What is Diabetes Flashcards
Define Diabetes
Diabetes Mellitus is a set of metabolic disorders in which defects in insulin secretion and/or action leads to Hyperglycaemia and disturbances in carb/protein/fat metabolism
What are the types of Diabetes?
Type 1 (Insulin Dependant DM) Type 2 - (Insulin Independant DM)
Maturity Onset Diabetes in the Young (MODY)
Secondary DM
Gestational Diabetes
Pathophysiology of Type 1 Diabetes
Its an autoimmune condition in which lymphocytes infiltrate the islets of langerhans causing insulitis (destruction of beta cells that produce insulin)
Describe the genetic component of Type 1 Diabetes?
Human Leukocyte Antigen (HLA) genes
How do we treat type 1 diabetes?
Daily insulin injections (as Peptide hormones don’t work orally)
Pathophysiology of Type 2 diabetes?
Central Adiposity
- > Free FAs in blood
- > Decreased Insulin Receptor Sensitivity (Insulin Resistance)
Normally the body increases production of insulin to match the resistance, however in people with gene variants that code for Poor high end insulin secretion cant keep up and end up hyperglycaemic
How do you treat Type 2 Diabetes
1) If you can catch them in a pre-diabetic stage you can restore sensitivity through exercise and diet
2) Oral Hypoglycaemics e.g. Metformin
3) Sulphonylureas
4) Insulin injections
Explain the OGTT:
Take fasting glucose level
Give glucose
Measure after 2 hrs
If raised= diabetes
How do we diagnose childhood onset diabetes?
4Ts:
- Tired
- Thinner
- Thirsty
- Toileting more (incl return to day or bed wetting)
Then test with a finger prick glucose test
If suspected refer to a specialist for a same day review
Why is it so important to diagnose diabetes as quickly as possible?
Undiagnosed children can very easily go into Diabetic Ketoacidosis -> Coma -> Death
Many children present with diabetes in Diabetic Ketoacidosis, how do we spot this?
N&V Sweet Ketotic breath Drowsiness Kussmaul breathing Coma
What does uncontrolled diabetes present in the short term?
Thirst (polydipsia) Tiredness Polyuria/nocturia Weight loss Blurred Vision Abdominal pain Dehydration Can develop into DKA or HHS
What are the methods of testing for Diabetes?
Random Glucose tests
Fasting Glucose Tests
Oral Glucose tolerance Test
HbA1c blood test
What are the diagnostic criteria for Diabetes?
Two Diagnostic tests without symptoms
Or 1 diagnostic tests with symptoms
What values would make a diagnostic test +ve for diabetes?
Fasting glucose > 7mmol/l
Random glucose >11.1mmol/l
OGTT >11.1mmol/l after 2 hours
HbA1C >48mmol/mol
When can we not use an HbA1c test?
Anything that effects the haemoglobin level e.g.:
- Pregnancy
- Acute illnesses
- Renal failure
- very recent pancreatic damage/removal
- HIV
- Meds that cause short term glucose spikes e.g. CCS
- Children
A diagnostic test for people with diabetes require showing they are hyperglycaemic, but what is intermediate hyperglycaemia?
Intermediate hyperglycaemia is where glucose/HbA1c levels are raised but don’t meet the threshold for diabetes.
These people are considered high risk for diabetes, CVD and associated complications
Acute complications of diabetes
Diabetic Ketoacidosis (DKA)
Hyperosmolar Hyperglycaemia State (HHS)
Define Diabetic Ketoacidosis?
Low levels of insulin cause a high level of Fatty Acids in the blood.
They’re converted to Ketone bodies in the liver to be used for energy
Causes acidosis of the blood leading to:
- N&V
- Sweet Ketotic breath
- Drowsiness
- Rapid deep sighing respiration (hyperventilation)
- Weakness, confusion -> Coma
- Polyuria
Define Hyperosmolar Hyperglycaemic State
High blood sugar levels resulting in a high osmolarity of blood without significant ketoacidosis.
More common in Type 2, it leads to: - Dehydration Weakness - Leg cramps - Visual problems - Altered Consciousness
What is MODY?
An autosomal dominant genetic syndrome making up 5% of diabetics, thus important to check for FH of diabetes.
Basically a single gene defect leads to impaired B-cell function.
It looks like Type 2 but presents in young people
What are the sub-types of MODY?
Depends on the kind of mutation:
Glucokinase mutations # Onset at Birth # Stable hyperglycaemia # Treated with diet # Rare complications
Transcription Factor Mutations # Adolescent onset # Progressive Hyperglycaemia # Treated with diet, oral hypoglycaemics and insulin # Frequent complications
What is Secondary Diabetes Mellitus?
DM brought on by:
- Drugs e.g. CCS
- Pancreatic destruction/removal
- Genetic syndromes
- Endocrine disorders e.g pheochromocytoma, cushings or acromegaly
What is gestational diabetes?
Increased insulin resistance brought on by pregnancy
Associated with FH of type 2, being overwight and inactive. It also increases risk of Type 2.
What does gestational diabetes cause regarding the baby?
- Foetal Macrosomia (big baby)
- Neonatal Respiratory arrest
- Neonatal Hypoglycaemia
In short how does diabetes present?
- thirst
- Tired
- Polyuria/nocturia
- Weight loss
- Blurred vision
- Abdominal pain
- Dehydration
- Low grade infections e.g. thrush
If they’ve reached DKA:
- Ketotic breath
- N&V
- Hyperventilation
- Tachypnoea/tachycardia
Type 2 diabetics are rarely ketotic but are usually overweight. They are also more likely to present with complications, having had long-term low grade diabetes
Diabetes presentation in children <5
Heavier/wetter nappies blurred vision Candidiasis (oral or vulval) Constipation Recurrent skin infections Irritability or behavioural changes
