Diabetes Mellitus Including Epidaemiology Flashcards Preview

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Flashcards in Diabetes Mellitus Including Epidaemiology Deck (30)
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1
Q

What are symptoms of hyperglycaemia?

A

Polydipsia

Polyuria

Blurred vision

Infections

DKA and HHS

Hyperosmolar hyperglycemic state is a metabolic complication of diabetes mellitus (DM) characterized by severe hyperglycemia, extreme dehydration,hyperosmolar plasma, and altered consciousness. It most often occurs in type 2 DM, often in the setting of physiologic stress.

2
Q

What are the long term complications of hyperglycaemia?

A

Microvascular - retinopathy, neuropathy, nephropathy

Macrovascular - stroke, MI and PVD

3
Q

What are the diagnostic tests for diabetes?

A
  • Diagnostic glucose levels (venous plasma) fasting greater than or equal to 7.0 mmol/l, random greater than or equal to 11.1 mmol/l
  • OGTT 2h after 75g CHO greater than or equal to 11.1 mmol/l
  • Diagnostic HbA1c ≥ 48 mmol/mol.
  • (different criteria for gestational diabetes)

OGTT stands for oral glucose tolerance test

CHO stands for carbohydrate

4
Q

What are the values for intermediate hyperglycaemia?

A

Impaired fasting glucose 6.1 - 7 mmol/l

Impaired glucose tolerance 2h glucose greater than or equal to 7.8 and less than 11 mmol/l

HbA1c 42-47

5
Q

How many diagnostic procedures are required for diagnosing diabetes?

A

One diagnostic lab glucose plus symptoms

Two diagnostic lab glucose or HbA1c levels without symptoms

6
Q

What is HbA1c?

A

Glycated haemoglobin

Gives indication of blood glucose levels over last 8-12 weeks

Measured primarily to identify the three-month average plasma glucose concentration

7
Q

When can’t HbA1c be used to make a diagnosis?

A
  • All children and young people.
  • Pregnancy—current or recent (< 2 months).
  • Short duration of diabetes symptoms.
  • Patients at high risk of diabetes who are acutely ill
  • (HbA1c ‡ 48 mmol⁄ mol confirms pre-existing diabetes, but a value < 48 mmol ⁄ mol does not exclude it and such patients must be retested once the acute episode has resolved).
  • Patients taking medication that may cause rapid glucose rise; for example, corticosteroids, antipsychotic drugs (2 months or less). HbA1c can be used in patients taking such medication long term (i.e. over 2 months) who are not clinically unwell.
  • Acute pancreatic damage or pancreatic surgery.
  • Renal failure.
  • Human immunodeficiency virus (HIV) infection.
8
Q

Look

A
9
Q

Describe the deviation of blood glucose during the day

A
  • Levels of glucose and other nutrients entering the blood vary markedly during the day
  • but, between a complete carbohydrate blow-out and NO food ingested, [BG] is maintained over a fairly tight range.
  • Insulin dominates the absorptive state. Only hormone which lowers [BG].
10
Q

What age group has the highest incidence of diabetes?

A

10-19

11
Q

Describe the genetic chance of inheritance of type 1 diabetes

A
12
Q

What is the development of type 1 diabetes?

A

–Genetic pre-disposition plus

–Trigger e.g.? Viral infection

–Auto immunity

13
Q

How does insulin act on adipose tissue, the liver and muscle?

A

Adipose tissue - reduces lipolysis

Liver - reduced glucose production

Muscle - increase glucose uptake

14
Q

What is the effect of reduced insulin on the glucose production by the liver and glucose uptak by the muscles?

Also what is the effect of insulin deficiency on adipose tissue?

A

Liver - raised glucose production

Muscle - raised glucose uptake

Adipose tissue - increase in lipolysis - risk of DKA

15
Q

What is the effect of hyperglycaemia on the kidney?

A

Hyperglycaemia causes glucosuria (osmotic diuresis)

This causes loss of water and electrolytes, leading to dehydration and impaired renal function

16
Q

What is the clinical presentation of type 1 diabetes mellitus?

A
  • Thirst
  • Tiredness
  • Polyuria / nocturia
  • Weight loss
  • Blurred vision
  • Abdominal pain

On examination:

  • Ketones on breath
  • Dehydration
  • May have increased respiratory rate, tachycardia, hypotension.
  • Low grade infections, thrush / balanitis
17
Q

What are the genetic inheritance traits of type 2 diabetes?

A
  • Identical twin 90-100% risk
  • One parent 15%
  • Both parents 75%
  • Sibling 10%
  • Non-identical twin 10%
18
Q

Why might beta cells become damaged in type 2 diabetes?

A

Lipotoxicity

Glucotoxicity

They can no longer compensate resulting in hyperglycaemia

19
Q

What are the symptoms of type 2 diabetes?

A

May have no symptoms

Thirst

Tiredness

Polyuria/nocturia

Sometimes weight loss

Blurred vision

Symptoms of complications (CVD)

20
Q

What are the signs of type 2 diabetes?

A
  • Not ketotic
  • Usually overweight but not always
  • Low grade infections, thrush / balanitis
  • In type 2 DM may have micro vascular or macrovascular complications at Dx
21
Q

What are the risk factors for type 2 diabetes?

A

Overweight

Family history

Over 30 if Maori / Asian

Over 40 if European

Previous history of diabetes in pregnancy

Had a big baby (more than 4kg) - not in immediate post - natal period

Inactive lifestlye (lack of exercise)

Previous high blood glucose / impaired glucose tolerance

22
Q

What are other types of diabetes mellitus?

A

Recognised genetic syndromes: MODY

Gestational diabetes

Secondary diabetes

23
Q

Define MODY

A

Maturity Onset Diabetes in the Young

  • Autosomal dominant
  • ? 5% of people with diabetes
  • Impaired beta-cell function
  • Single gene defect

Family history very relevant

24
Q

What are the potential gene defects for MODY?

A

Glucokinase mutations

Transcription factor mutations

25
Q

How do you tell the difference between glucokinase mutations and transcription factor mutations?

A

Glucokinase mutations:

Onset at birth
Stable hyperglycaemia
Diet treatment
Complications rare

Transcription factor mutations:

Adolescence/young adult onset
Progressive hyperglycaemia
1/3 diet, 1/3 OHA, 1/3 Insulin
Complications frequent

OHA - oral hypoglycaemic agent

26
Q

How does secondary diabetes mellitus arise?

A
  • Drug therapy e.g corticosteroids
  • Pancreatic destruction

–Haemochromatosis- excess iron deposition

–Cystic fibrosis

–Chronic pancreatitis

–pancreatectomy

  • Recognised genetic syndromes-DIDMOAD
  • Rare endocrine disorders e.g. Cushings syndrome, Acromegaly, Pheochromocytoma
27
Q

What is gestational diabetes?

A

Increasing insulin resistance during pregnancy

Develops in 2nd/3rd trimester

28
Q

What are the associations of gestational diabetes?

A

Increased risk of type 2 diabetes later in life

Associated with a family history of type 2 diabetes

29
Q

What are the neonatal problems associated with diabetes?

A

Macrosomia

The term “fetal macrosomia” is used to describe a newborn who’s significantly larger than average

Respiratory distress

Neonatal hypoglycaemia

30
Q
A