Diabetes Mellitus Flashcards
(46 cards)
What is diabetes mellitus?
Group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia with disturbances in carbohydrates, fat and protein metabolism from defects in insulin secretion, action or both
What are the symptoms of hyperglycaemia?
Polydipsia, polyuria, blurred vision, weight loss and infections
What happens if there is metabolic decompensation in diabetes?
Diabetic ketoacidosis
Hyperosmolar hyperglycaemic state
How is diabetes diagnosed?
Measure blood glucose or HbA1c
Fasting glucose >7mmol/l and random >11.1 mmol/l
OGTT 2hr after 75g CHO >11.1mmol/l
HbA1c > 48mmol/l
How many tests are needed in diagnosing diabetes?
One diagnostic lab glucose or HbA1c plus symptoms
2 without symptoms
What is the criteria for intermediate hyperglycaemia?
Impaired fasting glucose 6.1-7mmol/l
Impaired glucose tolerance 2hr glucose > 7.8 and 11mmol/l
HbA1c 42-47 mmol/mol
What is intermediate hyperglycaemia?
Group with higher risk of future diabetes and adverse outcomes such as cardiovascular disease
What is normoglycaemia?
Glucose levels associated with low risk of developing diabetes and cardiovascular disease
What is HbA1c?
Glycated haemoglobin
Gives indication of blood glucose levels over last 8-12 weeks
When can HbA1c not be used for diagnosis?
Children and young people
Pregnancy
Short duration of diabetes symptoms
Acutely ill
Patients on medication which could cause rapid rise in glucose
Acute pancreatic disease or surgery
Renal failure
HIV
What is involved in exam and initial assessment?
BMI
Ketones
Signs of complication - foot exam and retinal screening
What is type I diabetes characterised by?
Insulin deficiency
So there is increased lipolysis, raised glucose production and reduced glucose uptake
How does type I diabetes give diabetic ketoacidosis?
Hyperglycaemia
Ketonemia
What are the conterregulatroy hormones?
Glucagon
Cortisol
Catecholamines
Growth hormones
What does development of type I diabetes require?
Genetic pre-deposition
Plus trigger - viral infection
What are some clinical presentations of type I diabetes?
Thirst, tiredness, polyuria, weight loss, blurred vision and abdominal pain
On exam - ketones on breath, dehydration, increased resp. rate, tachycardia, hypotension and low grade infection
What are some key aspects of clinical diagnosis for type I diabetes?
Younger age
May be slim
Short duration of hyperglycaemic episodes
Other autoimmune condition
FH of autoimmune condition
Elevated ketones
What tests can be done at a later date to confirm diagnosis of type I diabetes?
Autoantibodies GAD, IA2 and ZNT8
C peptide - would expect undetectable c peptide in someone with longstanding t1d and low levels if recently diagnose. High would not have t1d
Genetics t1 genetic risk score
Describe genetics in type II diabetes
More inheritable than type I
Polygenic
What are the symptoms and signs of type II diabetes mellitus?
May have none
Thirst, tiredness, polyuria, weight loss, blurred vision, symptoms of complication
Not ketonic, usually overweight, low grade infections and complications
What are key aspects of making a diagnosis of diabetes mellitus?
Older age and overweight
FH of t2d
May have no symptoms
No ketones
What are risk factors for type II diabetes mellitus?
Overweight
FH
Gestational diabetes
Inactive lifestyle
Previous high blood glucose
What are some other types of diabetes?
Recognised genetic syndrome - MODY
Gestational diabetes
Secondary diabetes
What is MODY?
Maturity onset diabetes in the young
Autosomal dominant
Impaired beta cell formation
Single gene defect
