Type 1 Diabetes Mellitus Flashcards
To learn about T1DM
What is the typical presentation of T1DM?
- Typically a young person presents with a short history of polydipsia, polyuria, weight loss and malaise
What is the polyuria due to?
Due to the osmotic diuretic effect of glucose and ketone bodies in the urine
What is the weight loss due to in T1DM
Combined effects of dehydration and catabolism
What does NICE say in respect to the diagnosis of T1DM?
People with T1DM have one or more of:
- ketosis
- rapid weight loss
- Age of onset below 50
- BMI below 25kg/m2
- History of autoimmune disease in family
What is the pathogenesis of T1DM
Slow progressive immunological destruction of beta cells by antigen specific cytotoxic T lymphocytes
How is DM diagnosed?
- History
- Random venous plasma glucose conc >= 11.1 mmol/L
- fasting glucose >= 7.0mmol/L
- 2 hour plasma glucose conc >= 11.1 after 75g oral glucose tolerance test 2 hours
How is HbA1c used in the diagnosis of DM?
HbA1c >= 6.5%, but test should not be used alone
Where should HbA1c should not be used ?
- All children and young people
- Patients of any age suspected with T1DM
- Patents with symptoms of less than 2 months
- Patients on drugs that cause rapid glucose rise
- Pregnancy
- Factors that influence HbA1c and its measurement
What is the typical presentation of IDDM (subacute)
- Polydipsia, polyuria, weight loss, malaise
- Bacterial/fungal infections
- Cramps, blurred vision, abdominal pains
What are other acute complications of IDDM?
Acute diabetic ketoacidosis:
- Precipitating event
- ketotic breath
- acidotic respiration
- Nausea and vomitting
What are the aims diabetes management?
- To prevent Hypo/Hyperglycemia and to maintain a level of glycemic control
- To prevent longterm micro/macro vascular complications.
What does the treatment of DM involve?
- Dietary measures
- Therapy with oral hypoglycaemic agents
- Insulin therapy
What are the management options in T2DM?
- Diet
- Monitoring
- Metformin
- Insulin secretagogues
- PPAR gamma agonists
- Alpha glusidase inhibitors
- Insulins
What is diabetic eye disease?
Occurs in people aged 25-65:
- Diabetic retinopathy
- Diabetic cataract
- Glaucoma
Why is myopia present in diabetes?
Results in an increased refractive index of the lens, due to dehydration.
What is diabetic retinopathy?
- Microangiopathy affecting precapillary arterioles, capillaries and venules.
- Features micro vascular occlusion and leakage
What are the early clinical signs?
- Micro aneurysms
- Dot intraretinal heamorrhages
- Flame shaped hemorrhages
- Reinal oedema
- Hard exudates
What are the types of neuropathy that diabetics get?
- A sensory diffuse mononeuropathy
- Painful diabetic neuropathy
- Mononeuropathies
- Autonomic neuropathy
- Mononeuritis multiplex
What is diabetic mononeuropathy?
- Diabetic mononeuropathy. can affect peripheral or cranial nerves
- 3rd and 6th cranial nerves affected
- Palsy usually resolves in time
What is mononeuritis multiplex?
Involves more than one peripheral or cranial nerves
What is Diabetic autonomic neuropathy?
Tends to affect the parasympathetic arm of the autonomic nervous system, in particular vagal stimulation
What are the features of diabetic autonomic neuropathy?
- Postural hypotension
- Impotence
- Abnormal sweating
- Dependant oedema
What are the factors that predispose to the development of diabetic foot issues?
- Microangioathy: Decreased awareness
- Restricted capillary perfusion
- Arteriovenous communication from beneath skin, divert nutrion away from skin - poor healing
- Bacterial growth favoured by glucose rich tissue environment
Which patients are most at risk of diabetic foot complications?
- Older poorly controlled T2DM
2. Patients with long standing T1DM
