Session 7- An intro to Diabetes Flashcards
What is diabetes
When blood glucose is too high and over years leads to damage of the small and large blood vessels causing premature death from cardiovascular diseases
Pathophysiogy of diabetes
As blood glucose rises as you eat the body sends a signal to the pancreas, which releases insulin
Acting as a key insulin binds to a place on the cell membrane undocking the cell so glucose can pass through
Why does blood glucose rise
Inability to produce insulin due to beta cell failure
Insulin production adequate but insulin resistance prevents insulin working effectively and invariably linked to obesity
Type 1 diabetes
The pancreas does not produce enough insulin due to autoantibodies against the beta cells and insulin producing cells
Type 2 diabetes
Your pancreas may not produce enough insulin or your cells do not use insulin properly
Typical symptoms of hyperglycaemia
Polyuria Polydipsia Blurring of vision Urogenital infections- thrush Tiredness Weakness Lethargy Weight loss
Diagnosis of diabetes
Fasting glucose
Oral glucose tolerance test
HbA1c
You need symptoms and 1 abnormal test or 2 if asymptomatic
How does type 1 diabetes present
Rapid onset weight loss, polyuria, polydipsia
Late presentation- vomiting due to ketoacidosis
Treatment of type 1 diabetes
Exogenous insulin given by subcutaneous injection several times a day
When do ketone levels increase
In the absence of insulin ketone production is activated
Presence of ketones indice immediate insulin therapy is needed
What is ketoacidosis
Hyperglycaemia
Ketoneaemia
Acidosis
Absolute or relative deficiency of insulin
Enhanced lipolysis leads to uncontrolled ketosis
Large quantities of ketone bodes formed including 3-beta-hydroxybutarate and acetoacetic acid and acetone
Ketonaemia
> 3.0mmol/L in blood
Diagnosing ketoacidosis
Ketonaemia
Ketouria
Blood glucose >11.0mmol/L
Bicarbonate < 15,0 mmol/L
What causes insulin resistance in type 2 diabetes
Obesity Muscle and liver fat deposition Elevated circulating free fatty acids Physical inactivity Genetic influences
Symptoms of type 2 diabetes
Polyuria polydipsia weight loss
May be asymptomatic
Acute complications of diabetes
metabolic deomposition
diabetic ketoaciodis in type 1
hyperosmolar non-ketotic syndrome in type 2
Coma
Chronic complications of diabetes- macro vascular
Cerebrovascular, cardiovascular peripheral vascular disease
-Strokes MI, intermittent Claudication, gangrene
Microvascular complications of diabetes
Microvascular or capillary disease
-retinopathy, nephropahy, neuropathy, blindness, renal replacement therapy, erectile dysfunction, foot ulceration, diarrhoea, constipation, painful peripheral neuropathy
What is metabolic syndrome
Cluster of the most dangerous risk factors associated with cardiovascular disease: diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and BP
All confer a marked increase in cardiovascular disease
What causes metabolic syndrome
Insulin resistance and central obesity, genetics physical inactivity, ageing
What is insulinitis
Inflammation of the islets
Auto-Antibodies detected in type 1 diabetes mellitus
ICAs- Islet Cell Auto-antibodies
IAAs- Insulin Auto-Antibodies
IA2- an islet secretory protein
GAD- Glutamic Acid Decarboxylase
Progression of type 1 diabetes
Insulin deficiency
Catabolic state
Hyperglycaemia
Ketoacidosis
Dehydration
Coma
Death
How can untreated Type 1 lead to coma
Lack of insulin and corresponding elevation in glucagon
Rapid lipolysis
Excess fatty acids converted to ketone bodies in liver - smell of acetone on breath and ketouria
Ketoacidosis
Hyperventilation, nausea, vomiting, abdominal pain, coma
How can you test for diabetes
Urine
Finger prick - glucose and ketones
Smell of acetone on breath
Blood sampl for measurement of glucose urea, electrolytes HbA1c
Check for signs of dehydration
BP, pulse, chest sounds
Check RR
How do you treat type 1 DM
Diet and exercise
Insulin therapy
Macrovascular complications of diabetes mellitus
Increased risk of stroke
Increased risk of myocardial infarction
Poor circulation to periphery - feet
Microvascular complications of DM
Diabetic eye disease
Retinopathy
Nephropathy
Neuropathy
Diabetic foot
Retinopathy
Damage to blood vessels in retina leading to blindness
Neuropathy
Peripheral nerve damages producing loss of sensation
Diabetic foot
Poor blood supply damage to nerves, increased risk of infection. Foot ulcers
Nephropathy
Damage to glomeruli can lead to microaluminuria
Features of T2 DM
Late onset Ketoacidosis No acute weight loss- often obese Rate of fatality slower than type 1 Insulin replacement not immediate
HbA1c test
Measure of glycated haemoglobin reflects average glycaemia over a period of weeks
Non diabetics- 4% - 5.9%
Diabetics 6.5%
Diabetics at higher risk of hypoglycaemia- 7.5&
Management of T2 DM
Diet and exercise
Oral hypoglycaemic treatment
Insulin therapy
Metformin
Suphonylureas
How does metformin work
Reduces Hepatic Glucose Output
by Inhibiting gluconeogenesis
How do sulphonylureas work
Modulates ATP sensitive K+ channels function by decreasing open probability
Stimulates insulin secretion
