24 Questions
What is the main characteristic of Type 1 Diabetes Mellitus (T1DM) in terms of aetiology?
Chronic autoimmune destruction of the insulin-producing pancreatic beta cells
Which of the following autoimmune disorders is NOT commonly associated with Type 1 Diabetes Mellitus?
Rheumatoid arthritis
What is the typical duration of symptoms before presentation in Type 1 Diabetes Mellitus?
Weeks
Which of the following is NOT a common feature of Type 1 Diabetes Mellitus?
Majority of people with T1DM are obese
What is the significance of the presence of autoimmune markers in Type 1 Diabetes Mellitus?
Defines the diagnosis of T1DM
What is the common presentation of children and adolescents with Type 1 Diabetes Mellitus?
Diabetic ketoacidosis (DKA) as the first manifestation of the disease
What is the main reason for weight loss in patients with Type 1 Diabetes Mellitus?
Fat and protein are catabolised by tissues due to lack of insulin
What is the significance of autoantibody tests in Type 1 Diabetes Mellitus?
They have their lowest false negative rate at the time of diagnosis
What is the primary reason for the development of diabetic ketoacidosis?
Absolute or relative insulin deficiency
Which of the following symptoms is NOT typically associated with diabetic ketoacidosis?
Hypoglycaemia
What is the term used to describe the situation where there is plenty of glucose circulating in the blood but the lack of insulin prevents it from getting into the cells that need it?
Starvation in the midst of plenty
What is the primary cause of osmotic diuresis in diabetic ketoacidosis?
Hyperglycaemia
Which of the following is a risk factor for Type 2 Diabetes Mellitus?
Central obesity
What is the primary imbalance underlying Type 2 Diabetes Mellitus?
Between insulin resistance and relative insulin deficiency
Which of the following is a clinical sign of diabetic ketoacidosis?
Fruity smell of acetone on the breath
What is the primary reason why patients with diabetic ketoacidosis may experience shortness of breath?
The body is trying to get rid of excess CO2
What is the primary reason why Type 2 Diabetes Mellitus patients seldom develop spontaneous Diabetic Ketoacidosis?
They retain sufficient beta-cell function and insulin secretion
Which of the following is a common feature of Type 2 Diabetes Mellitus?
Predominant form of diabetes worldwide
What is the term used to describe the clustering of metabolic diseases that lead to cardiovascular disease?
Metabolic syndrome
Which of the following medications can contribute to insulin resistance?
All of the above
What is the term used to describe the life-threatening metabolic complication of diabetes that is a medical emergency?
Hyperglycaemic hyperosmolar state
What is the term used to describe the increasing prevalence of obesity and Type 2 Diabetes Mellitus?
Diabesity epidemic
What is the primary reason why Type 2 Diabetes Mellitus patients may present with a variety of symptoms?
Because hyperglycaemia develops gradually
What is the risk factor for developing Type 2 Diabetes Mellitus?
All of the above
Study Notes
Diabetic Ketoacidosis (DKA)
- Life-threatening acute metabolic complication of diabetes resulting from absolute or relative insulin deficiency
- Characterized by:
- Hyperglycemia
- Hyperketonemia
- Metabolic acidosis
- Clinical symptoms:
- Polydipsia and polyuria
- Weight loss
- Abdominal pain, nausea, and/or vomiting
- Shortness of breath
- Lethargy, drowsiness, and/or confusion
- Clinical signs:
- Fruity smell of acetone on the breath
- Tachypnoea
- Tachycardia
- Dehydration
- Shock (tachycardia, hypotension, drowsiness, reduced urine output)
Pathophysiology of DKA
- Hyperglycemia leads to osmotic diuresis, causing loss of water and electrolytes
- Insulin deficiency prevents glucose from entering cells, leading to "starvation in the midst of plenty"
Type 2 Diabetes (T2DM)
- Aetiology: imbalance between increasing insulin resistance and relative insulin deficiency
- Risk factors:
- Obesity and visceral adiposity
- Sedentary lifestyle
- Ethnicity (e.g., Asian, African, Afro-Caribbean)
- Family history of T2DM
- History of gestational diabetes
- Unhealthy diet
- Certain medications (e.g., statins, corticosteroids, diuretics, beta-blockers)
- Polycystic ovary syndrome
- Metabolic syndrome
- Metabolic syndrome:
- Clustering of metabolic diseases leading to cardiovascular disease
- Characterized by:
- Obesity (high BMI)
- Insulin resistance
- Dyslipidemia
- Hypertension
- People with metabolic syndrome have a 5-fold greater risk of developing T2DM
- Common features:
- Predominant form of diabetes worldwide (90%-95% of cases)
- More prevalent in older adults (≥65 years), but increasing in younger adults and children due to obesity
- Patients with T2DM are usually obese (but not always)
- Clinical presentation is heterogeneous, with a wide range in age at onset, severity of hyperglycemia, and degree of obesity
- Typical presentation:
- T2DM frequently goes undiagnosed for many years due to gradual development of hyperglycemia
- Patients may present with a variety of symptoms, including:
- Lack of energy
- Persistent infections
- Slow healing of minor skin damage
- Visual problems
- Hyperglycemic hyperosmolar state (HHS):
- Life-threatening metabolic complication of diabetes
- T2DM patients seldom develop spontaneous DKA due to retained beta-cell function and insulin secretion
Type 1 Diabetes (T1DM)
- Aetiology: chronic autoimmune destruction of the insulin-producing pancreatic beta cells
- Model of stages of T1DM:
- Autoimmune markers:
- Islet cell autoantibodies (ICA)
- Autoantibodies to GAD (GAD65)
- Autoantibodies to insulin, IA-2, IA-2b, and ZnT8
- T1DM is defined by the presence of one or more of these autoimmune markers
- Autoimmune markers:
- Common features:
- Most common form of diabetes in childhood and adolescence (90% diagnosed under the age of 30 years), but can occur at any age
- Majority of people with T1DM are lean, but obesity should not preclude testing for T1DM
- People with T1DM are prone to other autoimmune disorders (e.g., Hashimoto thyroiditis, Graves' disease, Coeliac disease, Addison disease, Vitiligo, Autoimmune hepatitis, Myasthenia gravis, and Pernicious anaemia)
- Typical presentation:
- Presenting symptoms (usually with rapid onset):
- Polyuria (excess urine production)
- Polydipsia (increased thirst)
- Weight loss
- Children and adolescents often present with DKA as the first manifestation of the disease.
- Presenting symptoms (usually with rapid onset):
Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication of diabetes, characterized by hyperglycemia, hyperketonaemia, and metabolic acidosis. Learn about its symptoms and causes.
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