Intro to diabetes Flashcards
What is diabetes?
A group of metabolic diseases characterized by hyperlycaemia resulting from defects in insulin secretion, insulin action or both
What type of diabetes is an absolute insulin deficiency?
Type 1 DM
What type of diabetes is a relative insulin deficiency?
Type 2 DM
What type of diabetes results from a failure of insulin synthesis, release or activity?
MODY
What is the diagnostic criteria for diabetes?
HbA1c: 48mmol/mol and above
Fasting glucose: 7.0 mmol/L and above
2-hr glucose in OGTT: 11.1 mmol/L and above
Random glucose: 11.1 mmol/L
What is the diagnostic criteria for imparied or pre-diabetes?
HbA1c: 42-47 mmol/mol
Fasting glucose: 6.1-6.9 mmol/L
2-hr glucose in OGTT: 7.8- 11.0 mmol/L
What are normal values?
HbA1c: 41 mmol/mol and below
Fasting glucose: 6.0 mmol/L and below
2-hr glucose in OGTT: 7.7 mmol/L and below
What defines fasting?
No caloric intake for at least 8 hours
What are the different categories of diabetes?
Type 1 due to autoimmune beta cell destruction
Type 2 due to a progressive loss of beta cell insulin secretion and insulin resistance
Type 3 is gestational diabetes
Type 4 is miscellaneous
What can cause type 4 diabetes?
Neonatal diabetes Maturity-onset diabetes of the young (MODY) CF Glucocorticoid use Treatment of HIV/AIDS Organ transplantation
Waht is the pathogenesis of type 1 DM?
Innate immunce cells etner the panceratic islets and enter the pancreatic lymph nodes where the antigens trigger T cell
These T cells arrive from the lymph nodes and initiate destructive insulitis
What is the clinical presentation of type 1 DM?
Acute onset
Severe weight loss
Ketonuria +/- metabolic acidosis
No evidence of microvascular disease at diagnosis
What are the age peaks of prevalance in type 1 DM?
Pre-school and peri-puberty
Another peak in late 30s
What are the age peaks of prevalance in type 2 DM?
Middle aged/elderly
What is stage 1 type 1 DM?
Normoglycemia
Presymptomatic
Multiple autoantibodies
No IGT or IFG
What is stage 2 type 1 DM?
Dysglycemic Presymptomatic Multiple autoantibodies Fasting Plasma Glucose of 5.6-6.9 2hr fasting glucose of 7.8-11.0
What is stage 3 type 1 DM?
New onset hyperglycaemia
Symptomatic
Clincal symptoms
Diabetes by clinical standard
What are risk factors for diabetes?
First degree relative with diabetes High risk race History of CVD Hypertension HDL cholesterol below 0.9mmol/l Women with POS Physicaly inactivity
How will diabetes mellitus present?
Thirst Polyuria Thrush Weakness/ fatigue Blurred vision Infections Weight loss
What are useful investigatory tests in type 1 DM?
Autoimmune markers; GAD65, insulin, tyrosine phosphatases
Ketones
C-peptide
HLA to DQA DQB genes
What is gestational diabetes?
Any degree of glucose intolearnce arising or diagnosed during pregnancy
What endocrine diseases can cause type 4 diabetes?
Cushings syndrome
Acromegaly
Phaeochromocytoma
Glucagonoma
What drugs can induce diabetes?
Steroids Bendroflumethiazide Beta blockers Atypical antiphychotics Statins
What genetic diseases can indude diabetes?
CF
Myotonic dystrophy
Turner’s syndrome
What is HbA1c?
A measure of glucose control over the past 2/3 months
What are the common macrovascualr complications of diabetes?
Heart disease
Stroke
What are the common micro-vascular complications of diabetes?
Retinopathy
Nephropathy
Neuropathy
PVD
