What is Diabetes and Epidemiology of Diabetes

Question 1

Definition ofDM?

Answer 1

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

Question 2

Symptoms of hyper-glycaemia?

Answer 2

Polydipsia
Polyuria
Blurred vision
Weight loss
Infections

Question 3

What is polydipsia?

Answer 3

Drinking excess water

Question 4

Why do DM patients get polyuria?

Answer 4

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

Question 5

Some complications that arise from hyperglycaemia?

Answer 5

Diabetic ketoacidosis

Hyperosmolar hyperglycemic state

Question 6

What is a hyperosmolor hyperglycaemic state?

Answer 6

Hyperglycaemia results in high osmolarity without significant ketoacidosis

Question 7

Why is there little ketoacidosis in HHS?

Answer 7

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

Question 8

Symptoms and diagnosis of HHS?

Answer 8

Dehydration
Leg cramps
Trouble seeing
Altered level of consiousness

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

Question 9

Management of HHS?

Answer 9

IV fluids over 24 hours
Electrolyte replacement
Insulin

Question 10

What type of diabetes does HHS normally affect?

Answer 10

Type 2

Question 11

What is DKA?

Answer 11

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

Question 12

Symptoms of DKA?

Answer 12

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

Question 13

Symptoms of severes DKA?

Answer 13

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

Question 14

How does body try to fight the ketoacidosis ?

Answer 14

Bicarbonate buffering mechanism - these quickly fail

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

Question 15

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

Answer 15

Tachycardia and low BP

Question 16

How is DKA diagnosed?

Answer 16

Arterial blood gas to demonstrate acidosis

Ketones in urine

Question 17

What is main difference between DKA and HHS?

Answer 17

Ketones in blood

Question 18

DKA treatment?

Answer 18

Fluid replacement
Insulin
Potassium
Bicarbonate

Question 19

What are some long-term complications from hyperglycaemia?

Answer 19

Retinipathy
Neuropathy
Nephropathy

Question 20

What are some vascular complications from hyperglycaemia?

Answer 20

Stroke
MI
PVD

Question 21

How is DM diagnosed?

Answer 21

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

Question 22

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

Answer 22

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

Question 23

Why are these levels useful?

Answer 23

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

Question 24

What is normoglycaemia?

Answer 24

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

Question 25

Diabetes diagnostic criteria identify a group which...?

Answer 25

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

Question 26

When would you measure blood glucose or measure HbA1c?

Answer 26

Only BG if there is symptoms 2 diagnotic glucose tests or 1 and HbA1c if no symptoms

Question 27

What is HbA1c?

Answer 27

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

Question 28

When can HbA1c not be used for diagnosis?

Answer 28

``` 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 ```

Question 29

How does insulin affect Adipose tissue, liver and muscle?

Answer 29

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

Question 30

Clinical presentation of type 1 - symptoms?

Answer 30

``` Thirst Tiredness Polyuria/nocturia Weight loss Blurred vision Abdo pain ```

Question 31

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

Answer 31

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

Question 32

Does type 1 and 2 have a genetic component?

Answer 32

Yes

Question 33

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

Answer 33

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

Question 34

Type 2 diabetes symptoms?

Answer 34

``` Thirst Tiredness Polyuria/nocturia Sometimes weight loss Blurred vision ``` May have NO SYMPTOMS at all

Question 35

Signs of type 2?

Answer 35

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

Question 36

Type 2 risk factors?

Answer 36

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

Question 37

What is MODY? Give some features.

Answer 37

Maturity onset diabetes in the young Is autosomal dominant with a single gene defectand leads to imparied B-cell function

Question 38

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

Answer 38

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

Question 39

What is a OHA?

Answer 39

Orah hypoglycaemic agents

Question 40

What is secondary diabetes mellitus?

Answer 40

DM due to pancreatic destruction

Question 41

How is pancreas destroyed in 2y DM?

Answer 41

Excess iron deposition - haemochromatosis Cystic fibrosis Chronic pancreatitis Pancreatectomy

Question 42

Treatment of 2y DM?

Answer 42

Drug therapy - corticosteroids

Question 43

What is gestational diabetes? What is it associated with?

Answer 43

Increasing insulin resistance during pregnancy Associated with increase FH of type 2

Question 44

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

Answer 44

Yes

Question 45

When does Gest. DM present?

Answer 45

2nd or 3rd trimester

Question 46

What patients is Gest. DM more common in?

Answer 46

FH of type 2 | Overweight and inactive

Question 47

How does Gest. DM affect the neonate?

Answer 47

Macrosomia Resp. distress Neonatal hypoglycemia But baby is normally delivered healthy as in the 1st trimester it grows normally