S10) Diabetes Mellitus Flashcards Preview

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Flashcards in S10) Diabetes Mellitus Deck (25)
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What is diabetes mellitus?

- 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 


What is a metabolic syndrome?

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 


Identify the requirements of a metabolic syndrome

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


Identify some causes of a metabolic syndrome

- Insulin resistance

- Central obesity

- Genetics

- Physical inactivity

- Ageing 


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

- Inability to produce insulin due to beta cell failure and

- Adequate insulin production but insulin resistance prevents insulin working effectively


Identify the following cell

Pancreatic islet cell


Outline the pathophysiology of Type I diabetes

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 


Outline the pathophysiology of Type II diabetes

- 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


How does Diabetes Mellitus present?

- Symptoms of hyperglycaemia – polyuria, polydipsia, blurring of vision, urogenital infections (thrush)

- Symptoms of inadequate energy utilisation – tiredness, weakness, lethargy, weight loss


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

- Fasting glucose

- Oral glucose tolerance test

- HbA1c 


What is required to diagnose diabetes mellitus in a patient?

- Symptoms & 1 abnormal test

- If asymptomatic, 2 abnormal tests


What is Type I Diabetes?

- 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)


What are the symptoms of Type I Diabetes?

- Rapid onset (usually weeks)

- Weight loss

- Polyuria

- Polydipsia

- Vomiting due to ketoacidosis (late presentation)


Which blood results assist in diagnosing Type I Diabetes?

- Elevated venous plasma glucose (random > 11 mmol/L)

- Presence of ketones (breakdown products of fats) 


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

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


Describe the treatment of Type I Diabetes

Exogenous insulin – given by subcutaneous injection several times per day


What is Type II Diabetes?

- 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)


What causes insulin resistance to develop?

- Obesity (85% – central)

- Muscle and liver fat deposition

- Elevated circulating free fatty acids

- Physical inactivity

- Genetic influences 


How can one prevent Type II Diabetes?

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


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

Regardless, identify the usual presentations

- Polyuria

- Polydipsia

- Weight loss

- No urinary ketones

- May be asymptomatic


What are the consequences of uncontrolled Diabetes Type II?

- Gradual worsening of symptoms

- Hyperglycaemic

- Inadequate energy utilisation

- Onset of complications of diabetes


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

Significant morbidity, mortality and financial cost 


How does one treat Diabetes Type II?

- Lifestyle

- Non-insulin therapies (drugs)

- Insulin 

- Look for other vascular risk factors (BP, smoking, exercise, diet)

- Surveillance for chronic complications 


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

- Complications of hyperglycaemia

- Complications of hypoglycaemia

- Hyperglycaemia – diabetic ketoacidosis (type 1), hyperosmolar non-ketotic syndrome (type 2)

- Hypoglycaemia – coma due to hypoglycaemic therapy 


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

- Macrovascular complications

- Microvascular complications

- 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