic ketone bodies
LActate rasied
Sweet pear drop smell on breath, confusion, drowsiness, blurred vision and coma possibly
treatment for dka
Iv insulin and fluids with electrolyte replacement
What is hyperosmolar hy[erglycaemic state
Associated with t2dm
is characterised by severe hyperglycaemia leading to diuresis leading to volume depletion, dehydration and haemoconcentration.
Why is Hyperosmolar hyperglycaemic state less often associated with katonaemia and acidosis
due to Presence of insulin which is enough to suppress lipolysis
What osmolality determines a state of HHS
> 320mmol/kg
Criteria to diagnose HHS
Hypovolaemia (due to osmotic diuresis)
Marked Hyperglycaemia (serum glucose>30mmol/L)
No significant ketonaemia/ketonuria (serum ketone <3mmol/L)
No significant acidosis (pH>7.3, bicarb >15mmol/L)
Osmolality >320mmol/kg
