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ZA - Endocrine System > What is Diabetes and Epidemiology of Diabetes > Flashcards

What is Diabetes and Epidemiology of Diabetes Flashcards

1
Q

Definition ofDM?

A

A group of metabolic disease characterized by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism

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2
Q

Symptoms of hyper-glycaemia?

A 
Polydipsia
Polyuria
Blurred vision
Weight loss
Infections
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3
Q

What is polydipsia?

A

Drinking excess water

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4
Q

Why do DM patients get polyuria?

A

excess glucose from the blood ends up in the urine where it draws more water

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5
Q

Some complications that arise from hyperglycaemia?

A

Diabetic ketoacidosis

Hyperosmolar hyperglycemic state

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6
Q

What is a hyperosmolor hyperglycaemic state?

A

Hyperglycaemia results in high osmolarity without significant ketoacidosis

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7
Q

Why is there little ketoacidosis in HHS?

A

Still some insulin in blood that inhibits hormone sensitive lipase mediated fat tissue breakdown

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8
Q

Symptoms and diagnosis of HHS?

A

Dehydration
Leg cramps
Trouble seeing
Altered level of consiousness

Plasma gluocse of over 30 mmol/L
Serum osmolarity of over 320 mOsm/kg

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9
Q

Management of HHS?

A

IV fluids over 24 hours
Electrolyte replacement
Insulin

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10
Q

What type of diabetes does HHS normally affect?

A

Type 2

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11
Q

What is DKA?

A

No insulin and high glucagon = uncontrolled glycogenolysis + gluconeogenesis
High glucose enters urine = dehydration
Ketones are made via lipolysis but due to there being no insulin they stay in blood = acidosis

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12
Q

Symptoms of DKA?

A 
Nausea and vomiting - to increase pH
Thirst
Excessive urine production 
Abdominal pain 
Dehydration
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13
Q

Symptoms of severes DKA?

A

Laboured and deep breathing with a gasping character known as Kussmaul respiration

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14
Q

How does body try to fight the ketoacidosis ?

A

Bicarbonate buffering mechanism - these quickly fail

Then via vomiting to get rid of acid and hyperventilation to lower CO2 - kussmaul respiration

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15
Q

In DKA - if dehydration is low enough to cause a drop in blood volume what signs will be seen?

A

Tachycardia and low BP

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16
Q

How is DKA diagnosed?

A

Arterial blood gas to demonstrate acidosis

Ketones in urine

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17
Q

What is main difference between DKA and HHS?

A

Ketones in blood

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18
Q

DKA treatment?

A

Fluid replacement
Insulin
Potassium
Bicarbonate

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19
Q

What are some long-term complications from hyperglycaemia?

A

Retinipathy
Neuropathy
Nephropathy

20
Q

What are some vascular complications from hyperglycaemia?

A

Stroke
MI
PVD

21
Q

How is DM diagnosed?

A

Diagnostic glucose levels - fasting levels >7 mmol/L and random levels >11.1 mmol/L

OGTT - 2hr after 75g carbohydrate - >11.1mmol/L glucose level

Diagnostic HbA1c > 48 mmol/mol

22
Q

What are the fasting glucose, impaired glucose tolerance and HbA1c levels for intermediate hyperglycaemia?

A

Fasting glucose - 6.1-7 mmol/L
OGTT - 7.8 to 11 mmol/L
HbA1c - 42-47 mmol/mol

23
Q

Why are these levels useful?

A

Measuring for intermediate hyperglycaemia identifies a group of people at risk for future diabetes and CV disease

24
Q

What is normoglycaemia?

A

Glucose levels associated with low risk of developing diabetes or cardiovascular disease

25
Q

Diabetes diagnostic criteria identify a group which…?

A

Have significantly increased premature mortality and increased risk of microvascular and cardiovascular complications

26
Q

When would you measure blood glucose or measure HbA1c?

A

Only BG if there is symptoms

2 diagnotic glucose tests or 1 and HbA1c if no symptoms

27
Q

What is HbA1c?

A

Glycated haemoglobin - it gives an indication of blood glucose levels over last 8-12 weeks

28
Q

When can HbA1c not be used for diagnosis?

A 
All young peopls
Pregnancy
Short duration of symptoms
Acutely ill high risk patients
Patients on meds that cause rapid glucose rises
Acute pancreatic damage/surgery
Renal failure
HIV infected patients
29
Q

How does insulin affect Adipose tissue, liver and muscle?

A

Adipose - reduced lipolysis
Liver - reduced glucose production
Muscle - increased glucose uptake

30
Q

Clinical presentation of type 1 - symptoms?

A 
Thirst
Tiredness
Polyuria/nocturia
Weight loss
Blurred vision
Abdo pain
31
Q

Clinical presentation of type 1 - on examination you will see?

A 
Ketones on breath
Dehydration 
Increased RR and HR
Hypotension
Low grade infections - thrush/balanitis
32
Q

Does type 1 and 2 have a genetic component?

A

Yes

33
Q

In type 2 - what are the initial insulin levels like and how does this change?

A

Initially hyperinsulinaemia as body is trying to illicit the response but eventually insulin levels drop

34
Q

Type 2 diabetes symptoms?

A 
Thirst
Tiredness
Polyuria/nocturia
Sometimes weight loss
Blurred vision

May have NO SYMPTOMS at all

35
Q

Signs of type 2?

A

Not ketoic
Usually overweight
Low grade infections - thrush/balanitis
Micro/macrovascular complications

36
Q

Type 2 risk factors?

A 
Overweight
Familiy history
Over 30 years ove rage and asian (inidan subcontinent)/maori
Over 40 years old if european
Sedentary lifestyles
37
Q

What is MODY? Give some features.

A

Maturity onset diabetes in the young

Is autosomal dominant with a single gene defectand leads to imparied B-cell function

38
Q

What 2 types of mutations are there in MODY and what do they lead to in the presenation and outcome of the disease?

A

Glucokinase malfuncions - onset at birth, stable hyperglycaemia, treated via diet and complications rare

Transcription factor mutations - Preents in adolescencr/young adult, treatment is 1/3 diet, 1/3 OHA and 1/3 insulin, complications frequent

39
Q

What is a OHA?

A

Orah hypoglycaemic agents

40
Q

What is secondary diabetes mellitus?

A

DM due to pancreatic destruction

41
Q

How is pancreas destroyed in 2y DM?

A

Excess iron deposition - haemochromatosis
Cystic fibrosis
Chronic pancreatitis
Pancreatectomy

42
Q

Treatment of 2y DM?

A

Drug therapy - corticosteroids

43
Q

What is gestational diabetes? What is it associated with?

A

Increasing insulin resistance during pregnancy

Associated with increase FH of type 2

44
Q

Does gestational diabetes increase risk of getting type 2 later in life?

A

Yes

45
Q

When does Gest. DM present?

A

2nd or 3rd trimester

46
Q

What patients is Gest. DM more common in?

A

FH of type 2

Overweight and inactive

47
Q

How does Gest. DM affect the neonate?

A

Macrosomia
Resp. distress
Neonatal hypoglycemia

But baby is normally delivered healthy as in the 1st trimester it grows normally

ZA - Endocrine System (21 decks)

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