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Questions and Answers
What primarily causes type 1 diabetes mellitus?
What percentage of diabetes cases are classified as primary diabetes?
Which condition significantly predisposes individuals to type 2 diabetes mellitus?
What is a common clinical manifestation of diabetes mellitus?
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Which of the following factors is NOT associated with type 2 diabetes mellitus?
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What is the principal treatment for type 1 diabetes?
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In managing type 2 diabetes, which lifestyle change is NOT typically recommended?
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What is the typical age of onset for Type 1 diabetes?
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Which symptom is strongly associated with Type 1 diabetes?
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What glucose level range is considered ideal for type 1 diabetes patients?
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Which type of diabetes is usually not insulin-dependent?
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What is a common first step in the treatment of type 2 diabetes?
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Which treatment option is primarily used for patients with type 1 diabetes?
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Which laboratory test is utilized to measure long-term glucose control in diabetics?
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What is a recommended lifestyle modification for diabetes management?
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What is the common body weight characteristic of individuals with Type 2 diabetes?
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Which of the following is NOT a method of achieving blood glucose control?
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What is a common complication of diabetes?
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What happens if oral medication for type 2 diabetes fails?
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Which glucose level indicates impaired fasting glucose (IFG)?
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Which treatment monitoring method is most commonly used for diabetes management at home?
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What is the primary purpose of a blood lancet?
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What condition is characterized by reduced insulin levels leading to fat being used for fuel?
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Which of the following is NOT a complication of diabetic ketoacidosis?
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Which symptom is common in a patient experiencing diabetic ketoacidosis?
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What measurement indicates hypoglycemia?
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What is typically the first step in treating hyperglycemic hyperosmolar state?
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Which factor can lead to hypoglycemia in diabetic patients?
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In which scenario is hypoglycemia most likely to be treated with glucagon?
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Study Notes
Diabetes Mellitus Definition
- A disorder affecting carbohydrate metabolism due to insulin deficiency, resistance, or both.
- Leads to hyperglycemia, potentially with glucosuria.
- Secondary disturbances in protein and fat metabolism can occur.
Diabetes Mellitus Incidence
- Most common endocrine disease.
- Prevalence is approximately 1-2% of the population.
Diabetes Mellitus Aetiology
-
Primary Diabetes ( > 95%)
- Type 1: Insulin-Dependent Diabetes Mellitus (IDDM), previously known as Juvenile-Onset Diabetes.
- Caused by insulin deficiency due to beta-cell damage.
- Type 2: Non-Insulin-Dependent Diabetes Mellitus (NIDDM), previously known as Maturity-Onset Diabetes.
- May involve insulin resistance, abnormal insulin structure, or a combination of both.
- Relatively reduced insulin secretion, which can become absolute in some cases.
- Type 1: Insulin-Dependent Diabetes Mellitus (IDDM), previously known as Juvenile-Onset Diabetes.
Type 2 Diabetes Theories
-
Central Obesity: Fat concentrated around the waist, affecting abdominal organs, but not subcutaneous fat, is a risk factor.
- This fat secretes adipokines that can impair glucose tolerance.
- Family History: Type 2 diabetes is more common in those with close relatives who have the condition.
Type 1 vs Type 2 Diabetes - Comparison
-
Type 1 (IDDM)
- Incidence: 10%
- Age of onset: < 30 years
- Sex: More common in males
- Body weight: Usually underweight
- Severity: Severe
- Stability: Unstable
- Insulin: Necessary
- Oral hypoglycemic agents: Ineffective
-
Type 2 (NIDDM)
- Incidence: 90%
- Age of onset: > 40 years
- Sex: More common in females
- Body weight: Usually overweight
- Severity: Mild or moderate
- Stability: Stable
- Insulin: Usually not required
- Oral hypoglycemic agents: Effective
Diabetes Mellitus Presentations
- Asymptomatic: Often discovered incidentally.
-
Classic Symptoms:
- Polyuria
- Polydipsia
- Polyphagia (weight loss, especially in IDDM)
- Pruritis
- Parathesia
- Premature loosening of teeth
- Repeated infections (e.g., boils)
- Complications: Occur in the long term and are detailed later.
- Diabetic Coma: A serious complication, detailed later.
Diabetes Mellitus Investigations
-
Plasma Glucose:
- Fasting ( < 100 mg%)
- 2 hours Post-Prandial ( < 140 mg%)
- Oral Glucose Tolerance Test (OGTT)
- Impaired glucose tolerance (IGT):
- Fasting (≥100 & < 126 mg%) - IFG
- 2 hours post-prandial (≥ 140 & < 200 mg%)
- Overt diabetes:
- Fasting (≥ 126 mg%)
- 2 hours post-prandial (≥ 200 mg%)
- Symptoms of diabetes plus a causal plasma glucose concentration ≥ 200 mg/dl
- Impaired glucose tolerance (IGT):
-
Urine Analysis:
- Glucose: Using strips or solutions (e.g., Benedict)
- Ketone bodies: Using strips or Rothera's Na nitroprusside test
-
Monitoring of Treatment:
- Home Blood Glucose Monitoring (HBGM) or urine testing for glucose
- Glycosylated Haemoglobin (HA1c):
- Formed by glucose linkage to B-chains of Hb A
- Estimated diabetic control over the preceding 8-12 weeks
- Normal level: 6% of total Hb
Diabetes Mellitus Management
- Patient Education: Crucial role in managing diabetes.
- Dietetic Support: Important for achieving optimal blood glucose levels.
- Sensible Exercise: Essential for blood glucose control.
- Self-Monitoring of Blood Glucose: Allows for adjustments in treatment plans.
- Goal: Maintain blood glucose levels within acceptable bounds.
Type 1 Diabetes Treatment
-
Insulin Therapy: The cornerstone of treatment, even in early stages.
- Delivered via injection.
- Combined with careful monitoring of blood glucose levels.
- Blood Glucose Monitoring: Utilized using blood testing devices for accuracy.
-
Target Blood Glucose Levels:
- Average glucose levels should be as close to normal (80–120 mg/dl) as possible.
- Some physicians allow for higher levels (140-150 mg/dl) for individuals prone to hypoglycemia.
Type 2 Diabetes Treatment
-
Initial Treatment:
- Increased Physical Activity: Promotes insulin sensitivity.
- Decreased Carbohydrate Intake: Helps regulate blood glucose.
- Weight Loss: Even modest weight loss can improve insulin sensitivity.
-
Oral Antidiabetic Drugs: Used when lifestyle modifications are insufficient.
- Improves insulin production, which is initially only moderately impaired in type 2 diabetes.
Insulin Therapy for Type 2 Diabetes
-
Insulin Therapy : May become necessary if oral medication fails to control glucose levels.
- Occurs due to further deterioration of beta-cell insulin secretion.
-
Importance of Control:
- Carefully manage glucose levels to reduce the risk of long-term complications.
- Achieved through a combination of diet, exercise, weight loss (for Type 2), oral medications, and insulin use.
Additional Management Considerations
-
Cardiovascular Risk Management: Lifestyle modifications are critical to control blood pressure and cholesterol because cardiovascular disease risk is elevated in diabetes.
- Exercise more.
- Smoke less.
- Consume an appropriate diet.
- Wear diabetic socks and shoes.
- Consider medications to reduce blood pressure when necessary.
Type 1 Diabetes Treatment Options
- Combined Insulin Regimens: Many individuals use a combination of regular and NPH insulin, as well as synthetic insulin analogs (e.g., Humalog, Novolog).
-
Insulin Pump Therapy:
- Allows for continuous delivery of insulin.
- Examples include FLEXIBLE-PUMP.
Blood Glucose Testing
- Blood Lancets: Used to pierce the skin (typically on a finger) to draw blood for testing.
- Purpose of Testing: Monitor blood sugar levels and adjust treatment accordingly.
Acute Complications of Diabetes
-
Diabetic Ketoacidosis (DKA): A medical emergency.
- Low insulin levels cause the liver to switch to fat for fuel, leading to ketosis.
- Elevated levels of ketone bodies in the blood decrease the pH, resulting in DKA.
-
Symptoms:
- Dehydration
- Rapid, deep breathing
- Abdominal pain (can be severe)
-
Complications:
- Hypotension
- Shock
- Renal failure
- Brain edema
- Death
- Prevalence: More common in type 1 diabetes than type 2.
Hyperglycemia Hyperosmolar State
- Acute Complication: Similar symptoms to DKA, but a different origin and treatment.
-
Cause: Very high blood glucose levels (usually above 300 mg/dl) lead to osmotic water loss from cells into the blood.
- The kidneys dump glucose into the urine.
- Resulting in water loss and increased blood osmolarity.
- Consequences: Dehydration, if fluid replacement is not provided.
- Progression: Lethargy can lead to coma (more common in type 2 diabetes)
Hypoglycemia
- Definition: Abnormally low blood glucose (below 70 mg/dl)
-
Symptoms:
- Agitation
- Sweating
- Symptoms of sympathetic activation of the autonomic nervous system
- Severe Cases: Consciousness can be altered, leading to coma, seizures, or even brain damage and death.
-
Causes in Diabetes Patients:
- Excess or incorrectly timed insulin
- Excessive or incorrectly timed exercise
- Insufficient food intake
- Treatment: Sugary drinks, food, or in severe cases, glucagon injection.
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