Diabetes Flashcards
1
Q
What is diabetes?
A
Diabetes is when blood glucose is too high (hyperglycaemia) and over leads to damage of the small and large blood vessles causing premature death from cardiovascular diseases
2
Q
Why is diabetes a major health concern?
A
- 10% of NHS budget spend on diabetes in 2014
- 1 in 4 develops kidney disease and is the single most common cause of ESRD in UK
- Leading cause of blindness of working age
- Most common cause of non-traumatic lower limb ampulation
- 15% lifetime risk of ampulation
- 70% deaths due to cardiovascular disease (CAD and stroke)
- Like expectancy is reduced on avg by 5 to 15 years in people with T1DM and 5 to 10 years with T2DM
3
Q
Pathophysiolgy of diabetes
A
- As blood rises, the body sends a signal to the pancreas which releases insulin
- Acting as key, insulin binds to a place on the cell wall (an insulin receptor), unlocking the cell so glucose can pass into it. There, most of the glucose is used the energy right away.
4
Q
Why does blood glucose rise?
A
- Inability to produce insulin due to beta-cell failure and / or
- Insulin production adequate but insulin resistance prevents insulin working effectively and invariably linked to obeisity
5
Q
What causes type 1?
A
90% of type 1 is due to autoimmune destruction of the B-cells.
There is a genetic predisposition to this.
6
Q
What causes type 2?
A
- Pancreas doesn’t produce enough insulin.
- Or, your cells do not use insulin properly. The insulin cannot fully “unlock” the cells to allow glucose to enter (insulin resistance)
7
Q
How does diabetes Mellitus present?
A
- Typical symptoms of hyperglycaemia
- Polyurea, polydisplasia, blurring of vision, urogenital infections - thrush
- Symptoms of inadequate energy utilisation
- Tiredness, weakness, lethargy, weightloss (type 1)
- The severety of these symptoms will depend upon the rate of rise of blood glucose as well as the absolute levels of glucose achieved
8
Q
How do you diagnose diabetes?
A
- You need lab tests to confirm
- Fasting glucose (above 7)
- Oral glucose tolerance test (swallow glucose and measure glucose before and 2 hours after -over 11.1)
- HbA1c (above 6.5%..)
- You need symptoms and 1 abnormal test or 2 if asymptomatic
- These are all acceptable tests but need to recognise that patients may be positive on 1 or 2 tests but not all three
9
Q
Causes of type 1 diabetes?
A
- Absolute insulinlack secondary to autoimmune destruction of B cells
- 250,000 people in UK (0.4% of population)
- 90% diagnosed under 30 years of age - but can occur at any age
- Prevalence doubled every 20 years since 1945
- Aetiology not fully understood - twin studies
10
Q
How do people with type 1 diabetes present?
A
Symptoms
- Rapid onset (usually weeks) weight loss, polyurea annd polydipsia
- Late presentation there may be vomitting due to ketoacidosis
Patient:
- Usually, but not always, young (under 30)
- Elevated venous plasma glucose
- Presence of ketones (breakdown products of fats)
Weightloss and ketones and high blood glucose is sign of type 1. If unsure, treat for type 1.
11
Q
How do you treat type 1 diabetes?
A
INSULIN!
- Given subcutaneously injection several times per day
- Specialist field as the amounts and type of insulin required are dependant upon many factors.
12
Q
Why does type 2 diabetes develop?
A
- These are many different theories BUT, difficult to ignore obesity epidemic.
- Likely there are many different types.
- “90% of people with type 2 diabetes are overweight or obese”
- Prevalence is increasing dramatically
- Many asymptomatic and diagnosis made at routine health checks
- Most are over 40 yrs
- Often managed by diet and tablets
- However, increasingly seen in younger people and children
13
Q
What causes insulin resistance to develop?
A
- Obesity - in particular central body obesity
- Accounts for 85% of the risk for developing diabetes
- Muscle and liver fat deposition
- Elevated circulating Free fatty acids
- Physical inactivity
- Genetic influences
14
Q
How does bariatric surgery or low calorie diet influence diabetes?
A
- Within 7 days, fasting blood glucose normalises in type 2 diabetes BEFORE any weightloss
- There is a massive fall in liver fat content and return of NORMAL insulin sensitivity
- This change is in step with decreasing pancreatic fat content NORMALISING b cell function
- Over 8 weeks first phase insulin release and maximal rates of insulin release retun to NORMAL
- Type 2 diabetes can be considered as a potential reversible metabolic disorder precipitated CHRONIC intraorgan fat.
15
Q
What are symptoms of type 2 diabetes?
A
Symptoms:
- Vary variable as slower rise in blood glucose
- May have polyurea, polydypsia, weightloss
- Can be difficult to elicit from patient
- No urinary ketomes
- May be asymptomatic
- Diagnosis made by routine screening
Patient:
- Usually (not always) older - ober 40 yrs old
- But, increasingly seen in younger people and childer
- 90% are overweight or obese
