What is Diabetes and Epidemiology of Diabetes Flashcards
Definition ofDM?
A group of metabolic disease characterized by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism
Symptoms of hyper-glycaemia?
Polydipsia Polyuria Blurred vision Weight loss Infections
What is polydipsia?
Drinking excess water
Why do DM patients get polyuria?
excess glucose from the blood ends up in the urine where it draws more water
Some complications that arise from hyperglycaemia?
Diabetic ketoacidosis
Hyperosmolar hyperglycemic state
What is a hyperosmolor hyperglycaemic state?
Hyperglycaemia results in high osmolarity without significant ketoacidosis
Why is there little ketoacidosis in HHS?
Still some insulin in blood that inhibits hormone sensitive lipase mediated fat tissue breakdown
Symptoms and diagnosis of HHS?
Dehydration
Leg cramps
Trouble seeing
Altered level of consiousness
Plasma gluocse of over 30 mmol/L
Serum osmolarity of over 320 mOsm/kg
Management of HHS?
IV fluids over 24 hours
Electrolyte replacement
Insulin
What type of diabetes does HHS normally affect?
Type 2
What is DKA?
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
Symptoms of DKA?
Nausea and vomiting - to increase pH Thirst Excessive urine production Abdominal pain Dehydration
Symptoms of severes DKA?
Laboured and deep breathing with a gasping character known as Kussmaul respiration
How does body try to fight the ketoacidosis ?
Bicarbonate buffering mechanism - these quickly fail
Then via vomiting to get rid of acid and hyperventilation to lower CO2 - kussmaul respiration
In DKA - if dehydration is low enough to cause a drop in blood volume what signs will be seen?
Tachycardia and low BP
How is DKA diagnosed?
Arterial blood gas to demonstrate acidosis
Ketones in urine
What is main difference between DKA and HHS?
Ketones in blood
DKA treatment?
Fluid replacement
Insulin
Potassium
Bicarbonate
What are some long-term complications from hyperglycaemia?
Retinipathy
Neuropathy
Nephropathy
What are some vascular complications from hyperglycaemia?
Stroke
MI
PVD
How is DM diagnosed?
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
What are the fasting glucose, impaired glucose tolerance and HbA1c levels for intermediate hyperglycaemia?
Fasting glucose - 6.1-7 mmol/L
OGTT - 7.8 to 11 mmol/L
HbA1c - 42-47 mmol/mol
Why are these levels useful?
Measuring for intermediate hyperglycaemia identifies a group of people at risk for future diabetes and CV disease
What is normoglycaemia?
Glucose levels associated with low risk of developing diabetes or cardiovascular disease
Diabetes diagnostic criteria identify a group which…?
Have significantly increased premature mortality and increased risk of microvascular and cardiovascular complications
When would you measure blood glucose or measure HbA1c?
Only BG if there is symptoms
2 diagnotic glucose tests or 1 and HbA1c if no symptoms
What is HbA1c?
Glycated haemoglobin - it gives an indication of blood glucose levels over last 8-12 weeks
When can HbA1c not be used for diagnosis?
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
How does insulin affect Adipose tissue, liver and muscle?
Adipose - reduced lipolysis
Liver - reduced glucose production
Muscle - increased glucose uptake
Clinical presentation of type 1 - symptoms?
Thirst Tiredness Polyuria/nocturia Weight loss Blurred vision Abdo pain
Clinical presentation of type 1 - on examination you will see?
Ketones on breath Dehydration Increased RR and HR Hypotension Low grade infections - thrush/balanitis
Does type 1 and 2 have a genetic component?
Yes
In type 2 - what are the initial insulin levels like and how does this change?
Initially hyperinsulinaemia as body is trying to illicit the response but eventually insulin levels drop
Type 2 diabetes symptoms?
Thirst Tiredness Polyuria/nocturia Sometimes weight loss Blurred vision
May have NO SYMPTOMS at all
Signs of type 2?
Not ketoic
Usually overweight
Low grade infections - thrush/balanitis
Micro/macrovascular complications
Type 2 risk factors?
Overweight Familiy history Over 30 years ove rage and asian (inidan subcontinent)/maori Over 40 years old if european Sedentary lifestyles
What is MODY? Give some features.
Maturity onset diabetes in the young
Is autosomal dominant with a single gene defectand leads to imparied B-cell function
What 2 types of mutations are there in MODY and what do they lead to in the presenation and outcome of the disease?
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
What is a OHA?
Orah hypoglycaemic agents
What is secondary diabetes mellitus?
DM due to pancreatic destruction
How is pancreas destroyed in 2y DM?
Excess iron deposition - haemochromatosis
Cystic fibrosis
Chronic pancreatitis
Pancreatectomy
Treatment of 2y DM?
Drug therapy - corticosteroids
What is gestational diabetes? What is it associated with?
Increasing insulin resistance during pregnancy
Associated with increase FH of type 2
Does gestational diabetes increase risk of getting type 2 later in life?
Yes
When does Gest. DM present?
2nd or 3rd trimester
What patients is Gest. DM more common in?
FH of type 2
Overweight and inactive
How does Gest. DM affect the neonate?
Macrosomia
Resp. distress
Neonatal hypoglycemia
But baby is normally delivered healthy as in the 1st trimester it grows normally
