What is Diabetes Mellitus? Flashcards by Lucy Jefford

What are some of the characteristics of diabetes mellitus?

Hyperglycaemia
Defects in insulin secretion, insulin action, or bothq

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RECAP- name the only hormone which lowers BG

Insulin

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How does insulin lower BG levels?

Insulin switches off hepatic glucose output
Increases the insulin uptake of fat and muscle cells

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What role does insulin have in adipose tissue?

Reduces lipolysis

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What role does insulin have in muscle tissue?

Increases glucose uptake

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List some of the symptoms of hyperglycaemia.

Polydipsia, polyuria, blurred vision, weight loss, infections

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What are some of the microvascular long term complications of hyperglycaemia?

Retinopathy
Neuropathy
Nephropathy

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What are some of the macrovascular long term complications of hyperglycaemia?

Stroke
MI
PVD- peripheral vascular disease

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What is used to diagnose diabetes?

Measuring blood glucose or HbA1c

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If taking a fasting glucose level, what level is diagnostic of diabetes?

> 7.0mmol/l

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If taking a random glucose level, what level is diagnostic of diabetes?

> 11.1mmol/l

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If taking an Oral Glucose Tolerance Test, what level is diagnostic of diabetes taken 2hrs after 75g carbohydrate?

> 11.1mmol/l

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If taking a HbA1c level, what level is diagnostic of diabetes?

> 48mmol/l

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In the diagnosis of diabetes, if a patient has symptoms, how many diagnostic lab glucose reading must they have before a diagnosis is made?

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In the diagnosis of diabetes, if a patient does not have any symptoms, how many diagnostic lab glucose reading must they have before a diagnosis is made?

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What is the name given to the stage before diabetes, sometimes known as pre-diabetes?

Intermediate hyperglycaemia

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What fasting glucose levels are indicative of intermediate hyperglycaemia/pre-diabetes?

6.1-7mmol/l

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What HbA1c levels are indicative of intermediate hyperglycaemia/pre-diabetes?

42-47mmol/l

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HbA1c?

Glucose bound to haemoglobin, an irreversible process. This blood test measures the levels of glucose bound to haemoglobin in the blood

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What are the advantages of using a HbA1c test compared to fasting BG?

HbA1c can be taken immediately, no fasting required

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List some of times in which HbA1c cannot be used for the diagnosis of diabetes mellitus.

-All children and young people
-Pregnancy
-Renal failure
-HIV infection
-Patients at high risk of diabetes who are acutely ill
-Patients on meds which can cause glucose spikes

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What is more common- type 1 or type 2 diabetes?

Type 2

->if you got this wrong girl pls just drop out already x

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What are some key points in history which help to determine which type of diabetes someone has?

-Age at diagnosis
-FH of diabetes
-Personal or familial history of autoimmune conditions
-Any hyperglycaemic symptoms

Which type of diabetes is an autoimmune condition?

Type 1 diabetes

What are some of the things you would examine or investigate to determine the type of a diabetes a patient has?

BMI Ketones Any sings of complications e.g. foot examination and retinal screening

Which cells are destroyed via autoimmune destruction in type 1 diabetes?

Islet cells - the insulin producing cells in the pancreas

Which auto antibodies can be measured and trigger the destruction of the insulin producing beta cells?

GAD antibodies- IAA, IA-2A, ZnT8

What is type 1 diabetes characterised by?

Insulin deficiency

What affect does this insulin deficiency have on the - adipose tissue -muscle -liver

Adipose- increase lipolysis Muscle- reduced glucose uptake Liver- raised glucose production

In type 1 diabetes, the body cannot use glucose as it's normal source of energy to breakdown muscle and fat. What does this result in?

Ketones

If type 1 diabetes is left untreated, what could develop?

Diabetic ketoacidosis (DKA)

Who is type 1 diabetes more common in?

Children and younger adults

In which type of diabetes is there a genetic link?

Both Type 2 diabetes is a lot more inheritable...this contradicts another lecture but I would probs listen to this one

What does the development of type 1 diabetes mellitus require?

Genetic predisposition AND Trigger e.g. viral infection

What are some of the symptoms of type 1 diabetes?

Polydipsia Polyuria/nocturia Tiredness Weight loss Blurred vision Abdominal pain

What are some of the signs upon examination of type 1 diabetes?

Ketones on breath Dehydration May have increased RR, tachycardia, hypotension Low grade infections e.g. thrush

What can ketones on breath smell like?

Pear drops

C-peptide levels can be used to confirm diagnosis of type 1 diabetes but is only reliable after 3yrs of diagnosis. What would the C-peptide levels be expected to be like at this point?

Undetectable Low levels would suggest more recently diagnosed

What happens in type 2 diabetes?

Increased cellular insulin resistance

Initially if you have insulin resistance, how does the body try to compromise?

By producing more insulin ->this keeps insulin levels fairly steady for a period of time but eventually almost 'burns out' as body cannot keep producing so much insulin over a longer period of time

Why is type 2 diabetes more common now?

-People heavier weight -Ageing population and more common as we get older -More sedentary lifestyle

What are some of the symptoms of type 2 diabetes?

Polydipsia Polyuria/nocturia Tiredness Sometimes weight loss but less common Blurred vision

What are some of the signs of type 2 diabetes?

Not ketotic Usually overweight Low grade infections e.g. thrush Microvascular/macrovascular complications at diagnosis

List some of the risk factors for type 2 diabetes.

Overweight Family history Older age Previous history of gestational diabetes Inactive life style Previously high blood glucose

What is a recognised genetic syndrome which can cause diabetes mellitus?

MODY- monogenic diabetes

Gestational diabetes?

Diabetes during pregnancy

Wat is MODY?

Autosomal dominant condition meaning there is impaired beta-cell function

What is a key factor of a history that would point to MODY?

Family history of many family members having diabetes

What happens in those with a glucokinase mutation?

Glucose levels from birth are always slightly higher

What is the treatment for monogenic diabetes cause by a glucokinase mutation?

Diet treatment

What is secondary diabetes mellitus?

Diabetes as a result of medications e.g. steroid use, pancreatic destruction, genetic syndromes, endocrine disorders

Which endocrine disorders can cause secondary diabetes?

Cushing's syndrome Acromegaly Pheochromocytoma

What other condition can cause destruction of the pancreas and can cause secondary diabetes?

Haemochromatosis- excess iron deposition Cystic fibrosis Chronic pancreatitis Pancreatectomy

In which trimesters does gestational diabetes occur?

2nd-3rd

Which neonatal problems can occur as a result of gestational diabetes?

Macrosomia Respiratory distress Neonatal hypoglycaemia