Jan 26 - Diabetes Type I

Question 1

What is diabetes mellitus?

Answer 1

A group of metabolic disorders all featuring hyperglycemia and/or insufficient insulin or insulin resistance

Question 2

What does diabetes mellitus cause?

Answer 2

Abnormalities of carbohydrate, lipid and protein metabolism

Question 3

What are the chronic complications due to diabetes mellitus?

Answer 3

They include microvascular, macrovascular and neuropathic disorders (you can’t feel pain in your extremities)

Question 4

What is the difference between diabetes type I and type II?

Answer 4

Type I diabetes has a complete absence of insulin

Type II diabetes is due to insulin resistance and insufficient insulin

Question 5

What are some of the serious problems caused by diabetes?

Answer 5

Lower limb amputations
Renal failure and it’s the leading cause of blindness
Cardiovascular events

Question 6

What are the main categories of symptoms of diabetes?

Answer 6

Central (polydipsia, polyphagia, lethargy, stupor)
Systemic (weight loss)
Respiratory (Kussmaul breathing aka hyperventilation)
Eyes (blurred vision)
Breath (smell of acetone)
Gastric (nausea, vomiting, abdominal pain)
Urinary (polyuria, glycosuria)

Question 7

Describe the clinical presentation of type I diabetes mellitus patients

Answer 7

It’s usually onset abruptly before the age of 30. Typically patients present lean. Insulin resistance is absent, autoantibodies are often present. Patients are usually symptomatic, there are usually ketones are present, there is an immediate need for insulin therapy. Acute complications include diabetic ketoacidosis (DKA), there are no microvascular complications and rarely macrovascular complications at or before diagnosis

Question 8

Describe the clinical presentation of type II diabetes mellitus patients

Answer 8

It’s usually onset gradually after the age of 30. Typically patients are obese or have a history of obesity. Patients are usually asymptomatic, there are rarely autoantibodies present, a present insulin resistance. Ketones are absent at diagnosis and patients only need insulin therapy years after diagnose (if at all). Acute complications includes hyperosmolar hyperglycemic state (HHS), and it is common to have microvascular and macrovascular complications at diagnosis

Question 9

What is fasting plasma glucose?

Answer 9

The patient is asked to fast for 8 hours and then the blood sugar. Normal blood sugar should be less than 5.6 mmol/L. Impaired fasting glucose is between 5.6 and 6.9 mmol/L. Diabetic patients will have a glucose reading of higher than 7 mmol/L

Question 10

What is 2-hour postload plasma glucose (oral glucose tolerance test)?

Answer 10

The patient is asked to consume 75 g of glucose (usually in an orange drink). Blood glucose is measured before and 2 hours postload. Normal postload glucose should be below 7.8 mmol/L. Impaired glucose tolerance will be between 7.8 and 11.1 mmol/L. Diabetic patients will have a 2-hour postload glucose reading higher than 11.1 mmol/L

Question 11

What is HbA1c?

Answer 11

Glycated hemoglobin test. Normal results are less than 5.7%. Increased risk of diabetes mellitus is between 5.7% and 6.4%. Diabetic patients have an A1c of over 6.5%

Question 12

What is DKA?

Answer 12

Diabetic ketoacidosis. The body cannot use the glucose consumed for energy because insulin is not moving glucose into the cell (hyperglycemia). Patients use fat to produce energy, this results in lots of byproducts (ketones). Ketones accumulate in the blood and urine (acidosis). The blood becomes thick and the glucose filters through the kidneys

Question 13

What are symptoms of DKA?

Answer 13

Frequent urination and thirst
Abdominal pain (acid accumulation)
Hunger
Symptoms may be present for days
Can be alert, stuperous, or comatose
Deep rapid breathing
Fruity breath

Question 14

How is C-peptide used as a diagnostic test?

Answer 14

It can help tell the difference between type I and type II diabetes. The pancrease produces insulin and C-peptide in equal amounts. In type I diabetes, there are low levels of insulin and low levels of C-peptide. In type II diabetes, there are normal levels or even high levels of C-peptide

Question 15

What are the therapy goals for type I diabetes?

Answer 15

Reduce the risk, ameliorate symptoms, reduce mortality, and improve quality of life
Set goals for glycemia, blood pressure and lipids
Blood glucose levels
Hb A1c

Question 16

What is the HbA1c goal for type I diabetes patients?

Answer 16

Less than 7% in order to reduce the risk of microvascular and macrovascular complications

Question 17

What is the HbA1c goal for type II diabetes patients?

Answer 17

Less than 6.5% may be targeted in some type II diabetes patietns to furthur lower the risk of nephropathy and retinopathy (but must be balanced agains the risk of hypoglycemia)

Question 18

What are common precipitating factors that cause DKA?

Answer 18

Insulin omission (the most common cause of DKA)
New diagnosis (patients don’t have total control yet)
Infection/sepsis
Myocardial infarction (small rise in troponin may occur without overt ischemia; ECG changes may reflect hyperkalemia)
Thyrotoxicosis
Drugs

Question 19

If DKA is diagnosed, what should be monitored?

Answer 19

Plasma electrolytes, anion gap, glucose, creatinine, plasma osmolality, fluid balance, level of consciousness every 2-4 hours (also precipitating factors and complications)

Question 20

How is DKA managed?

Answer 20

IV fluids
Serum potassium
Acidosis

Question 21

Why is serum potassium important in DKA diagnosis?

Answer 21

Hypokalemia is an avoidable cause of death in DKA; it is important to correct serum potassium levels then start insulin

Question 22

How is DKA prevented?

Answer 22

In type I diabetes, it is important to educate patients around sick day management, continue insulin even when not eating and to frequently monitor blood glucose when ill