Diabetes Mellitus Flashcards
1
Q
define diabetes.
A
- hyperglycaemia which overtime leads to damage of small and large blood vessels (plaque and elasticity compromised) causing premature death from CVS diseases.
2
Q
why is diabetes such a major health condition?
A
- leads to further complications like kidney disease, blindness, amputation, CVS complications, reduction in life expectancy.
3
Q
how would you describe the physiology of insulin and glucose? (lock and key)
A
- insulin secreted in response to rising blood glucose levels upon feeding, acts as a key and binds to insulin receptors unlocking cell.
- glucose passes into it and is utilised for energy mostly.
4
Q
what goes wrong in order for there to be an uncontrolled rise in blood glucose?
A
- inability to produce insulin due to beta cell failure.
- insulin production adequate but there is resistance preventing effective working LINKED TO OBESITY.
5
Q
what is diabetes type 1?
A
- autoimmune beta cell destruction.
- autoantibodies made against beta cells affecting insulin production.
- mostly genetic : alleles of HLA-DQB1 and MHC-II.
6
Q
what is type 2 diabetes?
A
- adequate insulin production (potential relative deficiency) or cells do not use properly due to error in “unlocking” which is resistance.
7
Q
how does diabetes mellitus present?
A
- hyperglycaemia : polyuria, polydipsia, blurred vision, thrush.
- inadequate energy utilisation : weight loss, tiredness, lethargy.
- severity depends on rate of rise and absolute levels.
8
Q
how would you diagnose diabetes?
A
- fasting glucose.
- oral glucose tolerance test.
- HbA1c.
- repeat tests 1 week apart if asymptomatic.
9
Q
how would type 1 diabetes present?
A
- rapid onset, weight loss, polyuria and polydipsia.
- late presentation shows vomiting due to ketoacidosis.
- elevated venous plasma glucose.
- ketones as fat broken down for energy.
10
Q
how would you treat type 1 diabetes?
A
- exogenous insulin.
- subcutaneous several times a day.
11
Q
what is the significance of ketones in diabetes?
A
- ketone production suppressed by insulin except in starvation.
- absence of insulin = ketone production.
- is ketones detected IMMEDIATE INSULIN THERAPY.
12
Q
what is ketoacidosis?
A
- hyperglycaemia, ketonaemia, acidosis.
- enhanced lipolysis leads to uncontolled ketosis, large quantities of 3-beta-hyroxybutyrate, acetoacetic acid and acetone.
13
Q
how might type 2 diabetes present?
A
- similar symptoms to type 1 but less rapid in onset.
- may habe polyuria, polydisisa and weight loss but no urinary ketones.
- many asymptomatic and diagnosed at routine health checks.
14
Q
what causes insulin resistance to develop?
A
- obesity specifically central obesity.
- muscle and liver fat deposition.
- elevated free FA.
- physical inactivity.
- genetic influences.
15
Q
how would type 2 diabetes be treated?
A
- bariatric surgery : altering stomach and how much you can eat in one seating.
- low calorie diets to reduce fatty depositions.
- can reverse and reinstate normal insulin sensitivity.
- decreasing pancreatic fat to normalise B cell function.
- non-insulin therapies (check slides).
- education and ability to monitor results of therapy.
- vascular risks awareness.
