S10) Diabetes Mellitus Flashcards Preview

(LUSUMA) Metabolism, Endocrinology & Haematology > S10) Diabetes Mellitus > Flashcards

Flashcards in S10) Diabetes Mellitus Deck (25)
Loading flashcards...
1

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 

2

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 

3

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

4

Identify some causes of a metabolic syndrome

- Insulin resistance

- Central obesity

- Genetics

- Physical inactivity

- Ageing 

5

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

6

Identify the following cell

Pancreatic islet cell

7

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 

8

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

9

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

10

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

- Fasting glucose

- Oral glucose tolerance test

- HbA1c 

11

What is required to diagnose diabetes mellitus in a patient?

- Symptoms & 1 abnormal test

- If asymptomatic, 2 abnormal tests

12

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)

13

What are the symptoms of Type I Diabetes?

- Rapid onset (usually weeks)

- Weight loss

- Polyuria

- Polydipsia

- Vomiting due to ketoacidosis (late presentation)

14

Which blood results assist in diagnosing Type I Diabetes?

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

- Presence of ketones (breakdown products of fats) 

15

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 

16

Describe the treatment of Type I Diabetes

Exogenous insulin – given by subcutaneous injection several times per day

17

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)

18

What causes insulin resistance to develop?

- Obesity (85% – central)

- Muscle and liver fat deposition

- Elevated circulating free fatty acids

- Physical inactivity

- Genetic influences 

19

How can one prevent Type II Diabetes?

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

20

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

21

What are the consequences of uncontrolled Diabetes Type II?

- Gradual worsening of symptoms

- Hyperglycaemic

- Inadequate energy utilisation

- Onset of complications of diabetes

22

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

Significant morbidity, mortality and financial cost 

23

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 

24

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 

25

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