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Diabetes Mellitus
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Diabetes Mellitus

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Questions and Answers

What is diabetes mellitus?

Diabetes mellitus is a chronic condition characterized by raised plasma glucose levels, resulting from the body's inability to produce or use insulin properly.

What are some common risk factors for Type 1 Diabetes Mellitus?

  • Obesity
  • Hypertension
  • Habitual physical inactivity
  • Genetic predisposition (correct)
  • Diabetic retinopathy is a complication associated with diabetes mellitus.

    True

    One of the complications of diabetes nephropathy is ____________.

    <p>microalbuminuria</p> Signup and view all the answers

    Match the following diabetes complication with its manifestation:

    <p>Diabetes neuropathy = Autonomic neuropathy, orthostatic hypotension, and erectile dysfunction Diabetic ketoacidosis = Omitting insulin, rapid deep breathing, fruity breath odor Peripheral vascular disease = Ischemia, peripheral neuropathy, secondary infection</p> Signup and view all the answers

    Study Notes

    Diabetes Mellitus

    • A chronic condition characterized by raised plasma glucose levels, resulting from the body's inability to produce or use insulin properly.
    • Regulation of plasma glucose levels involves the balance between insulin and glucagon.

    Types of Diabetes

    • Type 1 Diabetes: Destruction of B-cells, leading to absolute insulin deficiency, with two subtypes:
      • Immune-mediated
      • Idiopathic
    • Type 2 Diabetes: May range from predominantly insulin resistance with relative insulin deficiency to insulin deficiency with insulin resistance.

    Risk Factors

    • Type 1 Diabetes:
      • Genetic predisposition
      • Triggering event (e.g., virus or toxin)
    • Type 2 Diabetes:
      • Family history
      • Obesity
      • Habitual physical inactivity
      • Previously identified impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)
      • Hypertension
      • Hyperlipidemia

    Other Causes of Diabetes

    • Diseases of the Exocrine Pancreas:
      • Pancreatitis
      • Pancreatectomy
      • Neoplasia
      • Cystic Fibrosis
      • Hemochromatosis
    • Endocrinopathies:
      • Acromegaly
      • Cushing's syndrome
      • Glucagonoma
      • Pheochromocytoma
      • Hyperthyroidism
    • Drug- or Chemical-Induced Diabetes:
      • Glucocorticoids
      • Thyroid hormone
      • b-adrenergic agonists
      • Thiazides
      • a-interferon
      • Beta blockers

    Gestational Diabetes Mellitus (GDM)

    • First recognized during pregnancy
    • Diagnostic criteria: any one test should be confirmed with a second test, most often fasting plasma glucose (FPG)

    Signs and Symptoms

    • Excessive thirst (polydipsia)
    • Excessive urination (polyuria)
    • Dehydration
    • Excessive hunger (polyphagia)
    • Tiredness
    • Weight loss
    • Blurred vision
    • Muscle weakness
    • Acne
    • Erectile failure
    • Fungal infections
    • Diabetic foot

    Diabetes Mellitus Complications

    • Microvascular Complications:
      • Retinopathy
      • Nephropathy
      • Neuropathy
    • Macrovascular Complications:
      • Coronary artery disease
      • Peripheral vascular disease
      • Cerebrovascular disease
      • Gastrointestinal disease
      • Genitourinary disease

    Diabetic Retinopathy

    • Microaneurysm
    • Hemorrhage
    • Exudates
    • Retinal edema
    • Other

    Diabetic Nephropathy

    • 30-40% of all type 1 DM patients develop nephropathy in 20 years
    • 15-20% of type 2 DM patients develop nephropathy
    • Manifested as:
      • Microalbuminuria
      • Progressive diabetic nephropathy leading to end-stage renal disease

    Diabetic Neuropathy

    • Autonomic Neuropathy:
      • Orthostatic hypotension
      • Diabetic diarrhea
      • Erectile dysfunction
      • Difficulty in urination

    Peripheral Vascular Disease and Foot Ulcer

    • Incidence of gangrene of the feet in DM is 20-fold higher than control group due to:
      • Ischemia
      • Peripheral neuropathy
      • Secondary infection

    Diabetic Ketoacidosis

    • A true emergency
    • Usually results from omitting insulin in type 1 DM or increase insulin requirements in other illness (e.g., infection, trauma) in type 1 DM and type 2 DM
    • Signs and symptoms:
      • Fatigue
      • Nausea
      • Vomiting
      • Evidence of dehydration
      • Rapid deep breathing
      • Fruity breath odor
      • Hypotension
      • Tachycardia

    Management of Diabetic Ketoacidosis

    • Fluid administration
    • IV infusion of insulin
    • Titrate the dose according to the blood glucose level
    • Potassium and phosphate can be added to the fluid if needed
    • Follow up:
      • Metabolic improvement is manifested by an increase in serum bicarbonate or pH

    Treatment

    • Desired Outcome:
      • Relieve symptoms
      • Reduce mortality
      • Improve quality of life
      • Reduce the risk of microvascular and macrovascular disease complications
    • How to Achieve the Goals:
      • Near normal glycemic control
      • Control of traditional CV risk factors
      • Medications
      • Dietary and exercise modification
      • Regular complication monitoring
      • Self-monitoring of blood glucose

    Treatment Options

    • DPP4 Inhibitor:
      • Advantages: weight neutral, decreases postprandial glucose, once a day, well-tolerated
      • Disadvantages: heart failure (saxagliptin/alogliptin), arthritis, rare pancreatitis
    • SGLT2 Inhibitor:
      • Advantages: weight loss, decreases heart failure, decreases renal dysfunction, no hypoglycemia
      • Disadvantages: urinary tract infections, genital mycotic infections, increased LDL, increased risk of DKA

    Insulin

    • Types of Insulin:
      • Rapid-acting insulin
      • Short-acting insulin
      • Intermediate-acting insulin
      • Long-acting insulin
      • Ultra-long-acting insulin
      • Remixed insulin
    • Insulin Regimens:
      • Multiple daily injections
      • Basal-bolus insulin regimen
      • Premixed insulin regimen

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    Description

    A quiz about diabetes mellitus, a chronic condition characterized by high blood sugar levels due to the body's inability to produce or use insulin properly.

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