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Diabetes:a group of metabolic disorders in which persistent hyperglycaemia…
Diabetes:a group of metabolic disorders in which persistent hyperglycaemia (random plasma glucose more than 11 mmol/L) is caused by deficient insulin secretion, resistance to the action of insulin, or both.
Categories
Type 2 diabetes — insulin resistance and a relative insulin deficiency result in persistent hyperglycaemia
Gestational diabetes — hyperglycaemia develops during pregnancy and usually resolves after delivery, although the woman is at increased risk for overt type 2 diabetes in the future.
Type 1 diabetes — an absolute insulin deficiency causes persistent hyperglycaemia (insulin activity is normal).
Monogenic diabetes (due to a single gene defect; previously known as 'maturity-onset diabetes in the young'
Diabetes secondary to pathological conditions or diseases (such as pancreatitis, trauma, or pancreatic surgery).
Drug- or chemically-induced diabetes (such as from long-term corticosteroid treatment).
Aetiology
Type 1 diabetes is usually caused by destruction of beta-cells (which make insulin) in the pancreatic islets of Langerhans commonly caused by autoimmunity
Type 2 diabetes is caused by a combination of insulin resistance/insensitivity (where the body is unable to respond to normal levels of insulin) and insulin deficiency (where the pancreas is unable to secrete enough insulin to compensate for this resistance).Insulin resistance is exacerbated by overeating, inactivity, and other risk factors.
Risk Factors
Type 1- Genetic & Environmental
Type 2-Obesity &Inactivity, FHx, Ethnicity, Hx of gestational diabetes, low fibre and high GI diet, drug treatments, polycystic ovaries, metabolic disease and low birth weight
Complications
T1 &T2 DM
Microvascular complications — nephropathy, retinopathy, and neuropathy
Macrovascular complications — cardiovascular disease (CVD, for example myocardial infarction), cerebrovascular disease (for example stroke and transient ischaemic attack), and peripheral arterial disease (for example intermittent claudication).
Metabolic complications — diabetic ketoacidosis (DKA) and dyslipidaemia
Increased risk of other autoimmune conditions — people with type 1 diabetes are at increased risk of developing other autoimmune diseases, most commonly thyroid disease, autoimmune gastritis and/or pernicious anaemia, coeliac disease, vitiligo, and Addisons disease
Psychological complications — these include anxiety; depression; and eating disorders.
Reduced quality of life — challenges to daily living e.g. managing episodes of hypoglycaemia and hyperglycaemia, daily administration of insulin, regular self-monitoring of blood glucose, and the need to plan normal daily activities
Skin complications — these include granuloma annulare
Infections
Reduced life expectancy due to (T1) chronic complications of diabetes, although death from acute hypoglycaemia or DKA may occur.
Increased risk of dementia in T2DM
HSS usually in T2DM marked hyperglyceamic and dehydration without ketoacidosis
DKA hyperglycamiea, polyuria, polydipsia, hyperventilation and dehydration (can occur with type II)
Diagnosis
T1
Based on clinical grounds- hyperglycaemia (blood sugar more than 11mmol/l)usually with one or more of the following: rapid weight loss, younger than 50, BMI less than 25, family hx of autoimmune disease, and ketosis
T2
Persistent hyperglycaemia of 11mols/l, or Hba1c of more than 48mmol/l. If end stage KD, use fasting blood glucose greater than 7mmol/l
if asymptomatic, two tests results should be used. If symptomatic a raised hba1c result would be used. Note an acute infection, trauma, or circulatory (other stress) can cause hyperglycaemia
Referral
if T1 diagnosed refer the person immediately (on the same day) to a diabetes specialist team
Emergency - DKA
Emergency HSS
HbA1c should not be used to diagnose in
Children and young people (younger than 18 years of age).
Pregnant women or women who are two months postpartum.
People with symptoms of diabetes for less than 2 months.
People at high diabetes risk who are acutely ill.
People taking medication that may cause hyperglycaemia (for example corticosteroids).
People with acute pancreatic damage, including pancreatic surgery.
People with end-stage chronic kidney disease.
People with HIV infection.
Interpreted with caution in abnormal Hb, anaemia, post splenectomy, recent blood transfusion
diabetic ketoacidosis leads to dehydration and electrolyte imbalance
ketones in urine (+2) and blood (above 3)
hyperglycaemia of 11mmols/l and above
acidosis
precipitating factors e.g stress, infection, trauma, drugs, inadequate insulin, surgery
S&S- increased thirst and urinary frequency, weight loss, inability to tolerate fluids, D&V, abdominal pain, increased confusion and lethargy. Fruity acetone smell on breath, deep sighing respiration, dehydration (mild,moderate, severe, shock)
more common in T1 DM
Emergency hospital admission
Hypoglcyaemia- BS less than 3.5mmol