diabetes mellitus Flashcards
(30 cards)
what are the complications for diabetes mellitus ?
end stage renal disease amputations blindness diabetic neuropathy artheroscleortic damage -heart disease and cerebrovascular disease
what is the classification of diabetes mellitus ?
type 1 diabetes - immne mediaed and idiopathic
beta cell destruction - absolute insulin deficiency
type 2 -insulin resistance , relative insulin deficiency
MODY (maturity onset diabetes of young) - usually below the age of 25
genetic defect of beta cell function or glucokinase gene converts glucose to
genetic mutation in any of the 4 genes which encodes transcription factors involved in pancreatic development and insulin regulation
glucose 6 phosphate in the pancreas
autosomal dominant trait
gestational diabetes
pancreatitis
acromegaly
down syndrome sometimes associated with diabetes
infections - congenital rubella , cmv
drug or chemical induced
what is the criteria of diagnosis for diabetes mellitus ?
fasting plasma glucose level of more than 7 mmol /L on atleast TWO OCCASIONS diagnostic for diabetes
obtained after 8 hour of fasting
symptoms of hyperglycaemia -
polyuria , polydpsia , polyphagia
unexplained weight loss
casual plasma glucose of above 11.1mmol/L - indicate diabetes
Hba1c equal to or more that 6.5 percent
normal
fasting plasma glucose less than 100mg/dl (less than 5.6mmol/l)
2 hour plasma glucose level after 75g glucose load
less than 140mg/dl (less than 7.8mmol)
prediabetes
HbA1c 5.7-6.4 percent
impaired fasting glucose
fasting plasma glucose
5.6-6.9 mmol/L
impaired glucose tolerance
2 hour plasma glucose level after 75g glucose load
7.8-11.0 mmol
what is pre diabetes ?
condition in which glucose homeostasis is abnormal
but serum glucose levels are not yet high enough to be classified as diabetes
pre diabets have what impairment in diagnostic testing for diabetes ?
impaired fasting glucose
impaired glucose tolerance
criteria for gestational diabetes testing ?
1 hour plasma glucose level after 50 g glucose load
more than 7.2mmol/l = 90 percent detection for gestational diabetes
more than 7.8 mmol/l = 80 percent
oral glucose tolerance 100g OGTT fasting more than or equal to 5.3mmol/l 1 hour more than or equal to 10 2 hours more than or equal to 8.6 3 hours more than or equal to 7.8
75g OGTT
fasting more than or equal to 5.3mmol/l
1 hour more than or equal to 10 mol/l
2 hour more than or equal to 8.6mmol/l
what are the risk factor for gestation diabetes ?
greater than 25
prediabetes - elevated blood sugar precursor to diabetes type2
parent or sibling having diabetes type 2
gestational diabetes during previous pregnancy
baby weighing more than 9 pounds
unexplained still birth
BMI 30 or higher
non white race
when do gestational diabetes usually occur ?
in the second trimester
mothers blood brings extra glucose to the baby
as there is an insulin resistance by pregnancy hormones released from placenta - cortisol and progesterone
foetus makes more insulin to handle the extra glucose
how can we distinguish type 1 diabetes from type 2 diabetes ?
type 1
risk factors - genetic ,
autoimmune - destruction of beta cells
C peptide levels are very low
pre diabetes - autoantibodies
present - IAA, IA-2
medication - insulin necessary
multiple daily injection
therapy to prevent and day onset of diabetes - none known
type 2
risk factors - genetic , obesity , lifestyle , race , hypertension , dyslipidemia , polycystic ovarian syndrome
c peptide levels - detectable
autoimmune antibodes not present
medication therapy - oral agents and insulin commonly needed
therapy to prevent - weightless , physical activity
metoformin - oral medication useful
what is the genetic susceptibility in detecting type 1 diabetes ?
specific immune response genes HLA- DR/DQ on chromosome 6
viral exposure , toxin exposure ,or other environmental influence triggering autoimmune response
antibody markers of beta cell destruction are present when ?
before and at the time of onset of diabetes
autoantibody assay to which antibody is available ?
GAD65 - glutamic acid decarboxylase - highest sensitivity more common i adults
insulin antibodies - IAA
more common in children
islet cell antigen - ICA512
detection of two - increased risk of type 1 diabetes forming
because these autoantibodies are not present does not exclude it from not being type 1 diabetes !
people with type 2 diabetes can be free of symptoms ?
yes
who should be screened for
in any overweight or obese
recommend for 45 or older- screened every 3 years
why should home devices not be used to diagnose diabetes ?
10-15 percent lower than plasma glucose level
preventing or delaying the progression of microvascular complications in diabetes is by what ?
improved glycemic control
lowering glucose levels in patients with type 1 diabetes slows or prevents the development of?
retinopathy, neuropathy, and nephropathy
what is HBA1c ?
irreversibly glycosilated at n terminal of b chain in haemoglobin A
GHb assays vary in reliability in the presence of a variety of factors which are ?
carbamylated hemoglobin can occur with uremia, hypertriglyceridemia, and hyperbilirubinemia, and
salicylates can cause interference by acetylated species
Hemoglobinopathies - high red blood cell turnover and the need for transfusions
chronic alcohol or opiate use, iron deficiency, and lead poisoning
Vitamins C and E can falsely lower levels by inhibiting glycosylation
hemolysis,
recovery from acute blood loss,
splenectomy, will lower the HbA1c level as the result of reduced exposure to plasma glucose
what are the ketone bodies ?
β-hydroxybutyric acid, acetoacetic acid, and acetone are products of fatty acid degradation
what are the ketone testing specimens ?
using urine or blood
symptoms for diabetic ketoacidosis ?
ausea, vomiting, abdominal pain, electrolyte disturbances, and severe dehydration
requiring urgent treatment
what are the procedures for ketone testing ?
most commonly used strips and tablets use sodium nitroprusside and turn purple in the presence of elevated levels of acetoacetic acid
False-negative results in ketone testing how ?
old strips and with strips that have had excessive contact with air, and after ingestion of large amounts of vitamin C
