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ESA2 > MEH Diabetes Mellitus > Flashcards

MEH Diabetes Mellitus Flashcards

1
Q

What is diabetes mellitus?

A

Raised blood glucose level. Over years leads to damage of the small and large blood vessels causing premature death from cardiovascular diseases. Long term/chronic disease

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2
Q

Why is it a major concern?

A 
Major budget use of NHS
Cause of blindness
Cause of amputation
Cause of CVD/PVD/stroke
Reduces life expectancy
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3
Q

What is metabolic syndrome (4)?

A

A cluster of the most dangerous risk factors associated with CVD:

1) Diabetes and raised fasting plasma glucose
2) Abdominal obesity
3) High cholesterol
4) High BP

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4
Q

What are the markers for metabolic syndrome for each of the 4 criteria?

A

Waist >94cm for men >80cm for women
Plus any 2 of:

Raised triglyceride >1.7mmol/L or on treatment
Reduced HDL cholesterol <1 for men <1.2 for women
Raised BP >135/75 or on treatment
or Raised fasting glucose >5.6mmol or treated diabetes

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5
Q

What causes metabolic syndrome (5)

A 
Central obesity 
Insulin resistance 
Genetics
Ageing 
Sedentary lifestyle
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6
Q

What is insulin resistance linked to in particular?

A

Obesity

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7
Q

Insulin resistance often processes to type 2 diabetes true/false

A

True

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8
Q

What is the genetic and autoimmune basis of type 1 diabetes?

A

Mostly genetic –> alleles of HLA DQB1 an MHCII molecule.

Autoantibodies against beta cells destroy them

Environmental role in pathogenesis

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9
Q

How might diabetes mellitus present?

A

Polyuria
Polydipsia (excessive thirst)
Blurring of vision (change in refraction due to glucose)
Urogenital infections –> thrush

Tiredness
Weakness
Lethargy
Weight loss (due to effect of no insulin)

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10
Q

How do you test for diabetes mellitus?

How do you diagnose?

A

Fasting glucose
HbA1c - glycated Hb
Oral glucose tolerance test (not used now?)

1 abnormal test and symptoms
or 2 tests if asymptomatic

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11
Q

What are the benefits of using HbA1c over the fasting glucose (2)?

A

No need to fast

Indicates average of glucose levels over the past 3 months

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12
Q

Why could someone who was newly diagnosed with diabetes type 1 present with vomitting?

Why could they present with hyperventilation?

A

Could present as diabetic ketoacidosis —> a response is vomitting (would reduce acidosis)

Due to ketoacidosis —> lowers pH –> drive to breath off CO2 to reduce acidity leads to hypeventilation

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13
Q

Why would type I diabetic have ketones in their urine? Why would type II not?

A

Due to lipid break down due to reduced insulin:anti-insulin ratio –> excess leads to lipolysis. Liver uses triglycerides to make energy due to the lack of insulin to enable plasma glucose to be utilised. This leads to excess ketone formation.

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14
Q

What is Diabetic Ketoacidosis (DKA)?

A

Major life threatening complication of diabetes indicated by hyperglycaemia hyperketonuria and ketoacidosis (lowered pH)

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15
Q

What are the genetic markers for diabetes type I?

A

Genetic markers HLA DR3 and HLA DR4.

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16
Q

Why might the patients breath smell of pear drops?

A

Because acetone (a ketone due to liver fat metabolism) is volatile and can be breathed out via the lungs giving a smell.

17
Q

What are symptoms of DKA?

A

prostration, hyperventilation, nausea, vomiting, dehydration and abdominal pain

18
Q

How do you treat type I diabetes?

A

Sub cutaneous injections of insulin several times a day
Dietary requirements
Excercise
Psychosocial support

19
Q

What are the WHO (world health organisation) goals to maintain a health body weight (2)?

A

Adult to aim for BMI 20-25

For individuals to avoid weight gain greater than 11pounds (5kg) during adult life

20
Q

Why do some diabetics not comply with medication/insulin/lifestyle changes??

A

Sometimes asymptomatic so don’t have motivation to alter lifestyle/take medication as feel well.

Literacy difficulties with understanding disease/medication

Inconvenience/effort involved with lifestyle change/perceived costs of exercise/healthy food

Social reasons - esp injecting in public - appropriate places for teenagers etc

21
Q

What is involved in management of the diabetic patient (5)?

A

Treatment: insulin/metforming
Lifestyle: food/exercise
Education: about condition/what to do in hypo/hyper/how to control/how to monitor and take medication
Other risk factors: BP, cholesterol, smoking
Surveillance for chronic complications - e.g. neuropathy leading to ulcers on the foot/ischaemic cardiac disease etc

22
Q

What is hyperosmolar non ketotic syndrome in type 2 diabetes?

A

hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis

Similar to DKA
May need insulin to treat

Present usually with dehydration and sometimes neurological defects

23
Q

What are the complications associated with hypoglycaemia?

A

Coma
Brain needs glucose
Can be caused by hypoglycaemic therapy –> need oral or IV glucose.

24
Q

What are some chronic complications of diabetes?

A

CVD, PVD, stroke

Capillary: Retinopathy, nephropathy, neuropathy

25
Q

What causes ‘diabetic foot’?

A

Neuropathy
Poor blood supply due to peripheral arterial disease
Poor wound healing
Increased risk of infection
Can lead to diabetic foot - which can ulcer, gangrene and end up with amputation

26
Q

What is the most common cause of loss of pancreatic Beta cells in type I diabetes?

A
  • autoimmune 90%

- idiopathic - 10%

27
Q

What might you find in the islets of newly diagnosed diabetes?

A

Chronic inflammation - T lymphocytes and macrophages - Insulitis

28
Q

What is the trio of symptoms/signs in type 1 diabetes? Is it slow or fast onset often?

A

Polyuria
Polydypsia
Weightloss

Usually fast onset

29
Q

What is the mechanism of ketoacidosis in type 1 diabetes?

A

Perceived starvation by the body due to the plasma glucose not able to be taken up into the cells for use –> so fatty acids are used for energy leading to ketone body formation and ketoacidosis

30
Q

What is the mechanism of polyuria, glucosuria and dehydration?

A

> 10mM is the renal threshold where after this glucose will be excreted in the urine

Polyuria as H2O follows glucose

Dehydration as polyuria - leads to polydipsia

31
Q

What is a normal HbA1c % glycation? What is the target for diabetics %?

A

4-5.9%

Diabetics 6.5%

32
Q

What two types of oral medication are used in diabetes type II?

A

Metformin - inhibits gluconeogenesis in liver

Sulphonylureas - decreases opening probability of kATP channel so increases insulin secretion

33
Q

What are the two major concerns with metabolic syndrome?

A

Metabolic syndrome increases the risk of type 2 diabetes 5 fold and heart disease by approximately 3 fold

ESA2 (37 decks)

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