Pathophysiology of diabetes

Question 1

What is diabetes?

Answer 1

A disease characterised by hyperglycaemia caused by either lack of insulin or a reduction in the effectiveness of insulin.

Question 2

What are the types of diabetes?

Answer 2

Type 1 and type 2
Gestational diabetes - develops in pregnancy
diabetes secondary to other situations such as pancreatitis or pancreatic cancer.

Question 3

What is type 1 diabetes?

Answer 3

A form of diabetes mellitus that results from autoimmune destruction of insulin producing beta cells in pancreas. Results in complete lack of insulin, cells cannot take up glucose in blood.

Question 4

What is type 2 diabetes?

Answer 4

Body becomes resistant to effects of insulin as well as a relative lack of insulin.

Question 5

What are the risk factors for type 2 diabetes?

Answer 5

• obesity and inactivity
• family history
• ethnicity
• history of gestational diabetes
• poor dietary habits

Question 6

What are some symptoms of type 1 diabetes?

Answer 6

• polyuria (production of lots of dilute urine)
• polydispia (excessive thirst)
• weight loss
• increased appetite
• excessive tiredness

Question 7

What symptoms are more likely in patients with type 2 diabetes?

Answer 7

• infections
• poor wound healing
• blurred vision

Question 8

What are the short-term blood glucose levels of type 1 diabetes fasted and 90 minutes after food?

Answer 8

fasted - 4-7 (preferably 5-7)
90 minutes after food - 5-9

Question 9

What are the short-term blood glucose levels of type 2 diabetes fasted and 90 minutes after food?

Answer 9

fasted 4-7
90 minutes after food <8.5

Question 10

what are the normal, pre-diabetes, and diabetes long-term measurements of HBA1C?

Answer 10

normal - 42mmol/mol (6%)
pre-diabetes - 42-48mmol/mol(6-6.4%)
diabetes - >48mmol/mol (>6.5%)

Question 11

How is type 1 diabetes diagnosed?

Answer 11

Diagnosed in patient’s presenting with hyperglycaemia (random plasma glucose more than 11mmol/L)_ and the symptoms related to type 1 diabetes

Question 12

How is type 2 diabetes diagnosed?

Answer 12

Usually diagnosed by HbA1c of 48mmol/mol or more. Can also be diagnosed by a fasting plasma glucose of 7.0mmol/L or more.

Question 13

What is the most common method for checking blood glucose levels?

Answer 13

The finger prick test is the most common and accurate for use in healthcare setting. Requires patient to prick the skin every time they want to check their levels. Newer technology allows for reduction in this as a small sensor is attached to the body which can be linked to a smartphone or other device to allow for easier testing

Question 14

What are some complications of diabetes?

Answer 14

• hypoglycaemia
• hyperglycaemia and diabetic ketoacidosis
• mascrovascular complications
• microvascular complications

Question 15

What is hypoglycaemia?

Answer 15

Blood glucose less than 4mmol/L due to excessive breakdown of blood glucose. More common in type 1.

Question 16

What are some symptoms of hypoglycaemia?

Answer 16

• shakiness
• nervousness or anxiety
• sweating, chills and clamminess
• irritability or impatience
• confusion
• palpitations
• dizziness
• blurred vision
• hunger and nausea

Question 17

What are the causes of hypoglycaemia?

Answer 17

• medication
• too much exercise
• not enough food

Question 18

What is the treatment for hypoglycaemia?

Answer 18

• food or drink containing sugar
• long-acting ‘starchy’ carbohydrate food
• injection of glucagon
• IV glucose infusion

Question 19

What is hyperglycaemia?

Answer 19

Blood glucose levels over 8-9mmol/L.

Question 20

What are the symptoms of hyperglycaemia?

Answer 20

• blurry vision
• difficulty concentratin
• frequent urination
• headaches
• fatigue
• high blood glucose

Question 21

What are the causes of hyperglycaemia?

Answer 21

• stress
• illness
• eating too much
• lack of exercise
• dehydration
• missing doses of diabetes medication

Question 22

What is diabetic ketoacidosis?

Answer 22

It is a result of severe hyperglycaemia. When cells can’t use glucose for energy, they start to metabolise fat to fatty acids. The liver converts fatty acids into acid ketones.

Question 23

What are symptoms of DKA?

Answer 23

vomiting, thirst, dehydration, weakness, sweet smelling breath, collapse and coma

Question 24

What is the treatment for DKA?

Answer 24

• IV fluids to treat dehydration
• IV insulin to treat hyperglycaemia

Question 25

What are macrovascular complications of diabetes?

Answer 25

Complications affecting any large blood vessel in the body. Includes CVD, cerebrovascular disease, and peripheral artery disease, which affects blood flow to the extremities and can result in poor wound healing and ulceration of the skin.

Question 26

What are microvascular complications of diabetes?

Answer 26

Refers to complications affecting any small blood vessels in the body. It can cause kidney damage (nephropathy), damage to the eyes (Retinopathy), and nerve damage (neuropathy)

Question 27

What regular check ups are needed for microvascular complications?

Answer 27

Regular eye screening and foot check up ares required. Care is also needed in diabetic patients preventing issues associated with the eyes and feet.