Classifications and Causes of Diabetes Flashcards
(38 cards)
What is the definition of DM?
A metabolic disorder of multiple aetiology characterized by chronic hyperglycemia with disturbances of carbohydrate, protein and fat metabolism resulting from defects in insulin secretion, insulin action or both.
What are the symptoms of Hyperglycaemia?
Glycosuria depleting energy stores
- tried, weak, weight loss, poor concentration, irritability.
Glycosuria causing Osmotic Diuresis
- Polyuria, polydipsia, thirst, dry mucous membranes, reduced skin turgor, postural hypotension.
Glucose shifts - swollen ocular lenses
- Blurred vision.
Ketone Production
- Nausea, vomiting, abdominal pain, heavy rapid breathing, acetone breath, drowsiness, coma.
Depletion of energy stores (i.e. muscle)
- weakness, polyphagia, weight loss, growth retardation in the young.
Complications (T2DM)
- Macrovascular, microvascular, neuropathy, infection.
How is diabetes diagnosed?
One abnormal valve is diagnosed if symptomatic.
Two abnormal values if diagnostic if asymptomatic.
Fasting plasma glucose of >7.0mmol/L
2 hour plasma glucose of >11.1
Random plasma glucose of >11.1mmol/L
HbA1c 6.5% pr 48mmol/mol
How do T1DM and T2DM differ by definition?
T1: Immunopathogensis with severe insulin deficiency.
T2: Combo of insulin resistance and insulin deficiency.
What age group is normally diagnosed with T1/T2DM?
T1: <30
T2:>30
What weight are people with T1/T2 diabetes?
T1: Lean
T2: Overweight
What ethnicites are more susceptible to T1/T2DM?
T1: Northern European
T2: Asian, African, Polynesian and American Indian.
Which type of diabetes has a seasonal onset?
T1
Which genes are involved in T1DM?
HLA DR3 or HLA DR4
Which type of diabetes can result in ketonuria/ketonemia?
T1
Describe C-Peptide blood tests in T1/T2DM?
T1: C-peptide is negative
T2: Positive.
What should ketone level in the blood normally be?
Below 0.6mmol/L
What is the range for ketones in the blood that is abnormal but not DKA?
0.6-1.5mmol/L.
May require medical assistance, call healthcare team.
What valve of ketones in the blood indicates DKA?
Above 1.5mmol/L
What can be measured as markers of the immune process associated with T1DM?
Islet autoantibodies.
What are the most common islet autoantibodies measured?
Glutamic acid decarboxylase (GAD)
Insulinoma-associated antigen-2 (IA2).
Why is measuring C-peptide useful?
It is secreted in equimolar concentrations to insulin, so is a useful marker of endogenous insulin secretion.
When is c-peptide most useful?
3-5 years from diagnosis.
When is autoantibody testing most useful?
3-5 years from diagnosis.
How can C-peptide be measured?
Blood
Urine (Urine C peptide:creatinine ratio).
What % of all DM is T1DM?
5%
Define T1DM?
Chronic, progressive metabolic disorder characterized by hyperglycemia and the absence of insulin secretion.
It results in autoimmune destruction of the insulin-producing B cells in the islets of langerhans.
Occurs in genetically susceptible subjects and is probably triggered by one or more environmental agents.
Describe the disease progression of T1DM?
Start with a genetic susceptibility.
Immune activation can occur due to something environmental e.g. an infection, and B cells are attacked.
There is an immune response and development of a single autoantibody.
Stage 1: Normal blood sugar, >2 autoantibodies, start of T1DM.
Stage 2: Abnormal blood sugar, >2 autoantibodies.
Stage 3: Clinical diagnosis, glucose rises and you get symptoms, >2 autoantibodies.
Stage 4: Long standing T1DM.
What environmental factors could pre-dispose to T1DM?
- Viral infections: e.g. enterovirus.
- Immunisations
- Diet: especially exposure to cows milk at an early age.
- Higher socio-economic status.
- Obesity
- Vitamin D deficiency
- Perinatal factors: maternal age, history of pre-eclampsia, neonatal jaundice and low birth weight.
