Diabetes mellitus
Metabolic disorder
Characterisations
Chronic hyperglycaemia
Disturbances of carbohydrate, fat and protein metabolism
Due to defects in insulin secretion, action or both
Biochemical definition
Fasting plasma glucose = to or more than 7mmol/L
2-hour plasma glucose = to or more than 11.1mmol/L
Both confirmations required if patient has no symptoms, only one required if patient has symptoms
Impaired glucose tolerance
Biochemical definition
Fasting plasma glucose = to or less than 7mmol/L
2-hour plasma glucose = to or more than 7.8mmol/L and less than 11.1mmol/L
Both confirmations always needed
Type 2
Type 1
The absence or near absence of insulin
Due to autoimmune destruction of beta cells in the islets of Langerhans
Glucose production is uncontrolled
Insulin cant act on muscles
Insulin doesn't suppress lipolysis, leading to poor health and high fatty acids
onset between 9-14 usually but can be later
Insulin deficiency and resistance
Treatment
Generally diet and lifestyle alterations
Some medication
if patient is severely insulin deficient, given insulin treatment
prevalence
Generally more people have type 2
As people age, they get type 2 more
Europe and Africa have lower levels than south Asia and north America
Hyperglycaemia
Chronic
Acute
Diabetic ketoacidosis
Hyperosmolar non-ketotic coma (HONK)
Symptoms
Lethargy
Weight gain
Poor vision
Susceptible to infection
Thirst + polyuria
Skin, thrush
Macrovascular
Microvascular
Neuropathy
Atheroma
Stroke
Peripheral vascular disease
heart attack
Retinopathy
Nephropathy
important to scan for this as diabetes is the most common cause of blindness in the world
treatment
insulin treatments
Eating to improve hypoglycemic events
A mismatch to glucose surges can result in hyperglycemia
Managing diet
treatment
Good foot care
Insulin in some cases
Diet and exercise
A variety of drugs
Avoid refined carbohydrates
Moderate alcohol
moderate salt intake
Eat regularly
Drugs which promote insulin release
Drugs which sensitise the body to insulin
Drugs which stop the breakdown of complex carbohydrates to curb glucose release
GIP
GLP-1
GLP-1 is activated by DPP-IV
Other treatment options for DM
sodium-glucose transport protein 2 inhibitors
Physiological insulin delivery
Incretin therapies
Islet cell transplant
Helpful if patients with Type 2 DM are overweight as it suppresses appetite
Prevents reabsorption of glucose from blood filtered through
UK wide program of transplanting healthy B-cells into the islets of Langerhans
Continuous insulin infusion pump therapy with blood glucose monitoring