Diabetes my own

Blood glucose

• usual - <10mmol/L

• Fasting - 3.5-5

• Regulated by insulin and glucagon

Insulin synthesis

• Pre-proinsulin

  endo retic

• Pro-insulin

  golgi

• Insulin

Insulin Functions

Stimulatory

• Glucose uptake by muscles / adipose

• Glycolysis

• Glycogen synthesis

• Protein synthesis

• Cellular uptake of k/phosphate

Diabetes Mellitus

A syndrome characterised by hyperglycaemia due to an absolute or relative deficiency of and/or resistance to insulin

DM Clinical Problems

• Polydipsia

• Polaris

• Blurred vision

• Fatigue

• Infections

Diabetic Ketoacidosis

Precipitated by infections or stress

Increased counter regulatory hormones

• Glucagon

• Cortisol

• Catecholamines

• GH

6% mortality

DA Clinical

• Polydipsea/uria

• Vomiting

• Dehydration

• Coma

• Kussmaul respiration (deep laboured breathing)

DA Biochem

• Hyperglycaemia

• Ketonaemia/uria

• Metabolic acidosis

• Hyperphosphataemia

• Hyperkalaemia

• Uremia

DA Management

• Insulin infusion

• Isotonic saline

• Bicarbonate infusion

• Potassium supplements

T1DM

• Insulin dependent

• Pancreas fails to produce insulin

• Acute

• Ketosis prone

T2DM

• Non insulin dependent

• Damaged insulin receptors

• Gradual

• Ketosis prone

Fasting Glucose Test

• Non = <_ 6.0mmol/L

• Impaired glycaemia = 6.1-6.9

• Diabetes >_ 7.0mmol/L

Secondary Diabtetes

• Pancreatic Disease

• Acromegaly

• Cushings

• Drugs damage pancreatic B cells

Chronic Complications

Macrovascular

• Stroke

• Heart disease

• Peripheral vascular disease

• Foot issues

Microvascular

• eye disease

• Renal disease

• Neuropathy

• Foot issues

• Embryopathy

Glycosuria

Proximal tubular dysfunction

Reducing sugars in urine

Oral Glucose Test

• 8-12 hrs fasting

• 75g glucose given

• Venous plasma at 0 and 2 hrs

Diabetes = >7.0 - 11

IGT (CVD) = <7.0 - 7.8 - 11

IFG (risk of diab) = 6.1-6.9 - 7.8

Diabetes management

• diet

• Exercise

• Hypoglycaemic drugs

• Insulin therapy