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Yr3 Met 3B > 1. Diabetes Aetiology > Flashcards

1. Diabetes Aetiology Flashcards

1
Q

Roughly how many people are diagnosed with Diabetes per year?

A. 3 Million
B. 4.1 Million
C. 5.3 Million
D. 7 Million

A

A. 3 Million

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2
Q

Diabetes accounts for what percentage of adult cases?

A. 3%
B. 4%
C. 5%
D. 6%

A

C. 5 (4.9)%

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3
Q

T2DM Accounts for how many cases in the UK?

A. 55-65%
B. 65-75%
C. 75-85%
D. 85-95%

A

D. 85-95%

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4
Q

What are some “osmotic” symptoms of Diabetes?

A
  1. Polydipsia
  2. Polyuria
  3. Nocturia
  4. Pruritis
  5. Fatigue
  6. Weight Loss
  7. Blurred Vision
  8. UTI/Genitourinary
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5
Q

What are two main ways of diagnosing Diabetes instantly?

A
  1. Incidental Finding

2. Screening someone at high risk

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6
Q

Name two main Acute Emergencies resulting from Diabetes?

A
  1. Hyperosmolar Hyperglycemic Syndrome

2. DKA

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7
Q

What type of complications can Diabetic Patients present with systematically?

A
  1. Skin infections (Staph Skin Abscesses, Oral/Genital Candidiasis)
  2. Foot (Ulcer/Neuropathic Pain)
  3. Eyes (Retinopathy)
  4. Acute MI/Stroke
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8
Q

What are the Main Clinical ways of diagnosing Diabetes?

A
  1. Fasting Plasma Glucose (FPG) [Not Capillary Glucose]
  2. Random Plasma Glucose (RPG)
  3. 75 g Oral Glucose Tolerance Test (OGTT)
  4. HbA1c
  • No symptoms: Needs Two of above or One abnormal OGTT
  • Symptoms: Needs One of above
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9
Q

How is the OGTT done?

A
  1. Patient fasts for 9+ hours
  2. Check their FPG
  3. GIve 75g Glucose (Lucozade)
  4. Check 2 Hour PG
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10
Q

What is the HbA1c test?

A

Measures for Average glucose control over 3 months

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11
Q

What is the normal range for HbA1c?

A

<42 mmol/mol

Though it can vary between individuals depending on Age/Co-morbidities

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12
Q

What is the normal range for HbA1c for those with well controlled Diabetes?

A

<53 mmol/mol

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13
Q

Generally, what is the Glucose levels of a Normal individual undergoing a FPG?

A

<6 mmol/L

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14
Q

Generally, what is the 2 hr PG of a Normal individual undergoing a 2 HR PG?

A

<7.8 mmol/L

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15
Q

Generally, what is the 2 hr PG of a Normal individual undergoing a RPG?

A

<7.8 mmol/L

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16
Q

Generally, what is the Glucose levels of a Diabetic individual undergoing a FPG?

A

> 7 mmol/L

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17
Q

Generally, what is the Glucose levels of a Diabetic individual undergoing a 2 HR PG?

A

> 11.1 mmol/L

18
Q

Generally, what is the Glucose levels of a Diabetic individual undergoing an RPG?

A

> 11.1 mmol/L

19
Q

For those with an impaired Glucose Tolerance (IGT), what is their HbA1c levels?

A

42-47 mmol/mol

20
Q

List 5 differences between T1 and T2DM

A

Type 1 is

  1. Ketosis Prone
  2. Insulin Deficient
  3. Autoimmune (GAD/ICA Abs)
  4. Acute Onset
  5. Non-Obese associated
21
Q

List 5 Secondary Causes of Diabetes

A
  1. Gestational Diabetes
  2. Pancreatic Disease
  3. Endocrine Disease
  4. Genetic Defects of Beta cell function
  5. Genetic Defects of Insulin action
  6. Genetic Syndromes
  7. Infections
  8. Drugs
22
Q

List 5 Diseases of the Exocrine Pancreas

A
  1. Acute/Chronic Pancreatitis
  2. Trauma/Pancreatectomy
  3. Neoplasia
  4. Cystic Fibrosis
  5. Haemochromatosis /Thalassemia (Iron Overload)
  6. Fibrocalculous Pancreatopathy
23
Q

List 6 Endocrine Diseases that could cause Secondary Diabetes

A
  1. Acromegaly
  2. Cushing’s
  3. Conn’s
  4. Phaechromocytoma
  5. Hyperthyroidism
  6. Glucagonoma
24
Q

List 5 Drugs that can induce Diabetes

A
  1. Glucocorticoids
  2. Beta Blockers
  3. Thiazide Diuretics
  4. Tacrolimus
  5. Atypical Antipsychotics
25
Q

How does Tacrolimus cause Diabetes?

A
  1. Used in Transplantation

2. Causes NODAT (New Onset Diabetes after Transplantation)

26
Q

Give three examples of Atypical Antipsychotics that can cause diabetes

A
  1. Olanzapine
  2. Risperidone
  3. Clozapine
27
Q

**Give Four Examples of Genetic Defects of Beta Cell function

A
  1. Chr 20 (HNF-4A)
  2. Chr 7 (Glucokinase)
  3. Chr 12 (HNF-1A)
  4. Mitochondrial DNA
28
Q

Give Four Examples of Genetic Defects in Insulin Action

A
  1. Type A Insulin Resistance
  2. Leprechaunism (Insulin res)
  3. Rabson-Mendenhall Syndrome (Severe insulin res)
  4. Lipoatrophic Diabetes (Lack of adipose and issues with fat/glucose metabolism)
29
Q

Give 10 Examples of Genetic Syndromes associated with Diabetes

A
  1. Down’s
  2. Klinefelter’s
  3. Turner’s
  4. Wolfram’s (DIDMOAD)
  5. Friedrich’s Ataxia
  6. Huntington’s Chorea
  7. Lawrence-Moon-Biedl
  8. Prada Willi
  9. Myotonic Dystrophy
  10. Porphyria
30
Q

What is the acronym for the characteristics of Wolfram’s syndrome?

A

Diabetes Insipidus
Diabetes Mellitus (Childhood-onset)
Optic Atrophy
Deafness

31
Q

What types of infections can cause Diabetes?

A
  1. Congenital Rubella

2. CMV

32
Q

T2DM is described as a Heterogeneous syndrome? What does this mean?

A

It is a condition characterised by multiple aetiologies:

  • Environmental (Obesity)
  • Diabetogenic Genes
33
Q

How does Hyperglycemia exacerbate T2DM?

A
  1. “Glucose Toxicity”
  2. High glucose will impair Beta cell function –> Less insulin
  3. Lowering Glucose can make Beta cells work less hard
34
Q

What is described as a thrifty gene?

A

Genes favouring Fat Storage/Insulin resistance

Helping us in times of famine

35
Q

Is there a link between T2DM and Dementia?

A

Amyloid Peptides can be deposited in the Islets later in the disease

Potentially

36
Q

What criteria are needed to diagnose Metabolic Syndrome?

A
  1. Central Obesity (BMI>30)
  2. Abdo Waist Circum
    (Above 88/102 in Europe)
    (Above 80/90 in South Asia)

PLUS ANY TWO FROM:

  1. Low HDL
  2. High TGs
  3. High BP
  4. High Fasting Glucose
37
Q

Who should be screened for T2DM?

A
  1. Overweight
  2. Family History people
  3. History of Gest. Diabetes
  4. Ethnic Minorities (South Asia/Afro-Carib)
  5. Vascular Disease (CHD, PVD)
  6. Steroid/AntiPsychotic/Transplant patients
  7. Foot ulcers/Candida
38
Q

How is T1DM characterised?

A
  1. Pancreatic Beta Cell Destruction

2. ICA/GAD Antibody positive

39
Q

What is LADA?

A

Latent Autoimmune Diabetes in Adults

  • Non-Acute
  • ICA/GAD +
40
Q

What is the concordance rate of T1DM in Monozygotic Twins?

A

30-50%

41
Q

What are some environmental factors for those with T1DM?

A
  1. Puberty
  2. Seasons
  3. European
  4. 5-7 year peak age of onset
42
Q

What is the Pathogenic Sequence of T1DM?

A
  1. Genetic Susceptibility (HLA genes on Chr6)
  2. Environmental Insults (Cocksackie/Parvovirus)
  3. Insulitis (Infiltration of T-lymphocytes)
  4. Activation of Autoimmunity
  5. Immune attack on Beta Cells (ICA/GAD Abs)
  6. Diabetes Mellitus (90% Beta cell destruction)

Yr3 Met 3B (13 decks)

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