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year 2 endocrine - Robbie > What is Diabetes Mellitus? (including Epidemiology of Diabetes) > Flashcards

What is Diabetes Mellitus? (including Epidemiology of Diabetes) Flashcards

1
Q

How does the body make/get glucose?

A

Oral intake - Glucose absorbed from the gut

Hepatic - Gluconeogenesis and Glycogen breakdown

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2
Q

what uses glucose in the body?

A

brain

muscle

adipose tissue

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3
Q

A continuous supply of glucose is essential for what?

A

the brain

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4
Q

Levels of glucose and other nutrients entering the blood ____ _________ during the day

But, between a complete carbohydrate blow-out and NO food ingested, blood glucose concentrations are ____________ ____ _ _____ _____

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, blood glucose concentrations are maintained over a fairly tight range

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5
Q

Insulin dominates the _________ state; it is the only hormone which ______ blood glucose levels

A

Insulin dominates the absorptive state; it is the only hormone which lowers blood glucose levels

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6
Q

study this image carefully and think about it

A
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7
Q

affect of insulin on A

A

Reduced lipolysis

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8
Q

affect of insulin on B

A

Reduced glucose production

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9
Q

affect of insulin on C?

A

Increased glucose uptake

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10
Q

what is the definition of diabetes?

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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11
Q

what symptoms does hyperglycaemia cause?

A

polydipsia - excessive thirst or excess drinking

polyuria - excessive or an abnormally large production or passage of urine

blurred vision - Eye balls change shape leading to blurred vision

weight loss

infections

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12
Q

what does metabolic decompensation caused by hyperglycaemia cause?

A

DKA/HHS

(Hyperosmolar Hyperglycaemic State)

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13
Q

what are long term complications of hyperglycaemia?

A

microvascular (retinopathy, neuropathy, nephropathy)

macrovascular (stroke, MI, PVD)

(Retinopathy is any damage to the retina of the eyes, which may cause vision impairment)

(neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord from and to the rest of the body are damaged or diseased)

(Nephropathy is a general term for the deterioration of proper functioning in the kidneys)

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14
Q

name A?

All values are for venous plasma samples and units are mmol/L

A
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15
Q

name B

All values are for venous plasma samples and units are mmol/L

A
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16
Q

name C?

All values are for venous plasma samples and units are mmol/L

A
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17
Q

How can HbA1c levels diagnose diabetes?

A

Diagnostic HbA1c ≥ 48 mmol/mol

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18
Q

what is intermediate hyperglycaemia?

A

Increased risk of diabetes but don’t yet have it

Close eye of them, may get a yearly check up

a state of raised glycaemic levels in a person without diabetes

It is an independent risk-factor for type 2 diabetes and cardiovascular disease

The primary aim of management of intermediate hyperglycaemia is to prevent progression to diabetes

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19
Q

How do you 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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20
Q

What levels are rquired for someone to have 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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21
Q

why the criteria for diabetes?

A

Diabetes diagnostic criteria identify a group with significantly increased premature mortality and increased risk of microvascular and cardiovascular complications

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22
Q

What is normoglycaemia?

A

‘normoglycaemia’ is used for glucose levels associated with low risk of developing diabetes or cardiovascular disease

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23
Q

What is intermediate hyperglycaemia?

A

Intermediate hyperglycaemia (IGT and IFG) identifies a group at higher risk of future diabetes and adverse outcomes such as cardiovascular disease

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24
Q

What does diabetes diagnostic criteria say about a person?

A

Diabetes diagnostic criteria identify a group with significantly increased premature mortality and increased risk of microvascular and cardiovascular complications

25
Q

how can HbA1c be used in diagnosing diabetes?

A

Glucose in the blood binds irreversibly to a specific part of haemoglobin in red blood cells, forming HbA1c

The higher the glucose, the higher the HbA1c

HbA1c circulates for the lifespan of the red blood cell, so reflects the prevailing blood glucose levels over the preceding 2-3 months

American Diabetes Association have recommended that HBA1c can be used to diagnose diabetes (HbA1c >/= 48)

26
Q

what are the advantages of using glucose as a diagnostic tool?

A

established method

smaller variation between labratories

more feasible in developing countries

directly measures molecule thought to cause diabetic complications

27
Q

what are the disadvantages of using glucose as a diagnostic tool?

A

requies a fasting state

may require OGTT

higher variability within individuals

28
Q

what are the advantages of using HbA1c as a diagnostic tool?

A

No need for a fasting sample

More stable after collection

Marker of glycaemic control

Lower variability within individuals

29
Q

what are the disadvantages of using HbA1c as a diagnostic tool?

A

Measurement can be misleading with haemoglobinopathies, anaemia or renal failure

May differ with age & ethnicity

More costly

Surrogate marker of hyperglycaemia

30
Q

When can HbA1c not be used for diagnosis?

A

All children and young people

Pregnancy—current or recent (< 2 months)

Short duration of diabetes symptoms

Patients at high risk of diabetes who are acutely ill

(HbA1c ≥ 48 mmol⁄ mol confirms pre-existing diabetes, but a value < 48 mmol ⁄ mol does not exclude it and such patients must be retested once the acute episode has resolved)

Patients taking medication that may cause rapid glucose rise; for example, corticosteroids, antipsychotic drugs (2 months or less). HbA1c can be used in patients taking such medication long term (i.e. over 2 months) who are not clinically unwell

Acute pancreatic damage or pancreatic surgery

Renal failure

Human immunodeficiency virus (HIV) infection

31
Q

what are the types of diabetes?

A

Maturity Onset Diabetes of the Young (MODY) is an inherited form of diabetes mellitus

32
Q

what is the most common type of diabetes?

A
33
Q

is diabete sincreasing or decreasing around the world?

A

increasing

34
Q

is the numbers of diabetes increasing in scotland?

A

yes

5.5% of the population now have it

35
Q

what is the cause of type 1 diabetes?

A

Many different antibodies you can use to look for

Looking for antibodies that are attacking part of the pancreas attacking B cells leading to a lack of insulin

Anti GAD main ones

36
Q

what is the genetic risk of type 1 diabetes?

A

if father has type 1 = 6% risk

if mother has type 1 = 1% risk

if both parents have type 1 = 30% risk

if sibling has type 1 = 8% risk

Monozygotic twins = 30-50% concordance

If non-identical twin has Type 1 = 10% risk

37
Q

Development of Type 1 Diabetes Mellitus requires what?

A

Genetic pre-disposition plus:

Trigger e.g.? Viral infection

Auto immunity

People can be diagnosed at all different ages and it is unknown why people develop it at certain points

Struggled to find the underlying thing that starts the process

Patient with type 1 diabetes more likely to have other autoimmune conditions like coeliac disease and thyroid disease

38
Q

T1DM is characterised by what?

A

insulin deficiency

39
Q

flow chart showing type 1 diabetes summary

A
40
Q

What is the clinical presentation of type 1 diabetes mellitus on the short term?

A
  • Thirst
  • Tiredness
  • Polyuria/nocturia
  • Weight loss
  • Blurred vision
  • Abdominal pain

Key message – essential to make this diagnosis. Don’t ignore these symptoms at any age

41
Q

What is the clinical presentation of type 1 diabetes mellitus on examination?

A
  • Ketones on breath
  • Dehydration
  • May have increased respiratory rate, tachycardia, hypotension
  • Low grade infections, thrush/balanitis
42
Q

how did the survival time of T1DM change after the discovery of insulin

A

it greatly increased

43
Q

describe the evolution of type 2 diabetes

A

Pancreas becomes tired trying to overcome the increasing insulin resistance then glucose levels rise

44
Q

what is the genetics of type 2 diabetes?

A
  • Identical twin = 90-100% risk
  • One parent = 15% risk
  • Both parents = 75% risk
  • Sibling = 10% risk
  • Non-identical twin = 10% risk
45
Q

study this image as previously seen

A

Insulin has a key role in cellular metabolism

46
Q

A

A

altered lipolysis

47
Q

B

A

increased glucose production

48
Q

C

A

reduced glucose uptake

49
Q

Body not bale to produce enough insulin to keep up =

A

hyperglycaemia

50
Q

what are the symptoms of type 2 diabetes?

A

May have no symptoms

  • Thirst
  • Tiredness
  • Polyuria/nocturia
  • Sometimes weight loss
  • Blurred vision
  • Symptoms of complications e.g. CVD
51
Q

what are the signs of type 2 diabetes?

A
  • Not ketotic
  • Usually overweight but not always
  • Low grade infections, thrush/balanitis
  • In type 2 DM may have micro vascular or macrovascular complications at Dx
52
Q

Screening for diabetes in asymptomatic populations:

Who would you encourage to have a risk assessment?

A

All eligible adults aged 40 and above, except pregnant women

People aged 25–39 of South Asian, Chinese, African- Caribbean, black African and other high-risk black and minority ethnic groups, except pregnant women

Adults with conditions that increase the risk of type 2 diabetes

53
Q

What are particular conditions can increase the risk of type 2 diabetes?

A

cardiovascular disease

hypertension

obesity

stroke

polycystic ovary syndrome

a history of gestational diabetes

mental health problems

54
Q

what are other types of diabetes?

A
  • Recognised genetic syndromes: MODY - genetic cause of diabetes
  • Gestational diabetes - occurring in pregnancy
  • Secondary diabetes - occurring due to pancreatic insult
55
Q

Describe the features of MODY: Maturity Onset Diabetes in the Young

A
  • Autosomal dominant
  • ? 5% of people with diabetes
  • Impaired beta-cell function
  • Single gene defect
56
Q

what is important in people with new onset diabetes?

A

take a history

57
Q

what are the 2 ways MODY is caused?

A

Glucokinase mutations:

  • Onset at birth
  • Stable hyperglycaemia
  • Diet treatment
  • Complications rare

Transcription factor mutations (HNF-1a, HNF-1b, HNF-4a):

  • Adolescence/young adult onset
  • Progressive hyperglycaemia
  • 1/3 diet, 1/3 OHA, 1/3 Insulin
  • Complications frequent
58
Q

What is Gestational diabetes - hyperglycaemia of pregnancy?

A

Increasing insulin resistance in pregnancy

Associated with FH of Type 2 diabetes

Increased risk of Type 2 diabetes later in life

Develops 2nd/3rd trimester

More common if overweight and inactive

Neonatal problems – macrosomia/respiratory distress/neonatal hypoglycaemia

59
Q

what is secondary diabetes?

A

Any major disease of the exocrine pancreas can be associated with development of diabetes e.g. Chronic pancreatitis, Haemochromatosis, Cystic fibrosis

Endocrinopathies e.g. Acromegaly, Cushing’s syndrome, Glucagonoma, Phaeochromocytoma

Drug or chemical induced diabetes e.g. steroids

year 2 endocrine - Robbie (28 decks)

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