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what is diabetes mellitus Flashcards

1
Q

what is diabetes mellitus defined as?

A

a group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both

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2
Q

what clinical questions do you need to be aware of with a diabetic patient?

A

Does the person have diabetes?
Do they have hyperglycaemia? i.e. what are their blood glucose levels

What type of diabetes do they have?
I.e. What is the underlying cause of their diabetes?
( this will help determine what treatment is needed)

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3
Q

how do levels of glucose change throughout the day?

A

Levels of glucose and other nutrients entering the blood vary markedly during the day

but, between a complete carbohydrate blow-out and NO food ingested, [BG] is maintained over a fairly tight range.

Insulin dominates the absorptive state. Only hormone which lowers [BG].

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4
Q

how is blood glucose controlled?

A
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5
Q

what is the key role of insulin in cellular metabolism?

A

Insulin binds to receptors on cell surfaces and controls a range of intracellular processes

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6
Q

what effect does insulin have on adipose tissue?

A

reduced lipolysis

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7
Q

what effect does insulin have on the liver?

A

Reduced glucose production

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8
Q

what effect does insulin have on the muscle?

A

increased glucose uptake

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9
Q

what are symptoms of hyperglycaemia?

A

polydipsia, polyuria, blurred vision, weight loss, infections

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10
Q

what does metabolic decompensation of hyperglycemia result in?

A

DKA/HHS

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11
Q

what are long term conditions of hyperglycemia?

A

microvascular (retinopathy, neuropathy, nephropathy),
macrovascular (stroke, MI, PVD)

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12
Q

what are diagnostic levels for diagnosing diabetes?

A

Diagnostic glucose levels (venous plasma) fasting ≥ 7.0 mmol/l, random ≥ 11.1 mmol/l

OGTT 2h after 75g CHO ≥ 11.1 mmol/l

Diagnostic HbA1c ≥ 48 mmol/mol.

ONE diagnostic lab glucose or HbA1c plus symptoms

TWO diagnostic lab glucose or HbA1c levels without symptoms.

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13
Q

is the criteria the same for diabetes and gestational diabetes?

A

no different criteria

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14
Q

what is the criteria for intermediate hyperglycaemia?

A

Impaired fasting glucose 6.1-7 mmol/l

Impaired glucose tolerance 2h glucose ≥7.8 and <11mmol/l

HbA1c 42-47mmol/mol

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15
Q

what is normoglycaemia?

A

used for glucose levels associated with low risk of developing diabetes or cardiovascular disease

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16
Q

what is HbA1c?

A

Glycated haemoglobin
Gives indication of blood glucose levels over last 8-12 weeks

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17
Q

when can HbA1c not be used for diagnosis?

A

all children and young people

pregnancy - current or recent

short duration of diabetes symptoms

patientd st high risk of diabetes who are acutely ill

a value <48mmol/mol does not exclude diabetes

patients taking medication that may cause rapid glucose rise (corticosteroids/antipsycotic drugs)

acute pancreatic damage or pancreatic surgery

renal failure

human immunodeficiency virus (HIV)

18
Q

what are key points in the history for diabetes?

A

Age at diagnosis
Any hyperglycaemic symptoms at diagnosis?
Family history of diabetes?
Personal or family history of autoimmune conditions?

19
Q

what are key examinations and initial assessment for a patient with diabetes?

A

BMI at diagnosis
Ketones
Any signs of complications
Foot examination
Retinal screening

20
Q

what are the characteristics of type 1 diabetes?

A

insulin deficiency

increased lipolysis (adipose tissue)

raised glucose production (liver)

reduced glucose uptake (muscle)

21
Q

what can hyperglycaemia and ketonaemia lead to?

A

diabetic ketoacidosis

22
Q

describe the pathway for insulin deficiency?

A
23
Q

what are the genetics of type one diabetes?

A

Monozygotic twins 30-50% concordance
If father has Type 1: 6% risk
If mother has Type 1: 1% risk
If sibling has Type 1: 8% risk
If non-identical twin has Type 1: 10% risk
If both parents have Type 1: 30% risk

24
Q

what does the development of type 1 diabetes mellitus require?

A

Genetic pre-disposition plus
Trigger e.g.? Viral infection
Auto immunity

25
Q

what is the clinical presentation of type 1 diabetes mellitus?

A

Thirst
Tiredness
Polyuria / nocturia
Weight loss
Blurred vision
Abdominal pain

26
Q

on examination what might a patient with type one diabetes present with?

A

Ketones on breath
Dehydration
May have increased respiratory rate, tachycardia, hypotension.
Low grade infections, thrush / balanitis

27
Q

what point may help clinical diagnosis of type 1 diabetes?

A

Younger age at diagnosis
May be slim (need to consider weight distribution of general population)
Short duration of hyperglycaemic symptoms; thirst, polyuria, blurred vision, weight loss, infections e.g thrush
Other autoimmune conditions e.g thyroid
Family history of other autoimmune conditions eg thyroid, pernicious anaemia, vitiligo ( beware if strong family history of diabetes)
Elevated ketones

28
Q

what tests that can be done at a later date to confirm clinical diagnosis of type 1?

A

Auto antibodies GAD, IA2, ZNT8; usually take 6 weeks to come back so would not wait for this to make a diagnosis

C-peptide: Usually only reliable 3y after diagnosis, would expect undetectable c-peptide in someone with longstanding t1D, low levels in more recently diagnosed. High C peptide levels would suggest person does not have t1d

Genetics t1 genetic risk score- not used routinely, can be helpful if diagnosis not clear

29
Q

what effect does type 2 diabetes have on insulin?

A
30
Q

how has type 2 diabetes evolutionised?

A
31
Q

describe the incidence of both type one and two diabetes in relation to age?

A
32
Q

describe the genetics of type two diabetes?

A
33
Q

what are the symptoms of type two diabetes?

A

may have no symptoms
thirst
tiredeness
polyuria
weight loss
blurred vision
symptoms of complications (CVD)

34
Q

what are the signs of type 2 diabetes?

A

not ketotic
overweight
low grade infections (thrush, balanitis)
microvascular or macrovascular complications

35
Q

how is a diagnosis of type 2 diabetes made?

A

Older age at diagnosis
Overweight
Family history of t2D
May have no symptoms
No ketones

36
Q

what are risk factors for type 2 diabetes?

A
  • Overweight
  • Family history
  • Over age 30 years if Maori ⁄ Asian (Indian subcontinent)
    ⁄ Pacific Island descent
  • Over age 40 years if European
  • Previous history of diabetes in pregnancy (Gestational Diabetes)
    Had a big baby (more than 4 kg)—not in immediate post-natal period
  • Inactive lifestyle, lack of exercise
  • Previous high blood glucose ⁄ impaired glucose tolerance
37
Q

Monogenic diabetes also called MODY: Maturity Onset Diabetes in the Young

A

Autosomal dominant
? 5% of people with diabetes
Impaired beta-cell function
Single gene defect

38
Q

Glucokinase and Transcription factor diabetes

A
39
Q

Diagnosing diabetes-
measure blood glucose or HbA1c

A

ONE diagnostic lab glucose plus symptoms
TWO diagnostic lab glucose or HbA1c levels without symptoms.
Diagnostic glucose levels (venous plasma) fasting ≥ 7.0 mmol/l, random ≥ 11.1 mmol/l
OGTT BG ≥ 11.1 mmol/l 2h after 75g CHO
Diagnostic HbA1c ≥ 48 mmol/mol.

40
Q

summarise the different types of diabetes?

A

Endocrine (35 decks)

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