Diabetes Mellitus Overview

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Questions and Answers

What is the primary cause of Type 1 diabetes mellitus?

Insulin resistance

Damage to B-cells leading to insulin deficiency (correct)

Excessive fat accumulation around organs

Abnormal insulin structure

Which of the following statements accurately describes Type 2 diabetes mellitus?

It may involve insulin resistance and reduced insulin secretion. (correct)

It does not usually have a genetic component.

It is solely caused by insulin deficiency.

It is typically diagnosed in children.

Which of the following factors is associated with an increased risk of developing Type 2 diabetes?

Low levels of abdominal fat

A family history of Type 1 diabetes

Having a high level of subcutaneous fat

Central obesity concentrated around the waist (correct)

What percentage of patients with Type 2 diabetes are found to have obesity?

Approximately 55% Signup and view all the answers

What is a common disturbance in carbohydrate metabolism caused by diabetes mellitus?

Hyperglycemia often accompanied by glucosuria Signup and view all the answers

What is the typical age of onset for Type 1 diabetes?

12-14 years Signup and view all the answers

Which statement accurately describes the severity of Type 2 diabetes?

Generally mild or moderate Signup and view all the answers

How does Type 1 diabetes typically affect body weight?

Usually underweight Signup and view all the answers

Which of the following symptoms is especially associated with Type 1 diabetes?

Weight loss Signup and view all the answers

What is the normal fasting plasma glucose level?

Less than 100 mg/dl Signup and view all the answers

How effective are oral hypoglycemic agents at the onset of Type 2 diabetes?

Ineffective at least at the onset Signup and view all the answers

What is the purpose of measuring glycosylated hemoglobin (HbA1c)?

To estimate diabetic control over the preceding weeks Signup and view all the answers

Which complication is often not directly linked to diabetes?

Allergic reactions Signup and view all the answers

What is the primary treatment method for type 1 diabetes?

Artificial insulin via injection Signup and view all the answers

What is the recommended average glucose level for type 1 diabetes patients?

80–120 mg/dl Signup and view all the answers

Which is typically the first step in the management of type 2 diabetes?

Increasing physical activity Signup and view all the answers

What is a common complication management strategy for type 2 diabetes?

Use of multiple oral antidiabetic drugs Signup and view all the answers

What may be necessary if oral medication fails for a type 2 diabetes patient?

Insulin therapy Signup and view all the answers

Which of the following is NOT a recommended lifestyle modification for managing diabetes complications?

Exercising less Signup and view all the answers

What type of insulin is commonly combined with regular insulin in type 1 diabetes treatment?

NPH insulin Signup and view all the answers

What device may be used as a treatment option for type 1 diabetes?

Insulin pump Signup and view all the answers

What is the primary purpose of using a blood lancet?

To pierce the skin and draw blood for testing Signup and view all the answers

What is a critical complication that can arise from diabetic ketoacidosis (DKA)?

Dehydration Signup and view all the answers

Which statement accurately differentiates diabetic ketoacidosis from hyperglycemic hyperosmolar state?

DKA results in high levels of ketone bodies, whereas hyperglycemic hyperosmolar state does not Signup and view all the answers

What symptom is most commonly associated with severe hypoglycemia?

Dizziness and faintness Signup and view all the answers

What can cause hypoglycemia in patients with diabetes?

Too much or incorrectly timed insulin Signup and view all the answers

What initial treatment is common for both diabetic ketoacidosis and hyperglycemic hyperosmolar state?

Fluid volume replacement Signup and view all the answers

Which of the following symptoms is NOT typically associated with diabetic ketoacidosis?

High fidgeting behavior Signup and view all the answers

In a patient with hyperglycemic hyperosmolar state, what consequence is expected due to high blood glucose levels?

Loss of water from cells into the blood Signup and view all the answers

Study Notes

Diabetes Mellitus Definition

A disturbance of carbohydrate metabolism caused by insulin deficiency, resistance, or both, resulting in hyperglycemia and glucosuria, with secondary disturbances in protein and fat metabolism.
Affects about 1-2% of the population.

Diabetes Mellitus Types

Type 1 (IDDM): Insulin-dependent diabetes mellitus, previously termed juvenile-onset diabetes.
- Characterized by insulin deficiency due to damage of beta cells.
Type 2 (NIDDM): Non insulin-dependent diabetes mellitus, previously termed maturity-onset diabetes.
- May involve insulin resistance, abnormal insulin structure, or both.
- Combined with relatively reduced insulin secretion that may become absolute in some cases.

Theories of Type 2 Diabetes Etiology

Central Obesity: Fat concentrated around the waist, impacting abdominal organs, linked to insulin resistance.
Adipokines: Hormones secreted by abdominal fat that potentially impair glucose tolerance.
Family History: Predisposition to type 2 diabetes in individuals with close relatives who have the condition.

Comparing Type 1 and Type 2 Diabetes

Incidence: Type 1 accounts for 10% of cases while Type 2 represents 90%.
Age of Onset: Type 1 typically develops before 30 years of age (usually between 12-14), while Type 2 occurs after 40 years of age.
Sex: Type 1 is more common in males, while Type 2 is more prevalent in females.
Body Weight: Individuals with Type 1 are usually underweight, whereas Type 2 patients are commonly overweight.
Severity: Type 1 is generally more severe than Type 2.
Stability: Type 1 diabetes is often unstable and referred to as "brittle diabetes". Type 2 is generally more stable.
Insulin Requirement: Insulin is essential for Type 1, while it is usually not needed in the early stages of Type 2.
Oral Hypoglycemic Effectiveness: Oral hypoglycemic agents are ineffective in Type 1, but they can be effective in the initial stages of Type 2.

Symptoms of Diabetes Mellitus

Asymptomatic: Can go unnoticed and be discovered accidentally.
Classic Symptoms:
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased hunger, with weight loss especially in Type 1)
- Pruritis (itchiness, particularly in the vulva and anal region)
- Parathesia (tingling or numbness)
- Premature loosening of teeth
- Repeated infections (e.g., boils)
Complications: Long-term complications related to diabetes.
Diabetic Coma: A serious consequence of uncontrolled diabetes.

Diabetes Mellitus Investigations

Plasma Glucose: Measures fasting and 2-hour postprandial glucose levels and includes an oral glucose tolerance test (OGTT).
- Normal Levels: Fasting (less than 100 mg%), 2-hour postprandial (less than 140 mg%).
- Impaired Glucose Tolerance (IGT): Fasting (greater than or equal to 100 mg% but less than 126 mg%), 2-hour postprandial (greater than or equal to 140 mg% but less than 200 mg%).
- Overt Diabetes: Fasting (greater than or equal to 126 mg%), 2-hour postprandial (greater than or equal to 200 mg%). Symptoms of diabetes plus a causal plasma glucose concentration of greater than or equal to 200 mg/dl.
Glycosylated Hemoglobin (HA1c): Measures the level of glucose bound to hemoglobin in red blood cells.
- Used to assess diabetic control over the preceding 8-12 weeks.
- Normal level is 6% of total hemoglobin.
Urine Analysis:
- Tests for glucose using strips and less frequently, solutions like Benedict's reagent.
- Tests for ketone bodies using strips and Rother's sodium nitroprusside test.

Monitoring Diabetes Treatment

Home Blood Glucose Monitoring (HBGM): Regular self-monitoring of blood glucose levels.
Urine Testing: Testing urine for glucose.

Diabetes Mellitus Management

Patient Education: Critical component, providing information on diabetes and its management.
Dietetic Support: Tailored dietary recommendations for managing blood glucose levels.
Sensible Exercise: Regular physical activity is encouraged to improve insulin sensitivity.
Self-Monitoring: Regular blood glucose level testing to monitor treatment effectiveness.

Type 1 Diabetes Treatment

Insulin Therapy: Primary treatment, involving artificial insulin delivered via injections.
Blood Glucose Monitoring: Regular testing to monitor blood glucose levels.
Insulin Types:
- Regular Insulin: Rapid-acting insulin.
- NPH Insulin: Intermediate-acting insulin.
- Insulin Analogs: Synthetic insulin analogs like Humalog and Novolog (rapid-acting) and Lantus/Levemir (long-acting).
Insulin Pump: Option for delivering insulin continuously, allowing for more flexibility and control.
Blood Lancet: Tool used to draw blood for blood glucose testing.

Type 2 Diabetes Treatment

Lifestyle Modifications: Initial steps prioritizing:
- Increased Physical Activity: Regular exercise to enhance insulin sensitivity.
- Decreased Carbohydrate Intake: Reduced carbohydrate intake for optimal blood glucose management.
- Weight Loss: Weight loss can improve insulin sensitivity, even with modest reductions.
Oral Antidiabetic Drugs: Used when lifestyle modifications are insufficient.
- Improve insulin production and management of blood glucose levels.
Insulin Therapy: May become necessary as beta cell function deteriorates.
- Typically used for type 2 patients not responding to oral medications or those with longstanding diabetes.

Additional Considerations for Diabetes Management

Cardiovascular Disease Management: Increased risk for cardiovascular disease in patients with diabetes.
- Encourage:
  - Controlling blood pressure
  - Lowering cholesterol
  - Exercising regularly
  - Quitting smoking
  - Consuming a heart-healthy diet
  - Wearing diabetic socks and shoes.
Oral Hypoglycemic Agents: Medications that help lower blood glucose levels.
Insulin Therapy: Provides exogenous insulin to replace or supplement the body's own insulin production.

Acute Complications of Diabetes

Diabetic Ketoacidosis (DKA):
- Life-threatening complication, often associated with high blood glucose levels.
- Marked by low insulin levels, leading the liver to turn to fat for fuel (ketosis), producing ketone bodies.
- Ketone buildup leads to metabolic acidosis.
- Characterized by dehydration, rapid and deep breathing, and abdominal pain.
- Can cause hypotension, shock, renal failure, brain edema, and death.
- More common in type 1 diabetes.
Hyperosmolar Hyperglycemic State (HHS):
- Different from DKA but shares some symptoms.
- Occurs when very high blood glucose levels (often above 300 mg/dl) draw water out of cells into the blood.
- The kidneys then excrete excess glucose in urine, leading to dehydration and increased blood osmolarity.
- Requires urgent medical treatment, usually starting with fluid volume replacement.
- Lethargy can progress to coma, more common in type 2 diabetes than type 1.
Hypoglycemia:
- Abnormally low blood glucose levels (below 70 mg/dl).
- Can cause:
  - Agitation
  - Sweating
  - Symptoms of sympathetic nervous system activation
  - Altered consciousness
  - Coma
  - Seizures
  - Brain damage
  - Death
- May result from:
  - Excessive or incorrectly timed insulin
  - Excessive or incorrectly timed exercise
  - Insufficient food intake
- Treatment involves:
  - Sugary drinks or food
  - Glucagon injection in severe cases.

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Description

This quiz covers the definition and types of Diabetes Mellitus, including Type 1 and Type 2 diabetes. It explores the etiology theories related to Type 2 Diabetes, such as central obesity and the role of adipokines. Test your knowledge about this common metabolic disorder.