Diabetes

Question 1

What is diabetes?

Answer 1

• Diabetes - related to insulin resistance
• Diabetes mellitus – not a single but a group of conditions arising from the body’s inability to correctly utilise glucose
• Falls into two categories – chronic and reversible

Chronic
* Type 1 diabetes, formerly known as insulin dependent diabetes mellitus (IDDM)
* Type 2 diabetes, formerly known as non-insulin dependent diabetes
(NIDDM)

Reversible types are:
* Gestational diabetes – arising during pregnancy
* Pre-diabetes – does not reach the diagnostic threshold for diabetes mellitus although risk signs are present

Question 2

What is Type 1 Diabetes?

Answer 2

Aetiology – genetics and viral exposure are key components, now considered an autoimmune disorder. Severe chickenpox in childhood can be a trigger, onsets in young people.

Pathophysiology
* Beta cells in the Islets of Langherans in the pancreas are infiltrated and destroyed by lymphocytes
* Once beta cell destruction reaches over 80% this leads to severe hyperglycaemia and a diagnosis

Signs and Symptoms
* Extreme thirst
* Frequent urination - the bosy is trying to flush out the excess sugar
* Rapid weight loss as the body is starving, as the sugar in the blood can’t be transported to the right place and used
* Blurred vision

Key diagnostic tests:
* Urinalysis
* Random blood glucose
* Fasting blood glucose
* Glucose tolerance test

Conventional treatment
* Fast acting insulin injection around mealtimes to provide a boost
* Slow acting insulin injection, usually at night, to provide background insulin

Good management of insulin and circulation is important, as patients are more prone to cardiovascular disease

Question 3

What is Type 2 Diabetes?

Answer 3

Cause and risk factors
* Age over 45
* Obesity
* Family history of diabetes
* High calorie diet and sedentary lifestyle

Pathophysiology links to insulin resistance
* Insulin resistance and impaired insulin secretion
* Impaired connection between insulin release and glucagon release, the latter unchecked leads to hyperglycaemia

Signs and symptoms
The same as Type 1 diabetes, with increased hunger, persistent fatigue and paraesthesia - numbness and tingling - in hands and feet in addition.

Treatment
* Oral medicine - Metformin which maintains blood sugar control
* Advice around diet and exercise which can make a huge difference
* Insulin injections may become necessary

Why is paraesthesia (numbness) present in Type 2 before diagnosis but in Type 1 as a complication? This suggests circulation issues - in Type 1 neuropathy may not have developed, but in Type 2 that complication has already arisen.

Question 4

What is Gestational Diabetes?

Answer 4

All the following lead to this which is when Diabetes is diagnosed for the first time during pregnancy

• Minimal symptoms – sometimes increased thirst and urination but harder to spot. If family history good glucose monitoring is v important.
• Risk factors – being overweight, being
• sedentary, PCOS
• Risks to baby – high birth weight, pre-term birth, hypoglycaemia, respiratory distress
• Risks to mother – hypertension, pre- eclampsia, future diabetes
• Glucose tolerance testing is used, then insulin if necessary

Question 5

What are some glucose monitoring and
insulin delivery systems?

Answer 5

• Blood glucose monitor (monitoring) - Finger prick most prevalent, wearable continuous monitors are available
• Insulin injection pen (delivery) - Contains changeable cartridges of insulin or comes as single disposable unit
• Insulin pump (delivery) - Offers continuous infusion of insulin, may be less suitable for unstable diabetes

Important to know what a patient is using as it may impact on your advice to them.

Question 6

What is Metabolic Syndrome?

Answer 6

Metabolic Syndrome
* A multifactorial condition
* Insulin resistance and abnormal adipose deposition underly the presentation - someone with a specific pattern of gaining weight around the belly
* Increases risk of heart disease, stroke and type 2 diabetes

Aetiology
* Family history
* Poor diet
* Sedentary lifestyle
* Imbalance in gut microbiome
* Chronic inflammation

Signs and symptoms:
* Potential signs of diabetes (thirst, frequent urination, blurred vision)
* Large waist circumference - a flag for metabolic syndrome
* Hypertension - raised risk of stroke etc
* Hyperglycaemia - can test for blood glucose with a simple kit.
* High triglycerides