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Inflammation block > Diabetes mellitus in clinical practice > Flashcards

Diabetes mellitus in clinical practice Flashcards

1
Q

What is Diabetes Mellitus

A

A group of conditions characterized by high blood glucose & other metabolic and vascular derangements secondary to insufficient insulin action

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2
Q

How can we categorize diabetes mellitus

A

Type 1

  • Insulin-dependent diabetes
  • Beta cell destruction-total insulin deficiency
  • Type a.) autoimmune
  • Type b.) idiopathic ( no markers of autoimmunity)

Type 2

  • Non-insulin dependent diabetes
  • Impaired insulin action(insulin resistance) & inadequate insulin production(insulin deficiency)

Gestational diabetes

Other specific types

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3
Q

What comes under the phrase ‘other specific types’ of diabetes

A
  • Neonatal
  • Genetic defects of insulin secretion
  • Genetic defects of insulin action
  • Secondary to exocrine pancreatic disease
  • Secondary to endocrine disorders
  • Secondary to drugs or toxins
  • Secondary to infection
  • Uncommon forms of immune-mediated diabetes
  • Other genetic syndromes sometimes associated with diabetes
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4
Q

How can we categorize the vascular complications of diabetes?

A
  1. ) Microvascular complications

2. ) Macrovascular complications

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5
Q

Describe the microvascular complications of diabetes

A
  • Retinopathy
  • Nephropathy
  • Neuropathy
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6
Q

Describe the macrovascular complications of diabetes

A
  • Cerebrovascular disease
  • Ischaemic heart disease
  • Peripheral vascular disease
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7
Q

What is the ‘diabetic foot’

A
  • Neuropathy+diabetes+peripheral vascular disease all together causes this
  • Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer,ischemia,gangrene,ulceration and neuropathic osteoarthropathy is called diabetic foot syndrome.
  • Due to the peripheral nerve dysfunction associated with diabetes (diabetic neuropathy), patients have a reduced ability to feel pain.
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8
Q

Outline genetic predisposition of T1DM

A

Haplotypes which suggest predisposition:

HLA-DR3
HLA-DR4
IDDM2
IDDM12

A person with these haplotypes may/ may not develop T1DM depending on whether there’s a precipitating environmental event

-This is because autoimmune diseases are multifactorial

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9
Q

How can we classify neonatal diabetes?

A

Transient & permanent

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10
Q

Which diabetes arise from genetic defects of beta cell function?

A
  • Neonatal diabetes
  • Monogenic diabetes
  • Mitochondrial diabetes
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11
Q

What is mitochondrial diabetes associated with?

A

-Deafness & short stature

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12
Q

What mode of inheritance does mitochondrial diabetes present with

A

Matrilineal inheritance

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13
Q

What does MIDD stand for?

A

Maternally inherited diabetes & deafness

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14
Q

What does MELAS stand for?

A

Mitochondrial Encephalopathy, Lactic acidosis, and Stroke-like episodes

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15
Q

What does MODY stand for?

A

Maturity onset diabetes of the young

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16
Q

Outline the familial diabetes that are collectively called MODY

A
  • HNF4alpha
  • glucokinase
  • HNF1alpha
  • IPF-1
  • HNF-1beta
  • Neuro D1
  • CarbxylEsterLipase gene
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17
Q

Which diabetes arise from genetic defects in insulin action

A
  • Type a insulin resistance
  • Leprechaunism
  • Rabson-Meldenhall syndrome
  • Lipoatrophic diabetes
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18
Q

Which diabetes arise from diseases of the exocrine pancreas?

A
  • CF
  • Haemochromatosis
  • Pancreatitis
  • Fibrocalculous pancreopathy
  • Trauma/pancreatectomy
  • Neoplasia
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19
Q

Which endocrine disease can diabetes be secondary to?

A
  • Cushing’s
  • Acromegaly
  • Phaeochromocytoma
  • Glucagonoma
  • Hyperthyroidism
  • Somatostatinoma
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20
Q

What is phaeochromocytoma?

A

Too much adrenaline & noradrenaline

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21
Q

Other than some endocrine diseases, what else can diabetes be secondary to?

A
  • Drugs and chemicals eg glucocorticoids,thiazides, IFNalpha
  • Infections eg congenital rubella, cytomegalovirus
  • Uncommon immune mediated eg insulin autoimmune syndrome, anti-insulin receptor abs, ‘stiff-man’ syndrome
  • Other genetic syndromes eg Down’s; Friedrich’s ataxia; Huntington’s, myotonic dystrophy, Prader Willi’s, Turner’s
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22
Q

Which hormones promote proteolysis

A
  • Catecholamines
  • Cortisol
  • Glucagon
  • Cortisol
  • GH
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23
Q

What inhibits glycogenolysis?

A

Insulin

24
Q

What occurs in the absence of insulin action

A
  • Uncontrolled endogenous glucose production
  • Tissue glucose deprivation
  • Lipolysis
  • Proteolysis
25
Q

In terms of the physiology of symptoms involved in diabetes, what causes weight loss?

A
  • Proteolysis
  • Lipolysis
  • Dehydration
26
Q

In terms of the physiology of symptoms involved in diabetes, what causes nausea?

A

Ketosis

27
Q

What is ketosis

A

A metabolic state characterized by raised level of ketone bodies in the body tissue

28
Q

In terms of the physiology of symptoms involved in diabetes, what causes hyperventilation?

A

acidosis

29
Q

In terms of the physiology of symptoms involved in diabetes, what does dehydration lead to ?

A
  • Hypotension
  • Thirst & polydipsia
  • Weight loss
30
Q

In terms of the physiology of symptoms involved in diabetes, what causes dehydration?

A
  • Vasodilation due to ketosis ( which causes acidosis)

- Polyuria ( due to osmotic diuresis)

31
Q

Hyperglycaemia is due to lack of insulin; in terms of the physiology of symptoms involved in diabetes, what causes osmotic diuresis ?

A

-osmotic diuresis is caused by glycosuria (which is caused by hyperglycaemia)

32
Q

In terms of the physiology of symptoms involved in diabetes, what causes infection?

A

Hyperglycaemia

33
Q

State the symptoms associated with microvascular diabetic complications

A
  • Numbness,pain,tingling hands & feet
  • abormal sweating
  • gastroparesis
  • Diarrhoea
  • Postural dizziness
  • Erectile dysfunction
  • Incontinence
  • Pain,weakness (wasting)
  • Diplopia
  • Pain, tingling, weakness(may get carpal tunnel)
34
Q

What is Carpal tunnel?

A

-A medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. -Main symptoms are pain, numbness and tingling in the thumb, index finger, middle finger and the thumb side of the ring fingers.

35
Q

Define diplopia

A

double vision

36
Q

How do we diagnose diabetes?

A
  • Typical symptoms of hyperglycaemia
  • Unequivocally high blood glucose concentration or HbA1c
  • Venous plasma glucose> 11.1mmol/L or HbA1c>/= 48mmol/mol(6.5% or over)
37
Q

What HbA1c level do we class as having diabetes

A
  1. 5% or more

i. e 48mmol/mol

38
Q

What is HbA1c

A
  • Glycated haemoglobin; a form of haemoglobin that is covalently bound to glucose
  • Tells you your average blood glucose levels over the last 6-12 weeks
  • Red blood cells have a lifespan of 120days so this works
  • The HbA1c value, which is measured in mmol/mol, should not be confused with a blood glucose level which is measured in mmol/l
  • Needs to be done by healthcare professionals
  • Measured via venous blood draw
39
Q

What is the normal Hba1c level in non-diabetics

A
  • Normal= between 4% and 5.6%
  • Levels between 5.7% and 6.4% mean there’s a greater chance of getting diabetes
  • Levels of 6.5% or greater means you have diabetes
  • We set these figures at these levels cos these are the levels in which the microvascular complications start to happen
40
Q

How do we diagnose diabetes in the absence of typical symptoms

A

On 2 separate occasions (& days) there must be:
-Abnormal blood glucose
-Abnormally high amount of glucose on circulating proteins (HbA1c)
-any of:
HbA1c>/= 6.5%
Fasting venous plasma glucose>/=7mmol/l
Random or 2h post 75g glucose load>/=11.1mmol/l

41
Q

How can we define pre-diabetes

A
  • Borderline area at which HbA1c level isn’t completely normal but it is not yet high enough to be classed as diabetes
  • Here they have an increased risk of developing microvascular complications & and an increased risk of developing diabetes
  • Levels between 6.1% and 6.4%( 43-47mmol/mol)
  • Impaired glucose tolerance
  • Fasting venous plasma glucose< 7 and 2h post 75g glucose load >/=7.8 and <11.1mmol/l
  • Impaired fasting glucose
  • Fasting venous plasma glucose 6.1-6.9mmol/L
42
Q

Describe how the oral glucose tolerance test is performed

A
  • 180g CHO for 3days ebfore
  • Overnight fast
  • Sedentary during test
  • Fasting venous plasma glucose
  • 75g anyhdrous glucose over 5min
  • 2 hour venous plasma glucose
43
Q

Can we use the same diagnostic criteria for the values giving for venous plasma glucose, whole blood and capillary blood glucose

A

No because glucose concentrations are different in different samples

44
Q

What are the clinical features of T1DM

A
  • Insulin deficient
  • Ketosis prone
  • HLA markers
  • Autoimmune
  • Onset peak in adolescence
  • Weight loss
45
Q

What are the clinical features of T2DM

A
  • Insulin resistant & deficient
  • Not ketosis prone
  • Polygenic
  • S Asians> Africans & Caribbeans> Europids
  • Increases with ageing ( younger in ethnic groups with high prevalence)
  • Associated with obesity
46
Q

What are the aims of management of diabetes ?

A
  • Remove symptoms of uncontrolled diabetes
  • Avoid diabetes emergencies
  • Reduce risk of development/progression of complications of diabetes
  • Early detection & effective management of complications
  • Avoid adverse effects on QOL ( related to diabetes or its treatment)
47
Q

What are the modifiable risk factors for long term diabetes complications

A
  • Glycaemic control
  • Hypertension
  • Lipid profile/dyslipidaemia
  • Smoking
  • Exercise
  • Diet
  • Obesity/overweight
48
Q

What are the non-modifiable risk factors for long term diabetes complications

A
  • Age
  • Gender
  • Family history
  • Ethnicity
49
Q

Explain a ‘hard endpoint’ in a clinical trial

A

-An outcome important to patients
-Death
-MI
-Stroke
-Blindness
-Renal failure
-Amputation
This does not need to be measured

50
Q

Explain a ‘surrogate endpoint’ in a clinical trial

A
  • Biomarker intended to substitute for a hard endpoint
  • Risk factors/causal factors: eg BP, lipids, HbA1c
  • Subclinical indicators: eg retinal morphology
  • Correlated factors: eg C reactive protein (for CVD)
51
Q

What is the ‘glucocentric view’ in diabetes

A

-The view that blood glucose is the cause of diabetes

52
Q

What does UKPDS stand for

A

UK prospective diabetes study

53
Q

What are sulphonyureas?

A

A class of oral medications that control blood sugar levels in patients with type 2 diabetes by stimulating the production of insulin in the pancreas and increasing the effectiveness of insulin in the body

54
Q

What landmark trials took place for diabetes

A

UKPDS

  • 20 year study
  • > 5000people newly diagnosed with T2DM
  • RCT
  • Intensive group: sulphonyurea or insulin later metformin
  • Conventional treatment (diet,drugs if hyperglycaemic symptoms/ FPG>15

DCCT (Diabetes Control and Complications Trial )

  • 1447 people with T1DM
  • Randomised to intensive or conventional insulin therapy
  • Followed for mean 6.5years
55
Q

What is the normal blood glucose level

A
  • Tested while fasting should be between 3.9 and 7.1 mmol/L

- In a healthy adult male of 75 kg with a blood volume of 5 liters, a blood glucose level of 5.5 mmol/L

Inflammation block (27 decks)

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