S10) Diabetes Mellitus Flashcards

1
Q

What is diabetes mellitus?

A
  • Diabetes mellitus is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period
  • Over time, damage of small and large blood vessels causes premature death from cardiovascular diseases
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2
Q

What is a metabolic syndrome?

A

A metabolic syndrome is a cluster of the most dangerous risk factors associated with CVD – diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and BP

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3
Q

Identify the requirements of a metabolic syndrome

A
  • Waist measurement > 94cm (men) / > 80 cm (women)
  • Any two of the following:

I. Raised triglyceride

II. Reduced HDL cholesterol

III. Raised blood pressure

IV. Raised fasting blood glucose

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4
Q

Identify some causes of a metabolic syndrome

A
  • Insulin resistance
  • Central obesity
  • Genetics
  • Physical inactivity
  • Ageing
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5
Q

What are the two causes for hyperglycaemia seen in diabetes mellitus?

A
  • Inability to produce insulin due to beta cell failure and
  • Adequate insulin production but insulin resistance prevents insulin working effectively
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6
Q

Identify the following cell

A

Pancreatic islet cell

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7
Q

Outline the pathophysiology of Type I diabetes

A

Type I diabetes is due to autoimmune beta cell destruction:

  • Beta cells secrete insulin
  • Autoantibodies are directed against beta cells and insulin producing cells destroyed
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8
Q

Outline the pathophysiology of Type II diabetes

A
  • Insulin deficiency – pancreas may not produce enough insulin
  • Insulin resistance – cells do not use insulin properly i.e. insulin cannot fully “unlock” the cells to allow glucose to enter
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9
Q

How does Diabetes Mellitus present?

A
  • Symptoms of hyperglycaemia – polyuria, polydipsia, blurring of vision, urogenital infections (thrush)
  • Symptoms of inadequate energy utilisation – tiredness, weakness, lethargy, weight loss
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10
Q

Which tests are requested for in the diagnosis of a patient with suspected diabetes?

A
  • Fasting glucose
  • Oral glucose tolerance test
  • HbA1c
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11
Q

What is required to diagnose diabetes mellitus in a patient?

A
  • Symptoms & 1 abnormal test
  • If asymptomatic, 2 abnormal tests
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12
Q

What is Type I Diabetes?

A
  • Type I Diabetes is the absolute lack of insulin secondary to autoimmune destruction of β cells
  • The aetiology not fully understood but the patient is usually young (< 30 years)
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13
Q

What are the symptoms of Type I Diabetes?

A
  • Rapid onset (usually weeks)
  • Weight loss
  • Polyuria
  • Polydipsia
  • Vomiting due to ketoacidosis (late presentation)
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14
Q

Which blood results assist in diagnosing Type I Diabetes?

A
  • Elevated venous plasma glucose (random > 11 mmol/L)
  • Presence of ketones (breakdown products of fats)
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15
Q

How can one confirm the presence of ketones in a patient with suspected Type I Diabetes?

A

Most easily measured in urine using “ketostik” – signifies absolute lack of insulin

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16
Q

Describe the treatment of Type I Diabetes

A

Exogenous insulin – given by subcutaneous injection several times per day

17
Q

What is Type II Diabetes?

A
  • Type II Diabetes is a long-term metabolic disorder that is characterised by high blood sugar, insulin resistance, and relative lack of insulin
  • 90% of patients are overweight/obese, over 40 years old and often asymptomatic (diagnosis made at routine health checks)
18
Q

What causes insulin resistance to develop?

A
  • Obesity (85% – central)
  • Muscle and liver fat deposition
  • Elevated circulating free fatty acids
  • Physical inactivity
  • Genetic influences
19
Q

How can one prevent Type II Diabetes?

A

Maintain a healthy body weight – BMI of 20 to 25 kg/m2

20
Q

Symptoms of Type II Diabetes are very variable as there is a slower rise in blood glucose.

Regardless, identify the usual presentations

A
  • Polyuria
  • Polydipsia
  • Weight loss
  • No urinary ketones
  • May be asymptomatic
21
Q

What are the consequences of uncontrolled Diabetes Type II?

A
  • Gradual worsening of symptoms
  • Hyperglycaemic
  • Inadequate energy utilisation
  • Onset of complications of diabetes
22
Q

What are the consequences of uncontrolled Diabetes Type II on the NHS?

A

Significant morbidity, mortality and financial cost

23
Q

How does one treat Diabetes Type II?

A
  • Lifestyle
  • Non-insulin therapies (drugs)
  • Insulin
  • Look for other vascular risk factors (BP, smoking, exercise, diet)
  • Surveillance for chronic complications
24
Q

Identify some acute complications of diabetes mellitus in terms of the following:

  • Complications of hyperglycaemia
  • Complications of hypoglycaemia
A
  • Hyperglycaemia – diabetic ketoacidosis (type 1), hyperosmolar non-ketotic syndrome (type 2)
  • Hypoglycaemia – coma due to hypoglycaemic therapy
25
Q

Identify some chronic complications of diabetes mellitus in terms of the following:

  • Macrovascular complications
  • Microvascular complications
A
  • Macrovascular – cerebrovascular, cardiovascular, peripheral vascular disease i.e. stroke, heart attack, intermittent claudication, gangrene
  • Microvascular – retinopathy, nephropathy, neuropathy i.e. blindness, erectile dysfunction, foot ulceration, painful peripheral neuropathy