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case 16: diabetes > chemical pathology: type 1 & 2 diabetes > Flashcards

chemical pathology: type 1 & 2 diabetes Flashcards

(42 cards)

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1
Q

What is the definition of diabetes

A

Uncontrolled hyperglycemia due to deficiency insulin action

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2
Q

What is type 1 diabetes

A

B cell destruction with absolute insulin deficiency

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3
Q

What is type 2 diabetes

A

Insulin resistance or relative deficiency

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4
Q

What is a general treatment measure for all diabetic patients & why

A

Exercise & reduce high GI carbohydrates
It decreases insulin requirement

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5
Q

What is three short term complications of diabetes

A
  1. Polyuria & polydipsia
  2. Cerebral dehydration
  3. Keto-acidosis
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6
Q

Why does polyuria & polydipsia occur

A

Blood glucose rises extremely high & can not be reabsorbed by renal tubules leading to drawing water into urine leading to osmotic diuresis

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7
Q

Why does cerebral dehydration occur

A

Glucoses raises osmolality of ECF & drawing water out of cells especially brain

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8
Q

What is the three macrovascular long term consequences of diabetes

A
  1. Coronary heart disease
  2. Peripheral vascular disease
  3. Stroke
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9
Q

What is the three microvascular long term consequences of diabetes

A
  1. Retinopathy
  2. Nephropathy that can lead to CKD
  3. Neuropathy
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10
Q

What is the four counter regulatory hormones of blood glucose & their function

A
  1. Glucagon: glycogenolysis & gluconeogenesis
  2. Adrenaline: lipolysis & glycogenolysis
  3. Growth hormone: lipolysis & glycogenolysis
  4. Cortisol: proteolysis & gluconeogenesis
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11
Q

What is the regulatory hormone of blood glucose regulation & the functions

A

Insulin: glycogen synthesis, protein synthesis & fat synthesis

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12
Q

How does insulin secretion work

A
  1. Glucose enters the cell causing the potassium channels to close & calcium influx
  2. Pro-insulin is secreted as a granules via exocytosis
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13
Q

What two endocrinopathies causes diabetes

A
  1. Acromegaly
  2. Cushing syndrome
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14
Q

What drugs can cause diabetes

A

Glucocorticoids

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15
Q

What is the characteristics of type 1 vs type 2 diabetes in appearance

A

Type 1: <30 years, lean & otherwise healthy
Type 2: older, obese/overweight with other comobidities

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16
Q

How does type 1 vs type 2 diabetes get diagnosed

A

Type 1: acute onset, symptomatic & hyperglycemic
Type 2: gradual onset, asymptomatic & diagnosed at routine screening

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17
Q

What is the treatment for type 1 diabetes

18
Q

What is diabetic keto-acidosis

Study These Flashcards
A

Inappropriate & exaggerated starvation response due to lack of insulin

19
Q

Explain how diabetic keto-acidosis occur

20
Q

What is the three distinct symptoms of DKA

Study These Flashcards
A
  1. Polyuria, polydipsia,
  2. Ketones in urine
  3. Kussmaul breathing due to metabolic acidosis
21
Q

What is the treatment regimen for DKA

Study These Flashcards
A
  1. Restore ECV with bolus saline
  2. Replace insulin
  3. Replace potassium, phosphate & magnesium
  4. Dextrose infusion with insulin when blood glucose reaches 10mmol/L
  5. Treat infection/educate on use of medication
22
Q

What triggers DKA

Study These Flashcards
A
  1. Infetion
  2. Poorly controlled
23
Q

Why is dextrose given in DKA & for how long

Study These Flashcards
A

Restore glycogen stores
Until all ketones are removes

24
Q

What is a classic sign of type 2 diabetes

Study These Flashcards
A

Acanthosis nigricans

25
Why does Acanthosis nigricans occur
Proliferation of keratinocytes & fibroblasts due to insulin resistance & hyperinsulinemia
26
What is Acanthosis nigricans
Brown to black hyperpigmentation of skin at body folds
27
What is the reaction that causes Acanthosis nigricans
Chronically high levels of insulin cross reacts with IGF receptors
28
What population is at risk for type 2 diabetes
1. Obese patients 2. Polygenic genetic disposition 3. Refined carbohydrate diet that causes chronic hyperinsulinism & adipocyte hypertrophy increasing insulin resistance
29
What is the treatment for type 2 diabetes
1. Diet, exercise & metformin 2. Sulfonylureas 3. Insulin
30
What is hyperosmolar hyperglycaemic state
Occurs with type 2 diabetic patients due to insulin levels high enough to prevent ketosis but not to control blood glucose
31
What is the four complications of HHS
1. Severe dehydration 2. Intracellular dehydration 3. Increased blood viscosity 4. Whole body electrolyte loss
32
What is the treatment for HHS
1. Saline bolus 2. Insulin 3. Electrolyte replacement
33
What is the four test that can be used for diagnosis & amount
1. **Random plasma glucose:** 11.1mmol/L 2. **Fasting plasma glucose:** 7mmol/L 3. **2 hours glucose test:** 11.1mmol/L 4. **HbA1c:** 6.5%
34
What is HbA1c
Glucose binds irreversibly to N terminal of b-chain of the red cells & red cells survive for 120 days therefor long term indicator of glucose levels
35
What is the three shortfalls of HbA1c
1. Shortened erythrocyte lifetime causing false low HbA1c 2. Increase erythrocyte lifetime causing false high HbA1c 3. Haemoglobinopathies
36
What is the four population groups that should be screened for diabetes
1. >45 years patients 2. Overweight or obese patients 3. Gestational visit at week 24-28/women >40years prior pregnancy 4. Risk factors: physically inactive, family history, hypertension, PCOS, heart disease history, cholesterol levels high
37
What is gestational diabetes
Diabetes that occur in pregnancy due to changes in hormone but resolve after delivery
38
What is the treatment for gestational diabetes
Diet, exercise & insulin
39
What is the four effects of gestational diabetes on the baby
1. Macrosomia with birth complications 2. Premature 3. Transient hyperinsulinism 4. Future risk
40
What is the three effects of gestational diabetes on the mother
1. Pre-eclampsia 2. Birth complications 3. Future risk
41
What is the screening method of gestational diabetes
1. 50g glucose orally & test after an hour >7.8mmol/L 2. Fasting glucose
42
What is the follow up procedure in diabetes
1. Blood pressure & BMI 2. Type 1 daily glucose 3. HbA1c every 3-6 months <6.5% 4. Fundoscopy 5. Urinary albumin & creatinine for renal end organ damage 6. Plasma creatinine with eGFR 7. Lipids 8. ECG once a year 9. Vaccination 10. Assess for neuropathy, diabetic foot & gum disease

case 16: diabetes (8 decks)

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