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Flashcards in What is diabetes mellitis Deck (17):
1

Define diabetes mellitus

A group of metabolic diseases of multiple aetiologies characterised by hyperglycemia together with disturbances in fat, protein and carbohydrate metabolism resulting from defects in insulin secretion, insulin action or both

2

How do you diagnose diabetes mellitus?

• Diagnosing diabetes (worldwide standard)
○ Diagnostic glucose levels (venous plasma) fasting ≥7.0mmol/L, random ≥11.1mmol/L
○ OGTT (oral glucose tolerance test) 2h after 75g CHO≥11.1mmol/L
○ Diagnostic HbA1c ≥48 mmol/mol
• Diagnostic criteria for intermediate diabetes mellitus (worldwide standard)
○ Impaired fasting glucose 6.1-7 mmol/L
○ Impaired glucose tolerance 2h glucose ≥7.8 and <11 mmol/L
○ HbA1c 42-47 mmol
• To diagnose diabetes you need one diagnostic lab glucose plus symptoms
• To ensure that they don't have diabetes you need two diagnostic lab glucoses or HbA1c levels without symptoms

3

When can HbA1c not be used for diagnosis?

○ The patient is a child or young person
○ Pregnancy (current or recent less than 2 months)
○ Short duration of diabetes symptoms
○ Patients at high risk of diabetes who are acutely ill
○ Patients taking medication that may cause rapid glucose rise
○ Acute pancreatic damage or pancreatic surgery
○ Renal failure
○ Human immunodeficiency virus (HIV) infection
○ Anything where there is drastic changes

4

Explain MODY

• MODY: Maturity onset diabetes in the young
○ Autosomal dominant
○ Impaired beta cell function
○ Single gene defect
○ Important to take a family history in a patient with new onset diabetes
○ Glucokinase mutations
- Onset at birth
- Stable hyperglycaemia
- Diet treatment
- Complications rare
○ Transcription factor mutations (HNF-1α, HNF-1β, HNF-4α)
- Adolescence/ young adult onset
- Progressive hyperglycaemia
- Management
□ 1/3 diet
□ 1/3 OHA (oral hypoglycemic agent)
□ 1/3 insulin
- Complications frequent

5

Explain secondary diabetes mellitus

○ Drug therapy e.g. corticosteroids
○ Pancreatic destruction
- Hemochromatosis (excess iron deposition)
- Cystic fibrosis
- Chronic pancreatitis
- Pancreatectomy
○ Recognised genetic syndromes: DIDMOAD
○ Rare endocrine disorders e.g. Cushing's syndrome, Acromegaly pheochromocytoma

6

Explain gestational diabetes

○ Increasing insulin resistance in pregnancy
○ Associated with family history of type 2 diabetes
○ Increased risk of type 2 diabetes later in life
○ Develops 2nd/3rd trimester
○ More common in overweight and inactive
○ Neonatal problems
- Macrosomia (big baby)
- Respiratory distress
- Neonatal hypoglycaemia

7

Compare the aetiology of type 1 and type 2 diabetes

Type 1
• Largely unknown
Type 2
• Obesity
• Genetics

8

Compare the pathology of type 1 and type 2 diabetes

Type 1
• Autoimmune disease
• Beta cells are destroyed and so are unable to produce insulin
Type 2
• Receptors are desensitised to insulin

9

Who would most likely to have type 1 diabetes?

Younge people

10

Who would be more likely to have type 2 diabetes?

Older people

11

Compare the insulin levels of type 1 and type 2 diabetes

Type 1
- Little to none
Type 2
- May initially have hyperinsulinemia but there is a progressive decrease in insulin production (although there will never be no insulin)

12

What are the symptoms of type 1 diabetes?

• Polydipsia
• Polyuria
• Blurred vision
• Weight loss
• Infections
• Abdominal pain (due to ketones)
• Microvascular: retinopathy, neuropathy, nephropathy
• Macrovascular: MI, stroke, PVD

13

What are the symptoms of type 2 diabetes?

• May have no symptoms
• Thirst
• Tiredness
• Polyuria
• Sometimes weight loss
• Blurred vision
• Symptoms of complications e.g. CVD

14

What are the signs of type 1 diabetes?

• DKA/ HHS
• Ketones on breath
• Dehydration
• Increased respiratory rate, tachycardia, hypotension
• Low grade infections, thrush/ balanitis

15

What are the signs of type 2 diabetes mellitus?

• Not ketotic
• Usually overweight but not always
• Low grade infections, thrush/ balanitis
• May have micro or macro-vascular complications

16

How is glucose controlled in health?

• Levels of glucose and other nutrients entering the blood vary markedly during the day
• But between a complete carbohydrate blowout and NO food ingested, blood glucose is maintained at a fairly tight range
• Insulin dominates the absorptive state, the only hormone which lowers blood glucose

17

What happens to glucose control in type 1 diabetes?

Beta cells are destroyed resulting in there being a decrease in the amount of beta cells which means insulin production goes down