Transcript Diabetes student

Diabetes
Why Diabetes?
(Superficially)
Hyperglycaemic Hormones
• Glucagon
Hyperglycaemic Hormones
• Glucagon
• Catecholamines
– eg adrenalin
• Glucocorticoid hormones
– eg cortisol
Hyperglycaemic Hormones
• Glucagon
• Catecholamines
– eg adrenalin
• Glucocorticoid hormones
– eg cortisol
• Human Growth Hormone (HgH)
Hyperglycaemic Hormones
• Glucagon
• Catecholamines
– eg adrenalin
• Glucocorticoid hormones
– eg cortisol
• Human Growth Hormone (HgH)
• Thyroid Hormones
Hypoglycaemic Hormones
Insulin
Types
• Type 1A
• Type 1B
• Type 2
– obese
– non obese
• Gestational
Type 1A
• autoimmune condition
• strongly linked with HLA - DR3 and HLA DR4
• early onset
• Risk
– sibling 5% - 10%
– offspring 2% - 5%
Type 2
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impaired insulin secretion
peripheral insulin resistance
increased hepatic glucose production
late onset
associated with long term obesity
Approximately 90% are overweight
Risk
– sibling or offspring 10% -15%
Type 2
• Insulin levels can be high, normal or low
• Less prone to ketoacidosis
• Multiple metabolic imbalances influence
insulin action
• Adiponectin decreases
• Metabolic syndrome
Metabolic syndrome
Three or more of the following:
• Abdominal obesity – waist circumference >88cm
in women or 102cm in men
• Triglycerides ≥150mg/dL or(1.7mmol/L)
• HDL <50mg/dL (1.3mmol/L) in women or
<40mg/dL (1.0mmol/L)
• Blood pressure >130/85 mm Hg
• Fasting plasma glucose >100mg/dL (5.6mmol/L)
Gestational
• glucose intolerance usually in 3rd trimester
• occurs in 2% of pregnancies
• 60% develop diabetes mellitus within 15
years
Clinical manifestations
• Hyperglycaemia
• Normal range
– Adult 70 - 110 mg/dl or 3.9 - 5.8 mmol/L
• And...
Three polys
• Polyuria
• Polydipsia
• Polyphagia
Polyuria
• Glucose not taken up by body cells is
filtered at the kidneys
• Transport system in kidney can’t reabsorb
all
• The rest appears in the urine
• Osmotically attracts water
Polydipsia
• Polyuria
• ECF volume decreases
–  BP, renin, angiotensin, aldosterone, ADH
• ICF also reduces
• Thirst centre in hypothalamus stimulates
thirst
Polyphagia
• Cells use up stores of carbohydrates fats and
proteins
• Corresponding cellular starvation results in
hunger
• Not usually present in Type 2
Systemic effects
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Loss of weight in Type 1
Recurrent blurred vision
Fatigue
Paresthesias
Skin infections
– Pruritis and vulvovaginitis
– Balanitis
Acute Complications
• Diabetic ketoacidosis
• Hyperosmotic hyperglycemic state
• Insulin shock
Diabetic Ketoacidosis
• Body uses fats for energy
• Produces ketone bodies which are acidic
• “Fruity” breath and urine
Acute Complications
Diabetic
Hyperosmotic Insulin shock
ketoacidosis hyperglycemic
state
Onset
1 - 24 hrs 24 hrs - 2 weeks
Sudden
Skin
Dry, flushed
Dry
Moist, pale
Fever
Frequent
Hyperthermia
Mouth
Dry
Dry
May be
hypothermic
Drooling
Acute Complications
Thirst
BP
Pulse
DKA
HHS
IS
Intense
Extreme
Absent
Low
Low
Normal
Weak, rapid
Weak, rapid
Normal
Eyeballs
Soft
Normal
Vomiting
Common
Rare
Other
Kussmaul’s
+ve Babinski
Chronic complications
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Peripheral neuropathy
Nephropathy
Retinopathy
Vascular complications
Infections
Peripheral Neuropathy
• impaired blood supply to nerves
• segmental demyelinization process
• leading physiologic cause of impotence
– 30% - 60% of all diabetics
Peripheral Neuropathy
• Gastromotility disorders are common
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Constipation
Diarrhea
Fecal incontinence
Nausea and vomiting
Dyspepsia
Gastroparesis
Nephropathy
• basement membrane of glomerulus altered
• diabetes is most common cause of renal
failure
Retinopathy
• leading cause of acquired blindness
• non proliferative form micro aneurysms
– retinal oedema and haemorrhage
• proliferative
– fragile neovascularisation
– scar tissue and adhesions form between retina
and vitreous
Vascular Complications
• macro- and micro-circulation
• increased heart disease
• peripheral vascular insufficiency
– ulceration
– infection
– gangrene
Infections
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Diabetic foot ulcers
Osteomyelitis
UTIs
candidal infections of skin and mucous
TB
Diagnostics
• Fasting plasma glucose
– Normal <100mg/dL (5.6mmol/L)
• Oral Glucose Tolerance Test
– important screening test for diabetes
– follow response to amount of concentrated
glucose usually at 0.5, 1, 1.5, 2 & 3 hours
– normal person is normal in 3 hours
Diagnostics
• Capillary blood glucose monitoring
• Glycated haemoglobin testing
– Provides index of blood glucose over previous
6 to 12 weeks
– A1C levels <6% are normal.