Diabetes Mellitus (Type One) Flashcards
(200 cards)
1
Q
What is type one diabetes?
A
A chronic condition in which the pancreas is unable to produce insulin
2
Q
Describe the pathophysiology of type one diabetes
A
The body’s immune system attacks the beta Islet of Langerhans cells of the pancreas via anti-GAD autoantibodies
This results in lymphocyte infiltration and scarring of the Beta Islet of Langerhans cells – decreasing their ability to synthesis insulin
3
Q
What is the positive feedback mechanism of type one diabetes - which ultimately leads to further hyperglycaemia?
A
When there is no insulin being produced, the cells of the body are unable to uptake glucose from the blood and use it for as a source of fuel
Therefore, the cells of the body respond as though the body is fasting and there is no glucose supply
Specifically, blood glucose levels are raised via increased lipolysis in adipose tissue, raised glucose production in liver tissue and reduced glucose uptake in muscle tissue
This is therefore a positive feedback process, which further increases glucose levels and result in hyperglycaemia
4
Q
Describe the pathophysiology of ketogenesis in type one diabetes
A
Diabetes is similar to starvation, in the sense that individuals experience a lack of access to nutrients.
In periods of starvation, ketone bodies are produced by the liver from fatty acids as a source of energy for the brain.
However, it’s important to note that ketone body uptake is dependent upon insulin.
Therefore, in poorly controlled insulin-dependent diabetes, ketone body uptake is suppressed.
This causes an accumulation of ketone bodies in the plasma and life-threatening ketoacidosis
5
Q
What plasma pH is defined as ketoacidosis?
A
Plasma pH <7.1
6
Q
What is the normal blood ketone level?
A
< 0.6mmol/L
7
Q
What is the blood ketone level in DKA patients?
A
> 1.6mmol/L
8
Q
What ABG result indicates DKA?
A
Metabolic acidosis with an increased anion gap
9
Q
How does type one diabetes cause polyuria and polydipsia?
A
The hyperglycaemia overwhelms the kidneys and glucose starts being filtered into the urine
The glucose in the urine draws water out with it in a process called osmotic diuresis
This causes polyuria and polydipsia
10
Q
How does type one diabetes result in potassium imbalances?
A
Insulin usually drives potassium into cells
11
Q
In untreated type one diabetes what is the expected serum potassium level? Explain this
A
Increased
This is due to the fact that insulin levels are low, therefore potassium is unable to move into cells
12
Q
In untreated type one diabetes what is the expected total potassium level? Explain this
A
Decreased
This is due to the fact that there is no potassium stored in cells
13
Q
What happens to potassium levels when insulin treatment is commenced in type one diabetics? What can this lead to?
A
Severe hypokalaemia
Fatal arrhythmia
14
Q
What are the most dangerous aspects of DKAs?
A
Dehydration
Potassium imbalance
Ketogenesis
15
Q
What is the initial treatment of DKAs? Why?
A
Fluid resuscitation
This allows correction of dehydration, electrolyte disturbances and acidosis
16
Q
What are the four risk factors associated with type one diabetes?
A
Young Age < 20 Years Old
Family History
Autoimmune Conditions
Viral Exposure
17
Q
What two genes are associated with type one diabetes?
A
HLA DR3
HLA DR4
18
Q
What are the three autoimmune diseases associated with type one diabetes?
A
Thyroid disease
Coeliac disease
Pernicious anaemia
19
Q
What are the two viruses associated with type one diabetes?
A
Coxsackie B virus
Enterovirus
20
Q
What are the nine clinical features of type one diabetes?
A
Polyuria
Polydipsia
Dehydration
Weight Loss
Abdominal Pain
Nausea & Vomiting
Fruity Ketones Breath
Kussmaul Breathing
Reduced Consciousness
21
Q
What is polyuria?
A
It is defined as increased urinary frequency, > 3L per day
22
Q
What is polydypsia?
A
It is defined as increased thirst
23
Q
What is Kussmal breathing?
A
It is characterised by a deep, rapid breathing pattern
24
Q
When does Kussmal breathing tend to present? Explain
A
DKAs
It is a physiological response to acidosis, in which the body expels carbon dioxide to reduce acidic levels
25
What are the eight investigations used to diagnose type one diabetes?
Glycated Haemoglobin (HbA1C) Test
Random Blood Glucose Test
Fasting Blood Glucose Test
Oral Glucose Tolerance Test (OGTT)
C-Peptide Blood Test
Antibody Blood Tests
Blood Ketone Test
Urine Test
26
What is the HbA1c test?
It measures the quantity of glucose bound to haemoglobin
27
What does a HbA1c test indicate? How?
It indicates an average glucose levels for the past two to three months
This is due to the fact that glucose permanently binds to haemoglobin, which last up to a period of three months
28
What HbA1c test result indicates type one diabetes?
> 6.5% (48mmol/mol)
29
In what nine circumstances can a HbA1c test not be used to diagnose type one diabetes?
Haemoglobinopathies
Haemolytic Anaemia
Untreated Iron Deficiency Anaemia
Children
Pregnant Patients
HIV Patients
Chronic Kidney Disease Patients
Corticosteroid Administration
Patients with A Short Duration of Diabetes Symptoms
30
When after pregnancy is a HbA1c test no longer contraindicated?
> 2 months
31
What four conditions/treatments can result in a falsely low HbA1c reading?
Sickle Cell Anaemia
GP6D Deficiency
Hereditary Spherocytosis
Haemodialysis
32
What five conditions/treatments can result in a falsely high HbA1c reading?
Splenectomy
Iron Deficiency Anaemia
Folic Acid Anaemia
Vitamin B12 Deficiency
Alcoholism
33
Why are HbA1c tests not deemed as useful for diagnosing type one diabetes?
This is due to the fact that is may not accurately reflect a recent rapid rise in serum glucose
Therefore, a HbA1c < 6.5% does not exclude a diagnosis
34
What is a random blood glucose test?
It involves taking a blood sample and a random time
35
What random blood glucose test result indicates type one diabetes?
> 200mg/dL (11.1mmol/L)
36
What is the diagnostic criteria for a random blood glucose test for type one diabetes?
An increased result should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic
37
What is a fasting blood glucose test?
It involves taking a blood sample after an individual has fasted overnight
38
What fasting blood glucose test result indicates type one diabetes?
> 126mg/dL (7mmol/L)
39
What is the diagnostic criteria for a fasting blood glucose test for type one diabetes?
An increased result should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic
40
What is an oral glucose tolerance test (OGTT)?
It involves taking a patient’s baseline fasting plasma glucose, giving them a 75g glucose drink and then measuring their plasma glucose two hours later
41
What OGTT result indicates type one diabetes?
2 hour plasma level > 11.1 mmol/L
42
What is the diagnostic criteria for an OGTT for type one diabetes?
An increased result should be demonstrated once in symptomatic individuals, however on two separate occasions in those that are asymptomatic
43
What is c-peptide?
It is a by-product of insulin production
44
What does a c-peptide blood test measure?
The endogenous insulin level within the body
45
How is a c-peptide blood test used to diagnose type one diabetes?
It is the first line investigation used to differentiate between type one diabetes and other diabetes
46
What c-peptide level indicates type one diabetes?
Reduced
47
When is a c-peptide blood test is recommended in type one diabetes?
This investigation is only recommended in individuals who present with atypical features ( > 50 years old, BMI > 25, slow evolution of hyperglycaemia)
48
How are anitbody blood tests used to diagnose type one diabetes?
It is used to differentiate between a diagnosis of type one and type two diabetes mellitus
49
What are the four antibodies associated with type one diabetes?
Anti-Glutamic Acid Decarboxylase (GAD)
Islet Cell Antibody (ICA)
Insulin Autoantibody (IAA)
Insulinoma-Associated-2-Autoantibodies (IA-2A)
50
When are antibody blood tests recommended in type one diabetes?
This investigation is only recommended in individuals who present with atypical features ( > 50 years old, BMI > 25, slow evolution of hyperglycaemia)
51
What blood ketone level indicates type one diabetes?
> 3mmol/l
52
How is a urine test used to diagnose type one diabetes?
It is used to measure the patient’s pH levels and look for the presence of glucose and ketones
53
What urine pH level is used to diagnose type one diabetes?
< 7.3mmol/
54
What is the diagnostic criteria required to obtain a diagnosis of type one diabetes?
One clinical feature
AND
Hyperglycaemia evidence
55
What are the five DIAGNOSTIC clinical features of type one diabetes?
Ketosis
Rapid Weight Loss
Age < 50 Years Old
BMI < 25
Autoimmune Disease History
56
What are the three DIAGNOSTIC blood results of type one diabetes?
Fasting Glucose > 7 mmol/l
OR
Random Glucose > 11.1 mmol/l
OR
OGTT > 11.1 mmol/l
57
Where do we remove blood from when conducting a glucose test - artery or vein?
Vein
58
Does an unrecordable blood glucose indicate a ketoacidosis or hypogylcaemia?
Ketoacidosis
59
What are the seven management options of DKA's?
FIG-PICK
Fluids
Insulin
Glucose
Potassium
Infection
Chart
Ketones
60
Which IV fluid solution is used to treat DKA? At what dose?
1L 0.9% sodium chloride over one hour
Then 4 litres with added potassium over the next 12 hours
61
What is a complication of fluid resuscitation in DKAs?
Cerebral oedema
62
What is the insulin step of DKA management?
IV insulin infusion
63
Which insulin infusion is used to treat DKA? What rate is this given at?
Fixed rate actrapid
0.1 unit/Kg/hour
64
How do we modify the patient's typical insulin regime when insulin infusion is commenced?
Continue injectable long acting insulin only
65
What is the glucose step of DKA management?
It involves closely monitoring the patient’s blood glucose levels
If it falls below 14mmol/l we prescribe them a 10% dextrose infusion at 125mls/hr in addition to the current saline regime
66
What is the potassium step of DKA management?
We closely monitor the patient’s serum potassium levels every four hours and correct as required
67
What is the maximum rate that potassium should be infused at?
10mmol per hour
68
What is the infection step of DKA management?
We treat any underlying triggers, such as infections
69
What is the chart step of DKA management?
We monitor the patient’s fluid balance by plotting it upon a chart
70
What is the ketone step of DKA management?
We closely monitor the patient’s blood ketones levels
71
What is the management option of hypophosphataemia in DKAs?
We continue current insulin therapy and initiate parenteral phosphate replacement therapy
72
In cases where DKA's don't resolve with 24 hours of treatment, what is the next appropriate management step?
Endocrinology review
73
How do we conservatively treat type one diabetes?
It involves educating patients on their own condition
We encourage them to undergo lifestyle changes
74
Why is it important that we educate type one diabetes patients ?
It allows patients to effectively carbohydrate count, independently adjust their insulin dose and monitor complication signs
75
How do we educate type one diabetes patients ?
It is usually conducted via various measures, including specialist clinics, the STEP programme and support groups
76
What five lifestyle changes do we encourage type one diabetics to take?
Dietary modification
Regular exercise
Smoking cessation
Reduce alcohol intake
Driving advice
77
What dietary advice is recommended in type one diabetes?
To eat regular meals – which are high in fibre and low in starchy carbohydrates
78
What is the glycemic index?
A rating system for foods containing carbohydrates
It shows how quickly each food affects blood glucose levels when that food is eaten on its own
79
What is a high glycemic index?
A high glycaemic index suggests carbohydrates are broken down quickly during digestion and therefore release their glucose into blood quickly
80
What is a low glycemic index?
A low glycaemic index suggests carbohydrates are broken down slowly during digestion and therefore release their glucose into the blood gradually
81
Why is it important that diabetic patients are aware of what foods have a high and low glycemic index?
It alters how they administer their insulin
Specifically, they need to inject their insulin earlier before consuming meals with a high glycaemic index
82
What is diabulimia?
A condition in which insulin-dependent diabetic patients skip their insulin doses in order to lose weight
83
What are the two clinical features of diabulimia?
Poor glycaemic control
Recurrent DKA
84
What are the two reasons why we encourage diabetic patients to regularly exercise?
It enables weight loss
It increases insulin sensitivity
85
What three things should diabetic patients do before exercising?
Eat sufficiently
Check glucose levels
Reduce their glucose intake
86
What type of exercise should diabetic patients conduct? Why?
A mixture of both aerobic and anaerobic exercises
This is due to the fact that aerobic exercises, such as running, decreases blood glucose levels and anaerobic exercises, such as weightlifting, increases blood insulin levels
Therefore, a mixture prevents the risk of hypos developing
87
How long should patients wait after an hypo to exercise?
24 hours
88
Why do advise type one diabetics to stop smoking?
Smoking increases the risk of ischaemic heart disease, which is a common complication of diabetes
89
What alcohol advice to we give to type one diabetics?
They can consume the same quantity of alcohol as the general population
However, they are advised to not drink more than two to three units at one time due to the associated hypo risk
90
Why does alcohol increase the risk of hypos?
It reduces glycogenolysis
91
Do individuals need to inform the DVLA if they are on insulin?
Yes
92
What are the three criteria type one diabetes require to obtain a group one licence?
Hypoglycaemic awareness
They must not have an episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months
They have no relevant visual impairments
93
What are the five criteria type one diabetes require to obtain a group two licence?
They should not have a severe hypoglycaemic event in the previous 12 months
They should have full hypoglycaemic awareness
They should show adequate control by regular glucose monitoring
They should demonstrate an understanding of the hypoglycaemia risks
They should have no debarring complications of diabetes
94
How long prior to driving should individuals check glucose levels?
2 hours
95
How long should patients wait after a hypo to start driving?
45 minutes
96
What is the first line pharmacological option of type one diabetes?
Insulin
97
What are the two administration routes of insulin?
Subcutaneous injection
Insulin pumps
98
Why can insulin not be prescribed as an oral tablet?
It is a polypeptide inactivated by the GI tract
99
What are the three side effects of insulin?
Hypoglycaemia
Weight gain
Lipodystrophy
100
When does short acting insulin start to work? How long for?
30mins
8hrs
101
What are the three short acting insulins?
Humulin S
Actrapid
Insuman Rapid
102
When does rapid acting insulin start to work? How long for?
10mins
4hrs
103
What are the three rapid acting insulins?
Humalog
Novorapid
Apidra
104
When does intermediate acting insulin start to work? How long for?
1hr
16hrs
105
What are the three intermediate acting insulins?
Insulatard
Humulin I
Insuman Basal
106
When does long acting insulin start to work? How long for?
1hr
24hrs
107
What are the two long acting insulins?
Lantus
Levemir
108
What are the three insulin regimens?
Twice daily
Three times daily
Four times daily
109
What is a twice daily insulin regimen?
Rapid acting insulin mixed with intermediate acting insulin before breakfast (BB)
Rapid acting insulin mixed with intermediate acting insulin before evening meal (BT)
110
What is a three times daily insulin regimen?
Rapid acting insulin mixed with intermediate acting insulin BB
Rapid acting insulin before BT
Intermediate acting insulin at bedtime (BBed)
111
What is the gold standard insulin regimen?
Four times daily
112
What is a four times daily insulin regimen?
A short acting insulin before each meal (BB, BL, BT)
An intermediate acting insulin BBed
113
What insulin regimen is recommended in newly diagnosed type one diabetics?
Basal-bolus insulin regimen with twice daily insulin detemir
114
What unit of insulin is required per 10g of carbohydrates?
1 unit
115
How many mmol/l does one unit of insulin reduce glucose levels by?
3 mmol/l
116
In which three regions do patients tend to inject insulin?
Abdomen
Thigh
Buttocks
117
Why is it important that patients rotate injection sites?
This prevents the development of lipodystrophy
118
What is lipodystrophy?
It occurs when the subcutaneous fat hardens, and patients don’t absorb insulin properly from further injections into this spot
119
What is a sign of lipodystrophy?
A patient is not responding to insulin as expected
120
What is factitious hypoglycaemia? What does it indicate?
It is defined as high insulin levels in the absence of elevated c-peptide levels
It indicates that individuals are injecting too much insulin
121
What is insulinoma? What does it indicate?
It is defined as high insulin and c-peptide levels
It indicates an insulin secreting tumour
122
What is the triad of insulinoma?
Whipple's triad
* Hypoglycaemia Features
* Plasma Glucose < 2.5
* Glucose Administration Reverses Features
123
What investigation result indicates c-peptide?
The c-peptide levels do not fall on the administration of insulin
124
What are the four sick day rules of insulin?
They should increase the frequency of blood glucose and ketone monitoring
In cases where individuals have elevated blood glucose and ketone levels, they should administer a corrective dose of insulin
They should encourage fluid intake aiming for at least 3L in 24 hours
In cases where they are struggling to eat, they should intake sugary drinks to maintain carbohydrate levels
They should never stop their insulin, even if they are struggling to eat
125
How often should individuals monitor blood glucose and ketone levels when unwell?
Up to four hourly
126
How can individuals work out the corrective dose of insulin - when unwell and high glucose/ketone levels?
The total daily insulin dose divided by 6 – with a maximum of 15 units
127
Why should individuals never stop their insulin - even when ill?
To prevent a DKA
128
What should all individuals treated with insulin recieve?
Glucagon Kit
129
How should once-daily insulin doses be changed to on the day before and the day of surgery?
It should be reduced by 20%
130
When is metformin recommended to treat type one diabetes?
BMI > 25
131
What are the six monitoring investigations for type one diabetes?
HbA1c Test
Capillary Blood Glucose
Freestyle Libra
Digital Retinal Screening
Foot Screening
Urine Test
132
How often do we conduct a HbA1c test in type one diabetics?
Every 3 to 6 months
133
What is the target HbA1c level in type one diabetes?
< 6.5% (48 mmol/moll)
134
How often should individuals conduct a capillary blood glucose?
At least four times a day, including before each meal and before bed
135
In which six circumstances is it recommended that individuals increase capillary blood glucose monitoring?
Hypoglycaemic episodes
Illness
Before and after physical activity
When planning pregnancy
During pregnancy
Breastfeeding
136
What is the target capillary blood glucose level in the morning?
5 - 7 mmol/l
137
What is the target capillary blood glucose level before meals and other times of the day?
4 - 7 mmol/l
138
What is a freestyle libra?
It is a sensor on the skin that measures the glucose level of interstitial fluid
In order to obtain blood glucose readings, the user needs to swipe over the sensor
139
What is the advantage of a freestyle libra?
It records the glucose at short intervals, enabling patients to understand how their glucose levels fluctuate over time
140
How often do freestyle Libra sensors need replacing?
Every two weeks
141
How often should digital retinal screening be conducted in type one diabetics? What is an exception to this?
Annually
In pregnancy, this should be more frequent
142
Why do we conduct digital retinal screening in type one diabetics?
To monitor the development of diabetic retinopathy
143
How often should foot screening be conducted in type one diabetics?
15 months
144
Why do we conduct foot screening in type one diabetics?
To monitor the development of diabetic foot complications
145
How do we manage diabetic patients who develop foot problems, other than simple calluses?
A referral to the local diabetic foot clinic
146
How often should a urine test be conducted in type one diabetics?
Annually
147
Why do we conduct a urine test in type one diabetics?
To check for micrmicroalbuminuria and neuropathy development
148
What urine test is used to monitor type one diabetes?
Albumin: creatinine ratio (ACR)
149
What ACR urine test result indicates microalbuminuria development?
Increased ACR > 2.5
150
What are the three short term complications of type one diabetes?
Hypoglycaemia
Hyperglycaemia
Potassium Imbalance
151
What is hypoglycaemia?
It is defined as a low blood glucose level, specifically below 4mmol/L
152
What are the five reasons for hypoglycaemia in type one diabetics?
Skipping a meal
Injecting too much insulin
Lipodystrophy
Physical activity
Alcohol intake
153
What are the five clinical signs of hypoglycaemia?
Tremor
Sweating
Hunger
Dizziness
Blurred Vision
154
What is the first line management option of hypoglycaemia in a community setting?
Oral glucose 10 - 20g should be given in liquid, gel or tablet form
OR
A quick acting carbohydrate may be given - glycogen or dextrogel
155
What is the first line management option of hypoglycaemia in a hospital setting - when the patient is alert?
A quick acting carbohydrate may be given - glycogen or dextrogel
156
What is the first line management option of hypoglycaemia in a hospital setting - when the patient is unconscious or unable to swallow?
SC or IM glucagon
157
What is the second line management option of hypoglycaemia in a hospital setting - when the patient is unconscious or unable to swallow?
IV 20% glucose
158
What are the four reasons for hyperglycaemia in type one diabetics?
Eating too much
Eating the wrong types of foods
Not injecting enough insulin
Illness
159
How do we treat mild hyperglycaemia?
Patients can treat themselves by administrating an additional dose of insulin that should bring their glucose levels back to normal
Diabetic patients should be aware that it can take several hours to take effect and repeated doses could lead to hypoglycaemia
160
What glucose level indicates DKA?
> 40mmol/l
161
What are the five clinical features of DKA?
Nausea
Vomiting
Abdominal pain
Kaussmal breathing
Ketone breath
162
What six blood test results indicate DKAs?
Decreased Na levels
Increased K levels
Increased urea levels
Increased creatinine levels
Increased glucose levels
Decreased bicarbonate levels
163
What are the four macrovascular complications of type one diabetes?
Coronary Artery Disease
Peripheral Ischaemia
Stroke
Hypertension
164
What is the first line antihypertensive used to manage hypertension in type one diabetes?
ACEI/ARBs - regardless of age
ARBS = black patients
CCBs = renovascular disease
165
What is the blood pressure target in type one diabetics with hypertension?
< 135/85mmHg
166
What is the blood pressure target in type one diabetics with hypertension - however they have developed albuminuria or 2 features of metabolic syndrome?
< 130/80mmHg
167
How does type one diabetes result in macrovascular complications?
Diabetes accelerates the process of atherosclerosis
This is due to the fact that when glucose binds to LDL, it inhibits its ability to binds to liver cell receptors
This means that LDL continues to circulate within the bloodstream, resulting in hyperlipidaemia and thus atherosclerosis
168
What are the three management options after developing macrovascualr complication development in type one diabetics?
We review the patient’s diabetic treatment
We can consider prescribing statins
We encourage patients to adopt healthier lifestyle choices, such as smoking cessation, diet modifications, etc
169
What is the most common cause of death in diabetic patients?
MI
170
What are the four microvascular complications of type one diabetes?
Diabetic Retinopathy
Diabetic Neuropathy
Gastrointestinal Autonomic Neuropathy
Diabetic Nephropathy
171
What is diabetic retinopathy?
It is defined as damage to the blood vessels supplying the retina of the eye
172
What are the four clinical features of diabetic retinopathy?
Retinal infarction
Exudate formation
Haemorrhage
Cataract formation
173
What is diabetic neuropathy?
It is defined as nerve damage, which results in sensory loss to the bodies’ extremities – hands, feet and arms
174
What are the three clinical features of diabetic neuropathy?
Paraesthesia
Burning Neuropathic Pain
Neuropathic Ulcers
175
What is the characteristic feature of diabetic neuropathy?
'Glove and stocking’ distribution’
176
What is a glove and stocking’ distribution’?
It describes a distribution in which the lower legs are affected first
177
What are the two main contributing factors of diabetic foot disease?
Peripheral Arterial Disease
Loss of Sensation
178
What are the four pharmacological management options of diabetes neuropathy?
Amitriptyline
Duloxetine
Gabapentin
Pregabalin
179
What is the second line management option of diabetic neuropathy?
We trial one of the other three pharmacological management options
180
What is the management option of resistant diabetic neuropathy?
We can refer individuals to pain management clinics
181
What is gastrointestinal autonomic neuropathy?
It is defined as nerve damage involving those that control autonomic body functions of the gastrointestinal system
182
What are the three clinical features of gastrointestinal autonomic neuropathy?
Gastroparesis
Chronic diarrhoea
Gastro-oesophageal reflux disease
183
What is gastroparesis?
It is defined as bloating and vomiting associated with erratic blood glucose control.
184
What are the three pharmacological management options of gastrointestinal autonomic neuropathy?
Metoclopramide
Domperidone
Erythromycin
185
What is diabetic nephropathy?
It is is defined as damage to the renal blood vessels
186
What are the three complications of diabetic nephropathy, if untreated?
Microalbuminuria
End-stage renal disease
Renal failure
187
What is a feature of diabetic retinopathy on US scan?
Enlarged Kidneys
188
What are the four management options of diabetic nephropathy?
Dietary Protein Restriction
Glycaemic Control
ACE Inhibitor/Angiotensin-II Receptor Antagonist
Atorvastatin Administration
189
How do microvascular complications develop in diabetic patients?
In arterioles and capillaries, there is a subendothelial space located between the endothelial cells and the basal lamina layers. This subendothelial space allows the movement of molecules into and out of the vessel lumen.
In diabetes, molecules are unable to move out of this subendothelial space. This results in a build-up of trapped molecules, which thickens the basal lamina layer and narrows the vessel lumen. Overtime, this lumen narrowing can result in ischemia – which tends to affect the nerve and arteries of the kidney, foot and eyes.
There are two reasons as to which molecules are unable to move out of the subendothelial space in diabetic patients...
Albumin is a protein which freely moves in and out of the subendothelial space. However, in diabetic patients, albumin binds to glycosylated collagen fibres in the outermost layer of the vessel – thus trapping it in the subendothelial space.
In normal circumstances, basal lamina proteins don’t cross link and can therefore be removed from the subendothelial space. However, in diabetes, the glycosylated proteins bind to their neighbouring proteins (cross link) and therefore cannot be easily removed.
190
How is diabetes associated with the development of infections?
It causes suppression of the immune system
191
What are the four infections associated with type one diabetics?
Urinary Tract Infections
Pneumonia
Fungal Infections
Skin & Soft Tissue Infections
192
What fungal infection is associated with type one diabetes?
Candidiasis
193
What skin and soft tissue infection is associated with type one diabetes?
Feet
194
What organism is most commonly associated with diabetic foot infections?
Pseudomonas Aeruginosa
195
What drugs induce type one diabetes?
Thiaziade diuretics
196
What drug reduces hypoglycaemic awareness?
Beta-blockers
197
What are the differences between type one and type two diabetes?
Type one = onset < 20, more acute onset, recent weight loss, DKA features, ketonuria common
Type two = onset > 40, onset slower, obesity strong risk factor, milder symptoms, ketonuria rare
198
What are the two main contributing factors of diabetic foot disease?
Peripheral Arterial Disease
Loss of Sensation
199
How should once-daily insulin doses be changed to on the day before and the day of surgery?
It should be reduced by 20%
200
How should once-daily insulin doses be changed to on the day before and the day of surgery?
It should be reduced by 20%
