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endocrine system > What is Diabetes Mellitus > Flashcards

What is Diabetes Mellitus Flashcards

1
Q

What is diabetes mellitus?

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 are symptoms of hyperglycaemia?

A

polydipsia

polyuria

blurred vision

weight loss

infections

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3
Q

What is polydipsia?

A

Excessive thirst

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4
Q

What is polyuria?

A

Excess production or passage of urine

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5
Q

What are some metabolic decompensations that hyperglycaemia leads to?

A

DKA/HHS

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6
Q

What long term complications can hyperglycaemia cause?

A

Microvascular (retinopathy, neuropathy, nephropathy)

Macrovascular (stroke, MI, PVD)

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7
Q

What is measured to diagnose diabetes?

A

Glucose or HbA1c

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8
Q

Are glucose levels measured from arterial or venous plasma?

A

Venous plasma

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9
Q

What glucose levels are considered to a diabetic diagnosis?

A
  • fasting > 7mmol/L
  • random > 11.1mmol/L
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10
Q

What does OGTT stand for?

A

Oral glucose tolerance test

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11
Q

How is the oral glucose tolerance test done?

A
  • measure 2 hours after eating 75g CHO
  • glucose > 11.1 mmol/L = diabetic
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12
Q

What level of glucose is considered to be diabetic after the OGTT?

A

More than or equal to 11.1mmol/L

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13
Q

What level of HbA1c is considered to be diabetic?

A

>48mmol/L

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14
Q

What are the diagnostic levels for impaired fasting glucose, OGTT and HbA1c for intermediate hyperglycaemia?

A
  • fasting glucose: 6.1 - 7mmol/L
  • ogtt: 7.8 - 11mmol/L
  • HbA1c: 42 - 47mmol/L
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15
Q

Why is the diabetic diagnostic level criteria at the levels it is?

A

Identifies a group with significant increased

  • premature mortality
  • risk of microvascular & cardiovascular complications
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16
Q

Why is the diagnostic criteria for intermediate hyperglycaemia at the levels it is?

A

Identifies a group at higher risk of future diabetes and adverse outcomes

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17
Q

What are the different levels of increased glucose?

A
  • ‘normoglycaemia’: low risk of developing diabetes
  • intermediate hyperglycemia: higher risk of future diabetes and adverse outcomes
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18
Q

What is required to diagnose diabetes?

A

Measure blood glucose or HbA1c

  • one diagnostic lab glucose plus symptoms
  • two diagnostic lab glucose or HbA1c levels without symptoms
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19
Q

What is HbA1c?

A
  • glycosylated haemoglobin
  • gives an indication of blood glucose levels
  • over the last 8-12 weeks
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20
Q

Over what time period does HbA1c give an indication of blood glucose levels?

A

Last 8-12 weeks

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21
Q

When can HbA1c not be used to diagnose diabetes?

A
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22
Q

What are the different classifications of diabetes?

A

Type 1 (10.9%)

Type 2 (88.2%)

Other types (0.9%)

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23
Q

Is type 1 or type 2 diabetes more prevalent?

A

Type 2

24
Q

What is the only hormone that can lower [BG]?

A

Insulin

25
Q

What cell produces insulin?

A

B cells

26
Q

What cell produces glucagon?

A

a cells

27
Q

What effect does insulin have on adipose tissue?

A

Reduces lipolysis

28
Q

What is lipolysis?

A
  • breaks down fat into energy
  • lipid triglycerides hydrolysed into glycerol and three fatty acids
29
Q

What effect does insulin have on the liver?

A

Reduces glucose production

30
Q

What effect does insulin have on muscle?

A

Increased glucose uptake

31
Q

Is the incidence of type 1 diabetes greater in younger or older people?

A

Younger people

32
Q

What is the background population risk of developing type 1 diabetes?

A

0.4%

33
Q

What is the percentage risk of developing type 1 diabetes if your: mother, father, sibling, non-identical twin, both parents, monozygotic twin has it?

A

Mother - 1%

Father - 6%

Sibling - 8%

Non-identical twin - 10%

Both parents - 30%

Monozygotic twin - 30-50%

34
Q

What is required to develop type 1 diabetes?

A

Genetic pre-disposition plus:

trigger (perhaps viral infection)

autoimmunity

35
Q

What is type 1 diabetes characterised by?

A

Insulin deficiency

36
Q

What is the clinical presentation of type 1 diabetes?

A

Short duration of:

  • polydipsia
  • polyuria/nocturia
  • blurred vision
  • weight loss
  • abdominal pain
  • tiredness (fatigue)
37
Q

What is the medical term for blurred vision?

A

Myopia

38
Q

What is seen on examination for type 1 diabetes?

A
  • ketones on breath
  • dehydration
  • may have increased respiratory rate, tachycardia, hypotension
  • low grade infections, thrust/balantis
39
Q

Explain the evolution of type 2 diabetes?

A
  • blood glucose levels increase as B-cell function declines
  • B cells become damaged by liptoxicity and glucotoxicity as a result of insulin resistance
  • they can eventually no longer compensate resulting in hyperglycaemia
40
Q

Is the incidence of type 2 diabetes in Scotland increasing or decreasing?

A

Increasing

41
Q

Does the incidence of type 2 diabetes increase or decrease with age?

A

Increases with age

42
Q

Explain the genetics of type 2 diabetes for: identical twin, one parent, both parents, sibling, non-identical twin?

A

Identical twin - 90-100%

One parent - 15%

Both parents - 75%

Sibling - 10%

Non-identical twin - 10%

43
Q

What are the symptoms of type 2 diabetes?

A

may have no symptoms

  • polydipsia
  • polyuria/nocturia
  • myopia (blurred vision)
  • sometimes weight loss
  • fatigue

Symptoms of complications such as cardiovascular disease

44
Q

What are signs of type 2 diabetes?

A
  • not ketogenic
  • usually overweight but not always
  • low grade infections, thrush/balantitis
  • may have microvascular or macrovascular complications at diagnosis
45
Q

When is screening for diabetes in asymptomatic populations done?

A

when two risk factors are present:

  • overweight
  • family history
  • over age 30 if Maori/Asian
  • over age 40 if European
  • previous history of diabetes in pregnancy
  • had a big baby (>4kg)
  • inactive lifestyle, lack of exercise
  • previous high blood glucose/impared glucose tolerance
46
Q

Other than type 1 and 2, what are other types of diabetes?

A

Recognised genetic syndromes, such as MODY

Gestational diabetes

Secondary diabetes

47
Q

What does MODY stand for?

A

Maturity onset diabetes in the young

48
Q

Is MODY dominant or recessive?

A

Autosommal dominant

49
Q

What are the 2 types of MODY?

A

Glucokinase mutations

Transcription factor mutaitons

50
Q

What are the differences between onset, hyperglycaemia, treatment and complications for the 2 types of MODY?

A
51
Q

What are some things that secondary diabetes can occur after?

A
  • drug therapy: corticosteroids
  • pancreatic destruction
  • recognised genetic syndromes (such as DIDMOAD)
  • rare endocrine disorders (such as Cushings syndrome, Acromegaly, pheochromocytoma)
52
Q

What is gestational diabetes?

A

Hyperglycaemia during pregnancy

53
Q

What is gestational diabetes associated with?

A

Family history of type 2 diabetes

54
Q

When does gestational diabetes usually develop?

A

During 2nd or 3rd trimester

55
Q

What are risk factors for gestational diabetes?

A

Family history of type 2 diabetes

Overweight

Inactive

56
Q

What neonatal problems can gestational diabetes cause?

A

Macrosomia

Respiratory distress

Neonatal hypoglycaemia

endocrine system (27 decks)

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