27 Diabetes and Blood Glucose Management

Effects of Acute and Chronic Hyperglycaemia

• The lecture covered the effects of acute and chronic hyperglycaemia.
• Learning outcomes included describing the normal range of blood glucose concentrations, recalling diagnostic criteria for hyperglycaemia and diabetes, describing causes, symptoms, diagnosis, and treatment of acute hyperglycaemia (particularly diabetic ketoacidosis), and describing causes and symptoms of chronic hyperglycaemia and illustrating its molecular physiology and consequences.

Normal Range of Blood Glucose Concentrations

• NICE recommended target ranges for blood glucose are presented in the provided document.
• These ranges vary based on the type of diabetes (e.g., non-diabetic, Type 1, Type 2) and age (e.g., children).
• Fasting, before meals, and 2 hours post-prandial glucose levels are specified.

Diagnostic Criteria for Hyperglycaemia and Diabetes

• Diagnostic criteria are based on fasting and random plasma glucose levels.
• Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dL).
• Random plasma glucose ≥ 11.1 mmol/L (200 mg/dL).
• The text suggests using oral glucose tolerance tests (OGTT) under specific circumstances.

Acute Hyperglycaemia (Diabetic Ketoacidosis)

• Causes include immune-mediated selective destruction of beta cells in the pancreas (T1DM), and abnormal metabolism and insulin secretion in T2DM, stress, infections, medication side effects, or lifestyle factors.
• Symptoms and presentation include fasting blood glucose ≥ 7.0 mmol/L, 2-hour blood glucose (OGTT) ≥ 11.1 mmol/L, blood glucose ≥ 8-15 mmol/L, symptomatic ≥ 15-20 mmol/L, and glycosuria threshold ≈ 8-10 mmol/L.
• Diabetic ketoacidosis (DKA) is a severe complication that is most common in T1DM, but can also occur in T2DM.
• The condition results from metabolic effects of insulin deficiency, involving carbohydrate, fat and protein metabolism. This is a serious condition that can result in death if not treated.
• Treatment involves fluid replacement, insulin, and addressing electrolyte imbalances.

Chronic Hyperglycaemia

• Chronic complications (effects of long-term hyperglycaemia) are attributed to non-enzymatic glycosylation (NEG) and osmotic cellular damage.
• The lecture notes cover the causes and symptoms of chronic hyperglycaemia.
• Important elements include the molecular physiology and resulting complications of hyperglycaemia.
• Consequences also include microvascular and macrovascular complications, like nephropathy, retinopathy, neuropathy, heart disease, stroke, and peripheral vascular disease.