Glucose regulation Flashcards
How many people worldwide had diabetes in 2015?
415 million
How many people in the UK have diabetes
4.5 million
Basic pathogen of T1DM
pancreatic islet beta-cell deficiency
Basic pathogen of T2DM
insulin resistance
What is MODY?
Maturity onset diabetes of the young
monogenic AD disease- genetic defect
groups at risk of gestational diabetes
Overweight / obese Previous gestational diabetes Previous baby birthweight ≥4.5kg FH of diabetes South Asian, Black or African Caribbean or Middle Eastern ethnicity
when should gestational diabetes be diagnosed?
a fasting plasma glucose level ≥5.6mmol/L
or
a 2-hour plasma glucose level ≥7.8mmol/L
when to diagnose diabetes i.e. what results should be obtained
2 positive findings or 1 positive finding + symptom:
Fasting glucose ≥ 7.0 mmol/L
Random glucose ≥ 11.1 mmol/L
Oral glucose tolerance test (75g glucose)- Bloods taken at 0 and 120 mins
BM fasting ranges
Normal: 3.5 - 5.4 mmol/L
Pre-Diabetic: 5.5 - 6.9 mmol/L
Diabetic: > 6.9 mmol/L
Reference range for Hba1c
20-41
HBa1c levels for:
pre-diabetes
diagnostic of diabetes
42-47 mmol/mol: Pre-diabetes
>47 mmol/mol: Diagnostic of diabetes
5 factors that can affect Hba1c levels
Presence of abnormal haemoglobin Altered lifespan of the red cell Recent blood transfusion Anaemia (any cause) Ethnicity
examples of situations when Hba1c is not appropriate for diagnosis of diabetes
ALL children and young people
When Type 1 diabetes suspected
Symptoms of diabetes for <2 months
Acutely ill (ie hosp admission) + high diabetes risk
Meds that may cause rapid glucose rise e.g. steroids, antipsychotics
Acute pancreatic damage, including pancreatic surgery
Pregnancy
Presence of genetic, haematologic and illness-related factors that influence HbA1c and its measurement
Pathogenesis of DKA
insulin lack
increased gluconeogenesis, decreased glucose uptake
hyperglycaemia
glucosuria
osmotic diuresis
dehydration
lack of insulin
increased lipolysis
increased ketogenesis
ketonemia
ketonuria
acidosis
compensatory hyperventilation
define DKA
Acute decompensation due to insulin deficiency and glucagon excess (counter-regulatory hormone)
clinical features of DKA
vomiting, abdo pain, thirst and polyuria, hypotension, LOC, coma, hyperventilation
diagnostic features of DKA
D –Diabetes - hyperglycaemia > 11.1mmol/L,
K – Ketonaemia
A - metabolic Acidosis (pH<7.3)
5 causes of DKA
infection non-complicance with meds inappropriate insulin new diagnosis MI
clinical features of hyperosmolar hyperglycaemic state
insidious onset, vomiting, confusion, hypercoagulable state, venous thrombosis
biochemical diagnosis of HHS
hyperglycaemia (often 30-70 mmol/l), high serum osmolality ( often > 350 mosmol), NO ACIDOSIS/KETONAEMIA
causes of HHS
Ingestion of high sugar drinks
Inter-current infection
Myocardial infarction
Concomitant medication eg glucocorticoids
5 ways to monitor diabetes
Hba1c fructosamine creatinine lipid profile BM records
what is fructosamine
glucose attached to albumin- can get an idea regarding glucose levels in the past 2-3 weeks
3 potential microvascular complications of diabetes
nephropathy
retinopathy
neuropathy
3 macrovascular complications of diabetes
IHD
stroke
peripheral vascular disease
causes of hypoglycaemia
hyperinsulinaemia: endogenous e.g. islet cell tumour, sulphonyureas or exogenous e.g. iatrogenic or deliberate
endocrine deficiency
starvation
IGF2 secreting tumour
alcohol
galactosaemia
2 tests to be done in hypoglycaemia
Insulin and C peptide measurement
Screening for sulphonylurea metabolites
patient has to be hypoglycaemia at time of test
