Diabetes Mellitus Overview
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Questions and Answers

What is a major characteristic of diabetes mellitus?

  • Deficiency of insulin (correct)
  • Increased metabolism
  • Elevated glucose levels (correct)
  • None of the above

    • Which classification of diabetes is most prevalent among the elderly?

  • Type 2 Diabetes Mellitus (correct)
  • Diabetes associated with other conditions
  • Gestational Diabetes Mellitus
  • Type 1 Diabetes Mellitus

    • At what age is Type 1 Diabetes Mellitus usually diagnosed?

  • Before 18 years
  • Before 30 years (correct)
  • After 40 years
  • Between 30 and 40 years

    • What percentage of diabetes patients are estimated to be undiagnosed?

    <p>50%</p> Signup and view all the answers

    Which of the following is NOT a cause of Type 2 Diabetes Mellitus?

    <p>Immunologic factors</p> Signup and view all the answers

    What is a risk factor associated with Gestational Diabetes Mellitus (GDM)?

    <p>Family history of diabetes</p> Signup and view all the answers

    What is the expected number of diabetes mellitus patients worldwide by 2030?

    <p>552 million</p> Signup and view all the answers

    Which type of diabetes is primarily associated with the intake of certain drugs?

    <p>Diabetes mellitus associated with other conditions</p> Signup and view all the answers

    What is a common consequence of adrenal insufficiency?

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

    How does insulin affect glucose in muscle and liver cells?

    <p>It stores glucose as glycogen</p> Signup and view all the answers

    What role does glucagon play in blood glucose regulation?

    <p>It stimulates the liver to release stored glucose</p> Signup and view all the answers

    What leads to absolute insulin deficiency in type 1 diabetes mellitus (DM)?

    <p>Destruction of pancreatic beta cells</p> Signup and view all the answers

    Which of the following factors has been suggested as a potential trigger for type 1 diabetes?

    <p>Viral infections</p> Signup and view all the answers

    What maintains a constant level of glucose in the blood between meals?

    <p>The combined actions of insulin and glucagon</p> Signup and view all the answers

    What is indicated by the presence of autoantibodies in type 1 diabetes patients?

    <p>Autoimmune response against pancreatic tissues</p> Signup and view all the answers

    Which pancreatic cells are responsible for secreting insulin?

    <p>Beta cells</p> Signup and view all the answers

    What is the primary mechanism of action for Alpha Glucosidase Inhibitors?

    <p>Slow down glucose absorption</p> Signup and view all the answers

    Which type of insulin is characterized as clear and used for rapid action?

    <p>Lispro insulin</p> Signup and view all the answers

    What is a common indication for insulin therapy in patients with Type 2 diabetes?

    <p>During periods of stress</p> Signup and view all the answers

    Which medication category includes Repaglinide?

    <p>Insulin secretagogues</p> Signup and view all the answers

    What is the duration of action for rapid-acting insulin after administration?

    <p>30-90 minutes</p> Signup and view all the answers

    Which of the following is true regarding Thiazolidinediones?

    <p>They work by enhancing insulin action at receptor sites.</p> Signup and view all the answers

    What is the effect of Dipeptidyl Peptidase-4 (DPP-4) inhibitors on glucagon levels?

    <p>Decrease glucagon levels</p> Signup and view all the answers

    Which type of insulin is cloudy and has an intermediate duration of action?

    <p>NPH insulin</p> Signup and view all the answers

    What is a consequence of the destruction of beta cells?

    <p>Fasting hyperglycaemia</p> Signup and view all the answers

    Which of the following is a result of exceeding the renal threshold for glucose?

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

    What contributes to the unrestrained glycogenolysis and gluconeogenesis in insulin deficiency?

    <p>Lack of insulin</p> Signup and view all the answers

    What mechanism is primarily responsible for insulin resistance in Type 2 diabetes?

    <p>Decreased sensitivity to insulin</p> Signup and view all the answers

    What happens when beta cells cannot meet the insulin demand in Type 2 diabetes?

    <p>Type 2 diabetes develops</p> Signup and view all the answers

    Why does diabetic ketoacidosis (DKA) typically not occur in Type 2 diabetes?

    <p>Insulin levels are sufficient to prevent fat breakdown</p> Signup and view all the answers

    What syndrome can develop from uncontrolled Type 2 diabetes?

    <p>Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS)</p> Signup and view all the answers

    How does the onset of Type 2 diabetes differ from Type 1 diabetes?

    <p>Type 2 diabetes typically goes undetected for many years</p> Signup and view all the answers

    What is the primary goal of diabetes management?

    <p>To achieve normal blood glucose levels without hypoglycemia</p> Signup and view all the answers

    Which component is NOT considered part of diabetes management?

    <p>A strict exercise regimen</p> Signup and view all the answers

    Which of the following is true about Sulphonylureas?

    <p>They stimulate the pancreas to secrete insulin.</p> Signup and view all the answers

    When should Biguanides ideally be taken?

    <p>With or just after meals</p> Signup and view all the answers

    Which type of diabetes medication primarily enhances the glucose-lowering effect when used in combination with Sulphonylureas?

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

    What is a characteristic of first-generation Sulfonylureas?

    <p>They must be taken with food for maximum effect.</p> Signup and view all the answers

    What should be done when the criteria for diabetes are met?

    <p>It should be confirmed through repeat testing on another day.</p> Signup and view all the answers

    What aspect should be considered for adjusting diabetes treatment plans?

    <p>Advances in treatment methods and patient's lifestyle changes</p> Signup and view all the answers

    Which of the following is a risk factor for developing type 2 diabetes mellitus?

    <p>Race/ethnicity factors</p> Signup and view all the answers

    What symptom is NOT associated with hyperglycemia in diabetes mellitus?

    <p>Excessive sleepiness</p> Signup and view all the answers

    What blood glucose level is indicative of diabetes mellitus diagnosis?

    <p>Fasting plasma glucose ≥126 mg/dL</p> Signup and view all the answers

    Which of the following is NOT a common clinical manifestation of type 2 diabetes mellitus?

    <p>Weight gain</p> Signup and view all the answers

    What does the presence of ketones in urine indicate?

    <p>Diabetic ketoacidosis</p> Signup and view all the answers

    Which of the following criteria includes symptoms for diagnosing diabetes mellitus?

    <p>Symptoms plus random plasma glucose ≥200 mg/dL</p> Signup and view all the answers

    What level of HDL cholesterol is considered a risk factor for developing type 2 diabetes?

    <p>≤35 mg/dL</p> Signup and view all the answers

    Which condition is most likely related to the vascular changes observed in diabetes mellitus?

    <p>Sexual dysfunction</p> Signup and view all the answers

    Study Notes

    Diabetes Mellitus

    • Diabetes mellitus (DM) is a group of metabolic diseases characterized by elevated blood glucose (hyperglycemia)
    • Caused by defects in insulin secretion, insulin action, or both
    • Also defined as a chronic systemic disease with either insulin deficiency or reduced ability to use insulin
    • Often referred to as "high sugars"

    Incidence

    • In 1995, there were 135 million DM patients worldwide
    • 285 million in 2010, 366 million in 2011
    • Projected to reach 552 million in 2030
    • 80% of DM patients live in low and middle-income countries
    • Prevalent in the elderly, with up to 50% of patients over 65 years old
    • Approximately 183 million (50%) patients living with diabetes are undiagnosed
    • 4.6 million deaths from diabetes occurred worldwide in 2011
    • In April 2011, DM deaths in Ghana reached 2,752 (or 1.47% of total deaths)

    Classification

    • Four major classifications:
      • Type 1 (Juvenile/Insulin Dependent):
        • Affects 5-10% of people with diabetes
        • Typically diagnosed before age 30
        • Requires daily insulin treatment
        • Causes: genetic, immunologic, and environmental
      • Type 2 (Non-Insulin Dependent):
        • Affects 90-95% of people with diabetes
        • Usually diagnosed after age 40
        • Also common in certain ethnic/racial groups
        • Often referred to as stable diabetes
        • Causes: heredity, obesity, and environmental factors
      • Gestational Diabetes Mellitus (GDM):
        • Develops in up to 14% of pregnant women
        • Increases risk of hypertensive disorders
        • Typically occurs during the second half of pregnancy
        • Mothers are likely to have large babies
        • Common in women with a family history of diabetes; obesity is also a risk factor
      • DM associated with other conditions:
        • Associated with certain drugs (e.g., oral contraceptives, corticosteroids)
        • Hormonal conditions (e.g., adrenal insufficiency, Cushing's syndrome)
        • Accounts for 1-2% of all diagnosed DM cases

    Pathophysiology

    • In normal physiology, insulin is secreted by beta cells in the islets of Langerhans in the pancreas
    • After a meal, insulin release increases, moving glucose from blood to muscle, liver, and fat cells.
    • Insulin within these cells:
      • Transports and metabolizes glucose for energy
      • Stimulates glycogen storage in liver/muscle
      • Signals liver to stop glucose release
      • Enhances dietary fat storage in adipose tissue
      • Speeds up amino acid transport into cells
      • Inhibits the breakdown of stored glucose, protein, and fat
    • During fasting periods, the pancreas releases basal insulin. Glucagon (pancreatic hormone) is released to stimulate liver's release of stored glucose when blood sugar is low

    Type 1 DM Pathophysiology

    • In type 1 DM, there's destruction of pancreatic beta cells, resulting in absolute insulin deficiency
    • Potential causes: genetic, immunologic, or environmental factors (e.g., viral infections)
    • Genetic susceptibility is thought to be an underlying cause
    • Destruction mechanism may include autoimmune responses (antibodies targeting body tissues) or environmental factors like viruses or toxins

    Type 2 DM Pathophysiology

    • Type 2 DM involves insulin resistance and impaired insulin secretion
    • Insulin resistance: reduced sensitivity to insulin
    • Normal insulin receptors initiate glucose metabolism, but type 2 DM diminishes these intracellular reactions
    • This makes insulin less effective at stimulating tissue glucose uptake and regulating liver glucose release
    • Exact mechanisms are uncertain but genetic factors are a consideration
    • To overcome resistance, the body increases insulin secretion to maintain normal/slightly elevated glucose levels
    • If beta cells cannot keep up, blood glucose rises
    • Despite impaired secretion, sufficient insulin often prevents ketogenesis which causes diabetic ketoacidosis (DKA) in type 2, but it may present as hyperglycemic hyperosmolar non-ketotic syndrome (HHNS)
    • Slow progressive glucose intolerance means onset is often undetected for years

    Diabetic Symptoms

    • Symptoms of diabetes include:
      • Polyuria (increased urination)
      • Polydipsia (increased thirst)
      • Polyphagia (increased appetite)
      • Weight loss (body not getting glucose, uses fats/proteins)
      • Fatigue/weakness (cells lacking energy)
      • Glycosuria (excess glucose in urine)
      • Increased risk of infections (e.g., candidiasis)
      • Visual disturbances (blurred vision)
      • Paraesthesia (tingling/numbness in extremities)
      • Poor wound healing
      • Acetone breath (fruity/sweet odor) in cases of DKA
      • Type 1 specific symptoms include lethargy, stupor, and Kussmaul breathing

    Risk Factors for Type 2 DM

    • Race/ethnicity (African Americans, Hispanics, Native Americans, Asians, etc.)
    • Obesity (BMI ≥ 27kg/m2 or ≥20% over desired body weight)
    • Age ≥45 years
    • Impaired fasting glucose or impaired glucose tolerance
    • Hypertension (≥140/90 mmHg)
    • Low HDL cholesterol (≤35 mg/dL or 0.9 mmol/L) and/or high triglycerides (≥250 mg/dL or 2.8 mmol/L)
    • Family history of diabetes
    • History of GDM or delivery of babies over 9 lbs

    Diagnosis Investigations

    • Urine chemistry - elevated glucose and ketones
    • Blood chemistry - fasting blood sugar (≥ 7.0 mmol/L) or random blood sugar (≥11.1 mmol/L)
    • Oral Glucose Tolerance Test (OGTT) ≥ 11.1 mmol/L
    • HbA1c (glycosylated hemoglobin) - average blood glucose over ~3 months; normal: 4-8%
    • BUE - annually
    • Eye examination - annually

    Diagnostic Criteria for Diabetes

    • Symptoms of diabetes plus random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) (any time of day, regardless of last meal) or;
    • Fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L) (no caloric intake for at least 8 hours) or;
    • 2-hour postload glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (75g anhydrous glucose dissolved in water)
    • In the absence of unequivocal hyperglycemia with acute metabolic decompensation, these criteria should be confirmed by repeat testing on a different day

    Diabetes Management

    • Therapeutic goal: achieve euglycemia (normal blood glucose) without hypoglycemia, and without significantly impacting daily lifestyle
    • Five components of management:
      • Nutritional management
      • Exercise
      • Monitoring (self-monitoring of blood glucose = SMBG)
      • Pharmacologic therapy
      • Education

    Medications

    • Two or more drug types may be used for optimal effect
    • Older patients may first be treated with diet
    • Types of medications to treat DM include:
    • Sulphonylureas: stimulate pancreas to secrete insulin
    • Biguanides: enhance insulin action on peripheral receptors; only effective with insulin
    • Alpha Glucosidase Inhibitors: slow glucose absorption
    • Thiazolidinediones (TZDs): enhance insulin action at receptor sites
    • Non-sulfonylurea insulin secretagogues: stimulate insulin release
    • Dipeptidyl Peptidase-4 (DPP-4) inhibitors: enhance incretin action to increase insulin release and decrease glucagon
    • Insulin: used for type 1 diabetes, or type 2 in times of stress, surgery or infection; during pregnancy.

    Insulin Types and Delivery Equipment

    • Insulin types categorized by action speed and duration
    • Insulin delivery methods:
      • Syringe and needle
      • Insulin pen
      • Insulin pump

    Insulin Storage

    • Insulin storage practices: refrigerated (except vial in use)
    • Vials in use kept at room temperature (up to 4 weeks) unless temp> 86°F (~30°C) or <32°F (~0°C)

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    Diabetes Mellitus PDF

    Description

    Test your knowledge on diabetes mellitus, a group of metabolic diseases characterized by high blood sugar levels. This quiz covers key topics such as incidence, classifications, and the impact of diabetes worldwide. Understand the different types and the global statistics surrounding this chronic condition.

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