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10. CP - Endocrine System and Disease > (54) Diabetes > Flashcards

(54) Diabetes Flashcards

1
Q

What is diabetes?

A

A syndrome with hyperglycaemia due to various causes, with acute and chronic complications

  • diabetic patients also often have high BP and high cholesterol levels
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2
Q

What is the normal blood glucose level?

A

5mmol/l

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3
Q

How is a steady blood glucose level maintained?

A

By balancing the release of glucose from the liver, diet and exercise

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4
Q

Which hormone controls the release of glucose from the liver?

A

Insulin

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5
Q

What is insulin produced by?

A

The pancreas (beta cells)

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6
Q

What does insulin do?

A
  • promotes the absorption of glucose from the blood to skeletal muscles and fat tissue
  • causes fat to be stored rather than used for energy
  • stimulates formation of glycogen in liver
  • inhibits the production of glucose by the liver
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7
Q

What promotes insulin release?

A

High blood sugar

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8
Q

Where does glucose get turned into glycogen?

A

Liver

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9
Q

What does low blood sugar promote the release of?

A

Glucagon (from the pancreas)

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10
Q

What does glucagon do?

A

Stimulates breakdown of glycogen in the liver to produce glucose and raise blood sugar

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11
Q

What is hypoglycaemia?

A

Low blood glucose (less than 4mmol/l)

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12
Q

What is hyperglycaemia?

A

High blood glucose (greater than 11mmol/l)

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13
Q

What is a syndrome?

A

A collection of symptoms and signs that may be due to more than one cause

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14
Q

What are the symptoms of diabetes?

A
  • thirst
  • polyuria
  • weight loss
  • tiredness
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15
Q

What are the signs of diabetes?

A
  • dry mouth
  • weight loss
  • glycosuria
  • hyperglycaemia
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16
Q

Rise in incidence of diabetes is associated with what?

A

Rise in obesity and reduction in physical activity

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17
Q

There is a high prevalence of diabetes in which ethnic groups?

A
  • Asians

- Afro-Caribbeans

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18
Q

What is the diagnostic criteria for diabetes?

A
  • typical symptoms and high random blood glucose
  • fasting blood glucose over 7mmol/l
  • 75g OGTT
  • HbA1c; 48mmol/mol (6.5%)
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19
Q

What is GTT?

A

Glucose tolerance test

can be oral (OGTT)
or can be IV (IVGTT)

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20
Q

What is the glucose tolerance test?

A

A medical test in which glucose is given and blood samples taken afterward to determine how quickly it is cleared from the blood (blood glucose measures while fasting and at intervals)

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21
Q

What is the normal vs. diabetic fasting glucose levels?

A

Normal = less than 6mmol/l

Diabetic = more than 7mmol/l

22
Q

What is the diabetic 2-hour post-glucose load glucose levels?

A

Over 11mmol/l

23
Q

How is ‘borderline diabetes’ diagnosed?

A
  • impaired fasting glucose (6-7mmol/l)
  • impaired glucose tolerance (2 hour glucose levels of 7.8-11mmol/l)
  • 140-199mg/gl on 75g OGTT
24
Q

What investigations are done into diabetes?

A
  • HbA1c
  • renal function
  • liver function
  • lipids
  • thyroid function
25
Q

What is HbA1c?

A

Glycated haemoglobin

26
Q

What is HbA1c measured for?

A

To identify the three month average plasma glucose concentration

  • a test for diabetes diagnosis and assessing the degree of glycaemic control
27
Q

What is the lifespan of a red blood cell?

A

3 months

28
Q

What is type 1 diabetes?

A

Autoimmune destruction of the insulin-producing islet beta cells of the pancreas

  • usually young but can be any age
  • often other endocrine disorders in patient or family
29
Q

What is type 1 diabetes also called?

A

Insulin dependent

since they are insulin deficient

30
Q

What autoantibody tests are done in type 1 diabetes?

A
  • ICA
  • IA2
  • GAD
31
Q

What do you see on histology in type 1 diabetes?

A

Lymphocytic infiltration of the islets of Langerhans (insulitis)

32
Q

What is LADA?

A

Latent autoimmune diabetes in adults

  • presents often as type 2 diabetes
  • progressive deterioration in control, increasing therapy
33
Q

Who does LADA affect?

A

Older patients, often female

34
Q

Patients with LADA often have a medical or family history of which conditions?

A
  • type 1 diabetes
  • thyroid
  • pernicious anaemia
  • Addison’s
  • coeliac
  • vitiligo
35
Q

Which autoantibodies are tested for in LADA?

A
  • GAD
  • ICA
  • tTG
  • TPO
36
Q

Describe the main feature s of type 2 diabetes

A
  • insulin resistant/deficient
  • not absolutely insulin dependent
  • strong family history
  • often obese or overweight
  • usually hypertensive and hyperlipidaemia
37
Q

Name a type 2 diabetes variant

A

Ketosis-prone type 2

38
Q

Describe the main features of ketosis-prone type 2 diabetes

A
  • often obese, ethnic minority
  • ketosis when physically stressed with intercurrent illness
  • temporarily requires insulin
  • not insulin dependent
39
Q

What is ketosis?

A

Metabolic state in which most of the body’s energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis in which blood glucose provides most of the energy

40
Q

Describe the relationship between BMI and risk of diabetes

A

As BMI increases, risk of diabetes increases

higher risk in women than men

41
Q

Diabetets may be secondary to pancreatic disorders such as…

A
  • chronic/acute pancreatitis
  • calcific, tropical pancreatitis
  • pancreatectomy
  • pancreatic cancer
  • cystic fibrosis
  • haemochromatosis
42
Q

What is haemochromatosis?

A

Inherited disorder in which iron levels in the body slowly build up over many years (iron overload storage disorder)

43
Q

Which drugs can induce diabetes?

A
  • diuretics
  • steroids
  • antipsychotics eg. olanzapine
  • psychiatric drugs (weight gain)
44
Q

Which endocrine disorders can lead to diabetes?

A
  • acromegaly
  • Cushing’s syndrome
  • phaeochromocytoma
45
Q

What is acromegaly?

A

High growth hormone levels - can cause diabetes

46
Q

What is Cushing’s syndrome?

A

High cortisol levels - can cause diabetes

47
Q

What is phaeochromocytoma?

A

A neuroendocrine tumor of the medulla of the adrenal glands that secretes high amounts of catecholamines, mostly norepinephrine, plus epinephrine to a lesser extent

48
Q

Name some ethnic variants of diabetes

A
  • J type diabetes (Jamaican diabetes, Afro-Caribbeans)
  • flatbush diabetes (US Afro-Americans)
  • MRDM (malnutrition-related diabetes, tropical diabetes)
  • Z type diabetes
  • chronic calcific pancreatitis (secondary diabetes)
49
Q

Describe the main features of J type Jamaican diabetes

A
  • ketosis prone
  • not particularly obese
  • on and off insulin therapy
  • variable insulin requirements
  • also called flatbush diabetes
50
Q

What are the features of gestational diabetes?

A
  • diabetes appears during pregnancy and resolves after pregnancy
  • at risk of diabetes in later pregnancy and in future
51
Q

Name 2 diabetes sydnromes

A
  • Friedreich’s ataxia

- dystrophia myotonica

52
Q

What are the features of MODY (maturity onset diabetes in the young)?

A
  • autosomal dominant pattern
  • 1-2% of diabetic cases
  • onset under 25
  • insulin not required initially
  • glucokinase, HNF 1A, HNF 4A

10. CP - Endocrine System and Disease (5 decks)

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