Diabetes Mellitus

Exam Cram

• Diabetes mellitus describes disorders of blood sugar control, primarily hyperglycaemia

• Insulin lowers blood glucose levels through cellular uptake; glucagon does the opposite

• T1DM: autoimmune destruction of insulin producing pancreatic beta cells

• T2DM: metabolic condition, reduced insulin sensitivity

• DKA: diabetic ketoacidosis, hypo-insulinaemia causing starvation ketosis in type 1 diabetics

• HHS: profound dehydration from chronic hyperglycaemia in type 2 diabetes

Diabetes Mellitus Overview

Types

• T1DM

• T2DM

• MODY

• LADA

• Gestational

• Secondary diabetes / Type 3

  • • 3a : Genetic damage to Beta cells

    • 3b: Genetic damage to insulin secretion

    • 3c: Damage to pancreas

    • 3d: Hormonal changes

    • 3e: Chemical or medical changes

    • 3f: Infections

Gestational Diabetes

Form of type 2 diabetes

Management

1. Dietary, 

2. Metformin

3. Gliclazide

Type 1 diabetes during pregnancy- continue insulin

Secondary Diabetes / Type 3

Type 3c

Type 3c diabetes is caused by damage to the pancreas

Examples

• Pancreatitis : acute or chronic

• Pancreatic Cancer

• Cystic Fibrosis 

• Haemochromatosis 

Alzheimer's is sometimes unofficially referred to as type 3 diabetes. 

Complications of Diabetes

• Acute

  • Hyperglycaemia

    • DKA

    • HHS

  • Hypoglycaemia

• Chronic

  • Macrovascular- Coronary Artery Disease , Stroke 

  • Microvascular: 

    • Diabetic neuropathies- peripheral, amyotrophy

      • Diabetic Foot Ulcer 

      • Charcot Arthropathy 

    • Diabetic nephropathy

    • Diabetic retinopathy

Diabetic Amyotrophy

• Complication of T2DM > T1DM

• Presentation: 2-3m thigh pain, weakness and numbness

• Management

  • Physio

  • Analgesia

  • Improved glycaemic control

  • Pregabalin/ gabapentin

Diabetic Nephropathy

• Presentation: decline in creatinine on background of poorly controlled hyperglycaemia (HbA1c) and haemoproteinuria

• Pathology: glomerulosclerosis with thickening of glomerular basement membrane

• Management: 

  • HbA1c & blood pressure control

  • SGLT-2 inhibitors and GLP-1 agonists

References

1. Sapra A, Bhandari P. Diabetes. [Updated 2023 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/

Page written in 2024.