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*Diabetes & Endocrinology > What is Diabetes Mellitus? > Flashcards

What is Diabetes Mellitus? Flashcards

1
Q

Define diabetes mellitus (massive long one from Jane)

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

Give symptoms of hyperglycaemia

A 
Polydipsia
Polyuria
Blurred vision 
Weight loss
Infections
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3
Q

What can result from metabolic decompensation as a result of DM?

A

DKA/HHS

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4
Q

Give the long term microvascular complications of DM

A

Retinopathy
Neuropathy
Nephropathy

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5
Q

Give the long term macrovascular complications of DM

A

Stroke
MI
PVD

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6
Q

What is the diagnostic fasting glucose level in DM?

A

> 7 mmol/l

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7
Q

What is the diagnostic random glucose level in DM?

A

> 11 mmol/l

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8
Q

What is the diagnostic HbA1c level in DM?

A

> 48 mmol/mol

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9
Q

What is the expected OGTT (oral glucose tolerance test) measurement after 75g CHO (carbs) in DM?

A

> 11 mmol/l

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10
Q

What does intermediate hyperglycaemia indicate?

A

A person at higher risk of future diabetes and adverse outcomes such as CV disease

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11
Q

What is the expected intermediate hyperglycaemia fasting glucose level?

A

6.1 - 7 mmol/l

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12
Q

What is the expected intermediate hyperglycaemia OGTT level?

A

> 7.8 and <11 mmol/k

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13
Q

What is the expected intermediate hyperglycaemia HbA1c level?

A

42-47mmol/mol

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14
Q

What is the diagnostic criteria guideline for DM?

A

One diagnostic lab glucose plus symptoms

Two diagnostic lab glucose without symptoms

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15
Q

What does HbA1c (glycated haemoglobin) indicate?

A

Blood glucose levels over last 8-12 weeks

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16
Q

Try to name the patients in which HbA1c cannot be used for diagnosis

A 
All children + young people
Pregnant women
Short duration symptoms
Patients at high risk of DM who are acutely ill
Patients taking meds that may cause rapid glucose rise
Acute pancreatic damage/surgery 
Renal failure 
HIV infection
17
Q

Give the 3 factors required in the development of type 1 DM

A

Genetic pre-disposition
Trigger e.g. viral infection
Autoimmunity

18
Q

What cells are destroyed in Type 1 DM?

A

Beta cells

19
Q

At what age will most people with type 1 have presented?

A

30 yrs

20
Q

Give 3 features of insulin deficiency related to the main functions of insulin

A

Increased lipolysis
Raised glucose production
Reduced muscle glucose uptake
(hyperglycaemia/ketonaemia = DKA)

21
Q

Again, give the clinical presentation of type 1 DM (symptoms)

A 
SHORT duration of
Thirst
Tiredness
Polyuria/nocturia
Weight loss
Blurred vision 
Abdominal pain
22
Q

Give the clinical presentation of type 1 DM on examination (signs)

A

Ketones on breath
Dehydration
May have increased RR, tachycardia, hypotension
Low grade infections, thrush/balantis

23
Q

Briefly describe the mechanism of type 2 diabetes

A

Initial hyperinsulinaemia then progressive decrease in insulin production; increased cellular insulin resistance; occurs when insulin production cant overcome insulin receptor resistance

24
Q

Give the clinical presentation of type 2 DM (symptoms)

A 
May have NO symptoms
Thirst
Tiredness
Polyuria/nocturia
Sometimes weight loss
Blurred vision 
Symptoms of complications e.g. CVD
25
Q

Give the clinical presentation of type 2 DM on examination (signs)

A

Not ketotic
Usually overweight but not always
Low grade infections, thrush/balanitis
In type 2 DM may have macro/micro vascular complications at Dx

26
Q

What is more genetically determined type 1 or type 2?

A

Type 2

27
Q

Give some risk factors for type 2 DM

A 
Overweight
Fam history 
Over 30 yrs (if indian subcontient/pacific island descent)
Over 40 yrs (if european)
Prev history of gestational diabetes
Had a LGA baby
Inactive lifestyle
Prev high BG/impaired glucose tolerance
28
Q

Give three other types of DM

A

MODY
Gestational diabetes
Secondary diabetes

29
Q

What is MODY?

A

Maturity Onset Diabetes in the Young
Single gene defect
Autosomal dominant

30
Q

What 2 types of mutations cause MODY?

A

Glucokinase mutations

Transcription factor mutations

31
Q

What can cause secondary DM?

A
  • drug therapy e.g. corticosteroids
  • pancreatic destruction
  • recognised genetic syndormes - DIDMOAD
  • rare endocrine disorders
32
Q

Give examples of pancreatic destruction causes

A

Haemochromatosis
CF
Chronic pancreatitis
Pancreatectomy

33
Q

Give examples of rare endocrine disorders

A

Cushings
Acromegaly
Pheochromocytoma

34
Q

What is gestational diabetes?

A

Increasing insulin resistance in pregnancy

35
Q

What does gestational diabetes increase the risk of?

A

Type 2 DM later in life

36
Q

When does gestational diabetes develop?

A

2nd/3rd trimester

37
Q

Who is gestational diabetes more common in?

A

Overweight and inactive individuals

38
Q

What neonatal problems can gestational diabetes cause?

A

Macrosomia
Resp distress
Neonatal hypoglycaemia

*Diabetes & Endocrinology (24 decks)

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