S7 Diabetes Flashcards
What is diabetes?
When blood glucose is too high (hyperglycaemia) and over years leads to damage of small and large blood vessels causing premature death from cardiovascular diseases
What are the two types of diabetes?
Type 1 and type 2
What causes the diabetes epidemic?
Environment (e.g. obesity) not genetics
Why does blood glucose rise?
- inability to produce insulin due to beta cell failure
* insulin production adequate but insulin resistance prevents insulin working effectively (linked to obesity)
How does type 1 diabetes mellitus arise?
Autoantibodies are directed against beta cells and insulin producing cells are destroyed
Mostly due to genetics - alleles of HLA-DQB1 or MHC-II
How does type 2 diabetes mellitus arise?
The pancreas may not produce enough insulin (relative insulin deficiency) or the cells don’t use insulin properly (insulin resistance)
What are the symptoms of diabetes mellitus?
- polyuria (hyperglycaemia)
- polydipsia (hyperglycaemia)
- weight loss (inadequate energy utilisation)
(+ blurry vision, thrush, tiredness, weakness, lethargy)
Severity depends on levels of blood glucose
How do you diagnose diabetes?
Lab confirmation
- fasting glucose
- oral glucose tolerance test
- HbA1c
Need symptoms and 1 abnormal test or asymptomatic and 2 abnormal tests
What are the symptoms of type 1 diabetes?
- rapid onset weight loss
- polyuria
- polydipsia
- vomiting due to ketoacidosis (late)
Who is the typical type 1 diabetes patient? What are there bloods like?
- usually under 30 years
- elevated venous plasma glucose
- presence of ketones
How is type 1 diabetes treated?
Subcutaneous injections of exogenous insulin several times a day
The production of what is suppressed by insulin? How is this used in diagnosis of type 1 diabetes?
Production of ketones
If ketones are present in blood, it indicates immediate insulin therapy is needed as implies insulin absent
How does ketoacidosis occur? How do you treat it?
Hyperglycaemia —> ketoanameia —> acidosis
Enhanced lipolysis leads to uncontrolled ketosis
Hospitilisation, IV fluids and insulin
How is type 2 diabetes often managed?
Managed with controlling diet, tablets (metformin - reduces amount of glucose released by the liver and helps insulin work better) and weight loss, patient education, monitor chronic complications
Who gets type 2 diabetes mostly?
People over 40 years who are overweight/obese, however an increase in younger people/children with it
What causes insulin resistance to develop?
Obesity * muscle and liver fat deposition * elevated circulating free fatty acids Physical inactivity Genetic influences
What are the symptoms of type 2 diabetes?
Variable as there is a slower rise in blood glucose levels - could be asymptomatic
- possibly polyuria, polydipsia and weight loss
- no urinary ketones
What are the acute complications of diabetes?
- diabetic ketoacidosis in type 1
- hyperosomolar non-ketotic syndrome in type 2
- hypoglycaemia as a result of treatment (iatrogenic) - coma
What are the chronic complications of diabetes?
- macrovascular - cerebrovascular, cardiovascular, peripheral vascular diseases e.g. stroke, heart attack, claudication, gangrene
- microvascular - retinopathy, nephropathy, neuropathy e.g. blindness, renal replacement therapy, diarrhoea, painful peripheral neuropathy, constipation, foot ulceration
What is metabolic syndrome? How much of population of UK could have it?
Group of most dangerous risk factors associated with cardiovascular disease - diabetes, raised fasting plasma glucose, abdominal obesity, high cholesterol and BP
About 60%
How can someone have metabolic syndrome?
* if their waist is more than 94cm for men or more than 80cm for women Plus any 2 of the following: * high TAG * low HDL * high BP * high fasting blood glucose
What causes metabolic syndrome?
- insulin resistance
- central obesity
- genetics
- physical inactivity
- ageing
