DIABETES

1
DIABETES
This presentation is by Dawn Mellor in
conjunction with the Health Intelligence
Network Diabetes and the GMS 11th October
2004
2
TYPES OF DIABETES

• Type I sudden onset
• Type II gradual onset usually affects older
  age group

3
DIABETES MELLITUS

• Can be due to failure of pancreas
• This ceases to produce enough insulin
• May also be due to insulin resistance
• There can be a combination of both

4
DIABETES INSIPIDUS

• Has nothing to do with the pancreas
• Excessive amount of dilute urine
• Can be divided into Cranial diabetes
• Nephrogenic diabetes

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CRANIAL DIABETES

• Genetic defect
• Dominant
• Recessive - Didmoad syndrome associated
  with diabetes mellitus, optic atrophy and
  deafness
• Can be caused by- Head injury, pituitary
  tumour or encephalitis

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NEPHROGENIC DIABETES

• Genetic defect
• Sex linked
• Cystinosis
• Metabolic abnormality
• hypokalaemia
• hypercalcaeamia

• Poisoning
• Heavy metals
• Drug therapy
• Lithium
• demeclocycline

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DIABETES IS NOT

• Caught
• Eating too much sugar does not cause it
• Diabetics are not prone to more colds etc
• Diabetics do not need to eat special diabetic
  foods
• It does not mean they cannot do some jobs
• There are no restrictions on sport or driving.

8
EPIDEMIOLOGY

• Figures for 2004 show that
• 1.8 million in UK. 3 of population
• 5 of world population
• World wide 20 million have Type I
• 1 million with undiagnosed Type II
• Type II Five times higher in Afro Caribbean and
  Asian community

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PREVALENCE OF DIABETES

• U.K. Research studies (knownnew DM) - OGTT

Setting Age Prevalence (Age standardised) Prevalence (Age standardised) Prevalence (Age standardised)
European S. Asian Af/Caribbean
Coventry 91 20 3.2 4.7 11.2 12.4 -
Southall 91 40 69 2.3 4.8 16.1 19.9 14.6
Brent 93 40 64 4.0 6.5 - 12.9 17.7
Wandsworth 97 40 59 5 7 20 25 15 18
Newcastle 98 25 74 7.1 21.4 -
Manchester 01 35 79 8.1 22.7 15.7 48.1 15.7 29.5
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Ethnic differentials in diabetes

• Prevalence of known new diabetes

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SIGNS AND SYMPTOMS

• Thirst
• Polyuria
• Nocturia
• Fatigue
• Malaise
• But not everyone has these

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OTHER PHYSICAL SIGNS

• Obesity
• Hypertension
• Pruritus vulvae
• Hyperlipidaemia
• Pain and muscle weakness
• Paraesthesia
• Blurring of vision
• Minor infections

13
Obesity what is it?

• Body mass index BMI
• An index derived by the formula Weight in kg /
  (height)2 in metres
• Not very good for defining fat levels in an
  individual, but very good for monitoring trends
  over time, and across populations thus a very
  important public health statistic

WHO definitions Normal weight BMIlt25
kg/m2 Overweight BMI 25 30 kg/m2 Obese BMI gt30
kg/m2
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CAUSATIVE AND PREDISPOSING FACTORS

• Diet
• Lifestyle
• Genetics

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COMMON CAUSES

• Obesity
• most are over weight but not all
• Diet
• Refined carbohydrate foods
• High fat
• Alcohol

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COMMON CAUSES

• Lifestyle factors
• Physical activity
• smoking

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COMMON CAUSES

• GENETICS
• MAY be familial
• Researchers can now look at the genes for answers
• Cell transplantation

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COMMON TESTS

• Urine
• This is the easiest. Used by some diabetics.
• Can be tablets or strips latter most common A
  negative test turns blue and ranges through the
  colours green and brown to positive at orange
• 24 hour specimens can be collected. Normal random
  reading is negative lt0.5g/day or lt2.78mmol/day
  (SI units)

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GLUCOSE TOLERANCE TEST

• ORAL test
• Patient starved for 12 hours before test
• The urine is tested for glucose as is the blood
  serum
• Glucose is then administered orally
• The blood is then tested after 30 mins and there
  after hourly

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NORMAL RESULTS

• Fasting 70-115mg/dl or lt6.4mmol/l
• 30 mins lt200mg/dl or 11.1mmol/L
• 1 hour as above
• 2 hours lt140mg/dl or 7.8mmol/l
• 3 hours 70-115mg/dl or 6.4mmol/l
• No food or drink other than water is given until
  the end of the teat.
• Urine test should remain negative at all times

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GLUCOSE TOLERANCE TEST
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FASTING BLOOD SUGAR

• Normal values
• 70-110mg/dl or 3.9-6.1mmol/L
• 100 125mg/dl - impaired
• 126 or above Diabetes

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KETONES

• Normally not present in urine
• Uncontrolled diabetes and hyperglycaemia they may
  be present
• Here fat is used for energy as glucose is
  unavailable to the tissues
• Ketones and acetone are the end products of fatty
  acid breakdown
• Ketoacidosis also associated with - alcoholism,
  fasting, starvation and high-protein diets.

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PROGNOSIS

• Long term good control of blood sugar levels
  helps to reduce the risk of stroke and heart
  failure
• Some patients with type 2 eventually need more
  than one medication and often insulin
• Resistance to insulin increases with age and the
  pancreas does wear out.

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REFERENCES

• Anon. Diabetes UK www.diabetes.org.uk
  accessed 30.4.05
• Anon. NSF Diabetic Standard and research
  Department of health. www.publications.doh.gov.uk
  accessed 18.4.05
• Diabetics Care (2003) Age-and sex-specific
  prevalence of diabetes and impaired glucose
  regulation in 11 Asian Cohorts.
  http//carediabeticjournals.org/cgi/centent
  Accessed 23.4.05
• Diabetes Insipidus The Pituitary
  Foundation.org.uk/resources/di.htm
• Forouhi. N(2004) Estimating the burden of
  diabetes. Health Intelligence Network.
  www.Iho.org.uk/events/attach Accessed 23.4.05
• Pagana. K T (2002) Mosbys Manual of
  Diagnostic and laboratory Tests. Missouri.
  Mosbys Inc.
• Roberts. D (undated) Diabetes in the UK Country
  Doctor.co.uk Accessed 13.4.05
• Smoking and Diabetics Action on Smoking and
  Health November 2002 http//www.ash.org.uk/html/fa
  ctsheets/html.fact23/html
• Understanding diabetes West Suffolk NHS trust
  Suffolk Primary Care Trust. http//www.diabetesuf
  folk.com Accessed 13.4.05