Monday, May 24, 2010

Diabetes Mellitus (X)

Incomplete notes. For more info, read up Prof Hla Yee Yee’s lecture & Dr. Nurjahan.

Diabetes:

Group of diseases characterised by persistently high levels  of blood glucose resulting from defects of insulin secretion, insulin action or both. It is associated with abnormality in carbohydrate, fat and protein metabolism and a variety of complications.

Types of diabetes

  • Type 1
    • insulin dependent
    • juvenile type
  • Type 2
    • insulin independent
    • adult onset

Prediabetic states

  • metabolic syndrome
    • central obesity, hypertriglyceridemia, low HDL, hyperglycemia, hypertension
    • insulin resistance caused by incompletely understood defect in insulin action
      • heralded by: postpandrial hyperinsulinemia, fasting hyperinsulinemia, hyperglycemia
  • gestational diabetes mellitus

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Type 1 diabetes

  • total insulin deficiency
  • Autoimmune
    • Strong genetic link: HLA DR3, DR4
  • Destruction of pancreatic B-cells
  • Causes
    • idiopathic
    • 2ndary to viral infections/toxins (rat poison)
  • Young
  • Rapid onset

Type 2 diabetes

  • impaired insulin secretion/insulin resistance by target tissues

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Complications of diabetes

Acute complications

Infections

  • oral infections
  • bladder & kidney
  • fungal infectsion (skin, nails)
  • vaginal infections
  • foot infections
  • tuberculosis

Hypoglycaemia

  • patients on insulin treatment
  • sulphonylureas

Comas

  • Diabetic ketoacidosis (DKA)
    • usually type 1
  • Hyperosmolar Non-ketotic coma (HONK)
  • Lactic acidosis
  • Hypoglycaemic coma

image

Long term complications

Macrovascular

  • Ischaemic heart disease/ MI
  • Stroke
  • Diabetic foot/gangrene

Microvascular

  • Diabetic retinopathy
  • Nephropathy
  • Peripheral & autonomic neuropathy

Diagnosis of diabetes

Based on 3 criterias

  • symptoms of diabetes
  • fasting plasma glucose
  • 2 hour plasma glucose (oral glucose tolerance test)

Glycosuria is not very reliable

  • false +ve
  • raised renal threshold in chronic cases (might not have glycosuria)

Management of Diabetes Mellitus

  • Change of lifestyle
  • Oral hypoglycaemics
  • Insulin

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