1. Diabetes Aetiology Flashcards
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. 3 Million
Diabetes accounts for what percentage of adult cases?
A. 3%
B. 4%
C. 5%
D. 6%
C. 5 (4.9)%
T2DM Accounts for how many cases in the UK?
A. 55-65%
B. 65-75%
C. 75-85%
D. 85-95%
D. 85-95%
What are some “osmotic” symptoms of Diabetes?
- Polydipsia
- Polyuria
- Nocturia
- Pruritis
- Fatigue
- Weight Loss
- Blurred Vision
- UTI/Genitourinary
What are two main ways of diagnosing Diabetes instantly?
- Incidental Finding
2. Screening someone at high risk
Name two main Acute Emergencies resulting from Diabetes?
- Hyperosmolar Hyperglycemic Syndrome
2. DKA
What type of complications can Diabetic Patients present with systematically?
- Skin infections (Staph Skin Abscesses, Oral/Genital Candidiasis)
- Foot (Ulcer/Neuropathic Pain)
- Eyes (Retinopathy)
- Acute MI/Stroke
What are the Main Clinical ways of diagnosing Diabetes?
- Fasting Plasma Glucose (FPG) [Not Capillary Glucose]
- Random Plasma Glucose (RPG)
- 75 g Oral Glucose Tolerance Test (OGTT)
- HbA1c
- No symptoms: Needs Two of above or One abnormal OGTT
- Symptoms: Needs One of above
How is the OGTT done?
- Patient fasts for 9+ hours
- Check their FPG
- GIve 75g Glucose (Lucozade)
- Check 2 Hour PG
What is the HbA1c test?
Measures for Average glucose control over 3 months
What is the normal range for HbA1c?
<42 mmol/mol
Though it can vary between individuals depending on Age/Co-morbidities
What is the normal range for HbA1c for those with well controlled Diabetes?
<53 mmol/mol
Generally, what is the Glucose levels of a Normal individual undergoing a FPG?
<6 mmol/L
Generally, what is the 2 hr PG of a Normal individual undergoing a 2 HR PG?
<7.8 mmol/L
Generally, what is the 2 hr PG of a Normal individual undergoing a RPG?
<7.8 mmol/L
Generally, what is the Glucose levels of a Diabetic individual undergoing a FPG?
> 7 mmol/L
Generally, what is the Glucose levels of a Diabetic individual undergoing a 2 HR PG?
> 11.1 mmol/L
Generally, what is the Glucose levels of a Diabetic individual undergoing an RPG?
> 11.1 mmol/L
For those with an impaired Glucose Tolerance (IGT), what is their HbA1c levels?
42-47 mmol/mol
List 5 differences between T1 and T2DM
Type 1 is
- Ketosis Prone
- Insulin Deficient
- Autoimmune (GAD/ICA Abs)
- Acute Onset
- Non-Obese associated
List 5 Secondary Causes of Diabetes
- Gestational Diabetes
- Pancreatic Disease
- Endocrine Disease
- Genetic Defects of Beta cell function
- Genetic Defects of Insulin action
- Genetic Syndromes
- Infections
- Drugs
List 5 Diseases of the Exocrine Pancreas
- Acute/Chronic Pancreatitis
- Trauma/Pancreatectomy
- Neoplasia
- Cystic Fibrosis
- Haemochromatosis /Thalassemia (Iron Overload)
- Fibrocalculous Pancreatopathy
List 6 Endocrine Diseases that could cause Secondary Diabetes
- Acromegaly
- Cushing’s
- Conn’s
- Phaechromocytoma
- Hyperthyroidism
- Glucagonoma
List 5 Drugs that can induce Diabetes
- Glucocorticoids
- Beta Blockers
- Thiazide Diuretics
- Tacrolimus
- Atypical Antipsychotics
How does Tacrolimus cause Diabetes?
- Used in Transplantation
2. Causes NODAT (New Onset Diabetes after Transplantation)
Give three examples of Atypical Antipsychotics that can cause diabetes
- Olanzapine
- Risperidone
- Clozapine
**Give Four Examples of Genetic Defects of Beta Cell function
- Chr 20 (HNF-4A)
- Chr 7 (Glucokinase)
- Chr 12 (HNF-1A)
- Mitochondrial DNA
Give Four Examples of Genetic Defects in Insulin Action
- Type A Insulin Resistance
- Leprechaunism (Insulin res)
- Rabson-Mendenhall Syndrome (Severe insulin res)
- Lipoatrophic Diabetes (Lack of adipose and issues with fat/glucose metabolism)
Give 10 Examples of Genetic Syndromes associated with Diabetes
- Down’s
- Klinefelter’s
- Turner’s
- Wolfram’s (DIDMOAD)
- Friedrich’s Ataxia
- Huntington’s Chorea
- Lawrence-Moon-Biedl
- Prada Willi
- Myotonic Dystrophy
- Porphyria
What is the acronym for the characteristics of Wolfram’s syndrome?
Diabetes Insipidus
Diabetes Mellitus (Childhood-onset)
Optic Atrophy
Deafness
What types of infections can cause Diabetes?
- Congenital Rubella
2. CMV
T2DM is described as a Heterogeneous syndrome? What does this mean?
It is a condition characterised by multiple aetiologies:
- Environmental (Obesity)
- Diabetogenic Genes
How does Hyperglycemia exacerbate T2DM?
- “Glucose Toxicity”
- High glucose will impair Beta cell function –> Less insulin
- Lowering Glucose can make Beta cells work less hard
What is described as a thrifty gene?
Genes favouring Fat Storage/Insulin resistance
Helping us in times of famine
Is there a link between T2DM and Dementia?
Amyloid Peptides can be deposited in the Islets later in the disease
Potentially
What criteria are needed to diagnose Metabolic Syndrome?
- Central Obesity (BMI>30)
- Abdo Waist Circum
(Above 88/102 in Europe)
(Above 80/90 in South Asia)
PLUS ANY TWO FROM:
- Low HDL
- High TGs
- High BP
- High Fasting Glucose
Who should be screened for T2DM?
- Overweight
- Family History people
- History of Gest. Diabetes
- Ethnic Minorities (South Asia/Afro-Carib)
- Vascular Disease (CHD, PVD)
- Steroid/AntiPsychotic/Transplant patients
- Foot ulcers/Candida
How is T1DM characterised?
- Pancreatic Beta Cell Destruction
2. ICA/GAD Antibody positive
What is LADA?
Latent Autoimmune Diabetes in Adults
- Non-Acute
- ICA/GAD +
What is the concordance rate of T1DM in Monozygotic Twins?
30-50%
What are some environmental factors for those with T1DM?
- Puberty
- Seasons
- European
- 5-7 year peak age of onset
What is the Pathogenic Sequence of T1DM?
- Genetic Susceptibility (HLA genes on Chr6)
- Environmental Insults (Cocksackie/Parvovirus)
- Insulitis (Infiltration of T-lymphocytes)
- Activation of Autoimmunity
- Immune attack on Beta Cells (ICA/GAD Abs)
- Diabetes Mellitus (90% Beta cell destruction)
