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Questions and Answers
What is diabetes mellitus?
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?
What are some common risk factors for Type 1 Diabetes Mellitus?
Diabetic retinopathy is a complication associated with diabetes mellitus.
Diabetic retinopathy is a complication associated with diabetes mellitus.
True
One of the complications of diabetes nephropathy is ____________.
One of the complications of diabetes nephropathy is ____________.
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Match the following diabetes complication with its manifestation:
Match the following diabetes complication with its manifestation:
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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.