Poster- diabetes 1 Flashcards
Normal range for HbA1c
Less than 42
Diabetes range for HbA1c
Greater than or equal to 48
Normal range for fasting glucose
Less than 7mmol
Diabetes range for fasting glucose
Above 7 mmol
Normal range for 2 hour oral glucose tolerance test
Less than 11mmol
Diabetes range for 2 hour OGTT
Above 11.0mmol
Quick pathology of type 1 diabetes
Pancreatic beta cells are destroyed by T cells. This means they fail to produce insulin which causes glucose to remain in the blood and hyperglycaemia occurs.
What is type 1 diabetes associated with?
HLA DR3
HLA DR4
Characteristically these autoantibodies will be present in type 1 diabetes
Anti-islet cell antibodies
Anti- GAD
Type 1 diabetes is more common than type 2. T or F.
F- type two is more common.
It is likely that patients with diabetes will have a first degree relative also with diabetes. T or F
Partially true. 15% of people younger than 15 diagnosed have a first degree relative with type 1.
What other diseases is diabetes associated with?
Around 25% of CF sufferers also have DM. Coeliac disease Thyroid diseases Addisons disease Pernicious anaemia IgA deficiency.
Classic triad of symptoms of adults with type 1 diabetes
Polyuria- excessive urination
Polydipsia- excessive (often unquenchable) thirst
Weight loss
What other symptoms may accompany the triad for adults with type 1 diabetes?
Candida infection (thrush)
DKA
Fatigue
Blurred vision
Symptoms of children with type 1 diabetes
Often similar to adults with the polyuria, polydipsia and weight loss.
However also tend to have low muscle mass (due to lipolysis, gluconeogenesis and glycogenesis)
Also could have secondary nocturnal enuresis- child previously trained not to wet the bed, now has started doing it again.
How does DKA occur?
When there is prolonged insulin insufficiency, the body starts to do lipolysis (along with gluconeogenesis and glycogenolysis). The lipolysis provides energy however a breakdown product is free fatty acids.
These FFA are then converted to ketone bodies by the liver.
Symptoms of DKA
Kussmaul breathing- deep laboured breathing associated with kidney failure and DKA Dehydration Nausea Vomiting Change of mental state Fruit/pear drop smell of breath Polyuria Tachycardic and hypertensive
Treatment of DKA
Use fluids to stop dehydration.
Replace lost electrolytes
Insulin
What do you have to be wary of when treating children with DKA
Fluid resus should be done based on weight because they are at risk of cerebral oedema.
Blood glucose target level before meals in a normal patient
4-5.9mmol
Blood glucose target levels 2 hours after a meal in a normal individual
Less than 8
Blood glucose target levels before a meal in an adult type 1 diabetic
4-7
Blood glucose target levels 2 hours after a meal in an adult type 1 diabetic
Less than 9
Blood glucose target levels before a meal in a type 2 diabetic
4-7
Blood glucose target levels 2 hours after a meal in a type 2 diabetic
Less than 8.5
Blood glucose target levels before a meal in a child with type 1 diabetes
4-8
Blood glucose target levels 2 hours after a meal in a child with type 1 diabetes
Less than 10.
At what stage is it hypoglycaemia
4mmol and less
4 is the FLOOR
Symptoms of hypoglycaemia
Patient becomes pale and sweaty They have tremors and palpitations They are confused, nauseous, hungry Weak and fatigued Tachycardic
Cognitive symptoms of hypoglycaemia
Slow at processing information
Tense
Effects memory
Severe hypoglycaemia can present as
Seizures
Coma
Unconciousness
What is impaired hypoglycaemia awareness and why is it more dangerous than hypoglycaemia?
This is when the patient feels no symptoms during hypoglycaemia or no change in symptoms. This is dangerous as it doesn’t allow them to recognise it and then rectify the situation.
Who is most likely to get impaired hypoglycaemia?
Those who have frequent low blood glucose levels or patients being intensively treated.
Describe type 2 diabetes briefly
Insulin resistance leading to hyperglycaemia
How does obesity contribute to type 2 diabetes
Obesity leads to a decreased number of insulin receptors.
What are the risk factors for developing type 2 diabetes
genetic predisposition (family history) Obesity Gestational diabetes MI/stroke Age Ethnicity- Asian, African, afro-caribbean PCOS Metabolic disorders
Short pathophysiology of type 2 diabetes
Insulin resistance means that blood sugar levels are still high. Initially beta cells compensate for this by making more insulin however after a while they become exhausted and therefore people become insulin deficient.
Clinical features of type 2 diabetes
Polyuria, polydipsia and hyperglycaemia- however can be clinically silent for up to 12 years.
Also patients with type 2 diabetes tend to present with complications such as neuropathy, retinopathy, blurred vision, fatigue, weakness, infections and thrush.
Likely history from a patient with type 2 diabetes (include presentation, diet, PMH and FH)
Rapid onset of symptoms
Diet- contains lots of sugar
PMH- heavy alcohol consumption, previous pancreatitis
FH- diabetes, autoimmune conditions, insulin resistance, CV disease, high bp, high lipids,
How would you diagnose someone with type 2 diabetes
Blood glucose levels
Treatment of type 2 diabetes
Diet and exercise to lose weight. Prognosis greatly increases with weight loss.
Patient may need drug therapy e.g. metformin, sulphonylureas and possibly exogenous insulin.
Why would a patient with type 2 diabetes not have ketones in their urine?
The low circulating volume insulin means that ketone bodies are not produced.
Histological appearance of type 2 diabetes
Amyloid deposits in islet cells.
Gestational diabetes
Diabetes that comes on during pregnancy and resolves post natally. Increased future risk of type 2.
Secondary diabetes
Diabetes that comes secondary to other diseases e.g. endocrinopathies (Cushings, acromegaly), haemochromatosis, post pancreatitis, CF
Monogenic diabetes
Diabetes that develops due to a mutation in a gene regulating insulin action or secretion. MODY, mitochondrial diabetes.
