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Flashcards in Diabetes Mellitis Deck (22)
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1

Difference between diabetes mellitus and diabetes insipidus

DM = deficiency of insulin, resistant to effects of insulin
DI = deficiency of ADH

2

What is insulin?

peptide hormone released into the bloodstream
produced in B cells of Islets of Langerhans of the pancreas; also produce glucagon and pancreatic polypeptide
regulates glucose uptake and metabolism
skeletal muscles/fat cells require insulin to absorb glucose (large carb reserves)

3

Actions of insulin

uptake of glucose by cells
uptake of amino acids by cells
increases glycogen synthesis
increases synthesis of fatty acids
decreases lipolysis, proteinolysis, gluconeogenesis

4

Control of insulin release

Mainly direct feedback
Some autonomic control
Also released by cholecystokinin

5

Acute consequences of insulin deficiency

Hyperglycaemia
Ketosis (increased levels of ketones)
Acidosis
Hyperosmolar state (severe dehydration = coma and death)

6

Chronic consequences of insulin deficiency

CV disease
Nephropathy
Neuropathy
Retinopathy

7

Name the 4 types of diabetes

type 1
type 2
gestational
secondary

8

DM Type 1

autoimmune destruction of B cells = pancreas cant produced insulin ? triggered by infection eg rubella
susceptibility partly dependant on HLA gene subtypes
classically starts in childhood
symptoms: polyuria (increase volumes of urine), polydipsia (thirst), hunger, weight loss

9

DM Type 2

formally known as non-insulin dependant diabetes/obesity related/adult-onset diabetes
- peripheral insulin resistance
- B cell response to glucose delayed/absent
- insulin concs normal or high
strong association with lifestyle eg obesity

10

Gestational diabetes

genetic predisposition
become insulin resistant triggered by hormonal changes in pregnancy
resolves with delivery
risk factors:
- maternal age
- family history of type 2
- previous GB
- previous baby over 4kg
- smoking

11

Dangers of gestational diabetes

Mother: greater risk of diabetes later in life, hypertension, pre-clampsia, obstructed
Child: greater risk of diabetes later in life, risk of obesity, jaundice, hypoglycaemia

12

Secondary diabetes

diabetes that develops as a result of another condition
- chronic pancreatitis
- cystic fibrosis
- pancreatic surgery
- endocrine disease eg. Cushing's syndrome
- drug therapy eg. corticosteroids

13

Biochemical diagnosis of DM

fasting plasma glucose level at or above 7mmol/l
plasma glucose at or above 11.1mmol/l or 2 hours after a 75g oral glucose dose
random plasma glucose at or above 11.2mmol/l

14

Ketoacidosis

rapid breakdown of fat and protein releases ketones (inc acetone) and acids into the bloodstream
type 1, rarely type 2
can lead to coma and DEATH

15

Hyperosmolar nonketotic state

severe dehydration
type 2
can lead to coma and DEATH

16

Hypogylcaemia

insulin overdose = decreases levels of glucose dramatically
generally accidental
can lead to coma and DEATH

17

Diabetic foot

generalised sepsis and death

18

Chronic presentations of DM

Macro-vascular:
- ischaemic heart disease
- stroke
- peripheral vascular disease
Micro-vascular:
- retinopathy
- neuropathy
- nephropathy
Cataracts

19

Diabetic retinopathy

proliferation of blood cells in the retina (retinal haemorrhages)
macular oedema (fluid exudation into retina)

20

Diabetic neuropathy

macroangiopathy of vasa nervosum (disease of blood vessels)
- peripheral numbness/tingling
- neuropathic pain
- muscle weakness
- autonomic neuropathy = vomiting, diarrhoea, incontinence, constipation, impotence

21

Diabetic nephropathy

Macroangiopathy if glomerular capillaries
clinical = chronic renal failure, nephrotic syndrome, hypertension

22

Infections in diabetes mellitus

osteomyelitis
septicaemia
post-op infections
rectal abscesses
pyelonephritis (upper UTI infection - kidneys and ureters affected)