General diabetes notes

Question 1

What hormones work against the action of insulin?

Answer 1

Glucagon, catecholamine, cortisol and growth hormone (these are catabolic hormones

These work to increase blood glucose

Question 2

What is diabetes mellitus?

Answer 2

A reduction in insulin action sufficient to cause a level of hyperglycaemia that over time will result in diabetes specific microvascular (capillary) pathology in eyes, kidneys and nerves

Question 3

What blood glucose levels are used to diagnose diabetes?

Answer 3

Fasting glucose (x2 or + symptoms) > 7.0 mmol/L
2-hour post glucose load (or random glucose) > 11.1 mmol/L

HbA1c > 48 mmol/mol = DIAGNOSED DM (shows glucose levels over past 3 months)

Question 4

What is type 1 diabetes mellitus?

Answer 4

Beta-cell destruction
Organ specific autoimmune
Early viral trigger
Most childhood onset
Ketosis prone - due to inappropriate fat burn

Makes up 10% of cases

Question 5

What is type 2 diabetes mellitus?

Answer 5

Insulin resistance + beta-cell dysfunction (so can’t overcome increased need for insulin)
Most adult onset
Ketosis RESISTANT

Makes up about 90% of cases

Question 6

What are other types or causes of diabetes?

Answer 6

Genetic defects of beta-cell function or insulin action (MODY - maternal transmission)
Diseases of exocrine pancreas (e.g. pancreatitis, cancer, CF)
Endocrinopathies (e.g Cushing's, acromegaly, pheochromocytoma)
Drug induced (e.g. steroids, antipsychotics)

Question 7

What are the risk factors for T2DM?

Answer 7

Age
More common in men
Overweight (visceral obesity has a bigger effect)
Lack of exercise
Ethnicity
- 3x more likely in Afro-Carribean's
- 6-7x more likely in South Asians

Question 8

What are the differences between T1DM vs T2DM?

Answer 8

Typically under 30 for ages of onset in T1DM
T1DM is autoimmune, T2DM is NOT
T1DM prone to ketosis, T2DM NOT
Family history and ethnicity is MORE significant in T2DM
Obesity is a risk factor for T2DM, NOT T1DM
Inactivity is a risk factor for T2DM, NOT T1DM

Question 9

What are the clinical presentation of diabetes?

Answer 9

POLYDIPSIA - thirst
POLYURIA - large amount of urine
POLYPHAGIA - excessive appetite (due to lack of insulin so less nutrients taken into tissue)
Weight loss
Tiredness (as glucose cannot be utilised for energy)

Question 10

What are the names of the hyperglycaemic emergencies?

Answer 10

T1DM - diabetic keto-acidosis (DKA)

T2DM - Hyperosmolar hyperglycaemic state (HHS)

Question 11

What are the treatment goals in DM?

Answer 11

Minimise treatment side effects - e.g. hypoglycaemia, weight gain
As near-normal glucose as possible - to minimise complications
Cardiovascular risk management