What is diabetes mellitus? Flashcards
Define diabetes mellitus
a group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia together with disturbances of CHO, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both
Symptoms of hyperglycaemia
thirsty, tired, polyuria, blurred vision, weight loss, infection
Polydipsia
excessive thirst
2 metabolic decompensations of DM and are these more common in type 1 or type 2?
DKA
HHS
type 1
long term microvascular complications of DM
retinopathy
neuropathy
nephropathy
Long term macrovascular complications of DM
stroke
MI
PVD
What can we measure to diagnose diabetes?
blood glucose
HbA1c
What bodily fluid is used to measure diagnostic blood glucose levels?
venous plasma
Numbers for diagnosis of diabetes
blood glucose fasting >7mM, random > 11.1mM
OGTT 2h after 75g CHO >11.1mM
HbA1c > 48 mM
What is the diagnostic criteria for gestational diabetes?
different
not universally agreed
How are diagnostic diabetes criteria numbers picked?
microvascular and CV complications
increased premature mortality
How are intermediate hyperglycaemia numbers picked?
higher risk of future diabetes and adverse outcomes eg CVD
diagnosing diabetes - how many tests?
1 diagnostic lab glucose with symptoms
2 diagnostic lab glucose or HbA1c with no symptoms
What is HbA1c and what does it tell us?
glycated haemoglobin
indication of blood glucose levels over last 8-12 weeks
not accurate with acute changes
List some reasons why HbA1c cannot be used
all children and young people pregnancy - current or recent <2 months short duration of diabetes symptoms HIV pancreatic or renal disease patients on glucose rising medications eg CCS
Type 1 DM results of insulin deficiency
increased lipolysis
raised glucose from liver
reduced muscle glucose uptake
hyperglycaemia and DKA
Clinical presentation of type 1 DM symptoms
short duration of thirst, tiredness, polyuria/nocturia, blurred vision, weight loss and abdominal pain
Clinical presentation of type 1 DM on examination
ketones on breath
dehydration
low grade infections
increased resp rate, tachycardia, hypotension
Is type 1 or type 2 DM more genetically determined?
type 2
Effect of insulin insufficiency in type 2 DM
altered lipolysis
increased glucose from liver
decrease muscle glucose uptake
Symptoms of type 2 DM
may have none
complications eg CVD
thirst, tired, weight loss, blurred vision, polyuria
Signs of type 2 DM
not ketotic
overweight
low grade infection
micro/macro vascular complications
risk factors for type 2 DM
overweight FH >30 Asian, >40 European inactive gestational diabetes, big baby previous high glucose
Name 3 other types of diabetes (other)
gestational
recognised genetic syndromes eg MODY
secondary diabetes
