Lecture 13- Diabetes Flashcards
What is diabetes?
Chronically high blood glucose leading to long term clinical complications
Aetiology?
Cause of disease
Why does blood glucose rise?
Either inability to produce enough insulin or resistance prevents insulin from working effectively
What causes type 1 diabetes.
Autoimmune beta cell destruction
How does diabetes present?
Polyuria and polydipsia with weight loss, weakness, tiredness and lethargy
Blurring of vision and urogenital infections like thrush
How is diabetes diagnosed?
Test fasting blood glucose
Test oral glucose tolerance
HbA1c test
Need symptoms and one abnormal test or be asymptomatic and two abnormal tests
What is an oral glucose tolerance test?
Give glucose orally and check blood levels to see if its being taken into cells or remaining in blood.
Type 1 diabetes presentation?
Rapid onset (weeks)
Weight loss, polyuria and polydipsia
Vomiting due to ketoacidosis
Usually young patients with ketones and high venous glucose
Why would there be ketones in the blood?
They are the breakdown products of fat
Type 1 diabetes treatment?
Exogenous insulin
Type 2 diabetes?
90% overweight or obese
Often managed by diet and tablets
Insulin not given as insulin is already being made
What causes type 2 diabetes?
Obesity (abdominal) Muscle and liver fat Inactivity Elevated free fatty acids Genetics
What is bariatric surgery.
Where gastric band put around stomach to make it smaller or part of stomach removed
Can type 2 diabetes be reversed?
Yes
Within 7 days of bariatric surgery or low calorie diet fasting glucose normalises and this occurs before weight loss.
Fall in liver fat content and normal insulin sensitivity returns and decreasing pancreatic fat lead to normal beta cell function
Type 2 diabetes symptoms?
Polyuria, polydipsia, weight loss.
No urinary ketones as some insulin is produced.
Usually patients older and overweight
How to treat type 2 diabetes?
Lifestyle changes like diet improvements. Increas3d exercise and weight loss. Reduce other risk factors like smoking etc. Medications such as biguanides to inhibit glucose production by liver and sulphonylureas to stimulate insulin production and improve its effectiveness
Should type 2 diabetics get insulin?
No as they already produce it
Major acute diabetic complications?
Type 1 DKA
Type 2 hyperosmolar non-ketotic syndrome
Hypoglycaemia can lead to coma
Chronic diabetes complications?
Cardiovascular disease
Stroke p, heart attack, gangrene
Retinopathy, neuropathy, ulceration of feet.
Blindness, erectile dysfunction
What is metabolic syndrome?
A combination of most dangerous risk factors for cardiovascular disease.
These include diabetes and raised fasting glucose. High cholesterol, high blood pressure and abdominal obesity
