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Week 9 - Phase 3 > Classifications and Causes of Diabetes > Flashcards

Classifications and Causes of Diabetes Flashcards

1
Q

What is the definition of DM?

A

A metabolic disorder of multiple aetiology characterized by chronic hyperglycemia with disturbances of carbohydrate, protein and fat metabolism resulting from defects in insulin secretion, insulin action or both.

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2
Q

What are the symptoms of Hyperglycaemia?

A

Glycosuria depleting energy stores
- tried, weak, weight loss, poor concentration, irritability.

Glycosuria causing Osmotic Diuresis
- Polyuria, polydipsia, thirst, dry mucous membranes, reduced skin turgor, postural hypotension.

Glucose shifts - swollen ocular lenses
- Blurred vision.

Ketone Production
- Nausea, vomiting, abdominal pain, heavy rapid breathing, acetone breath, drowsiness, coma.

Depletion of energy stores (i.e. muscle)
- weakness, polyphagia, weight loss, growth retardation in the young.

Complications (T2DM)
- Macrovascular, microvascular, neuropathy, infection.

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3
Q

How is diabetes diagnosed?

A

One abnormal valve is diagnosed if symptomatic.
Two abnormal values if diagnostic if asymptomatic.

Fasting plasma glucose of >7.0mmol/L
2 hour plasma glucose of >11.1
Random plasma glucose of >11.1mmol/L
HbA1c 6.5% pr 48mmol/mol

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4
Q

How do T1DM and T2DM differ by definition?

A

T1: Immunopathogensis with severe insulin deficiency.

T2: Combo of insulin resistance and insulin deficiency.

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5
Q

What age group is normally diagnosed with T1/T2DM?

A

T1: <30
T2:>30

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6
Q

What weight are people with T1/T2 diabetes?

A

T1: Lean
T2: Overweight

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7
Q

What ethnicites are more susceptible to T1/T2DM?

A

T1: Northern European
T2: Asian, African, Polynesian and American Indian.

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8
Q

Which type of diabetes has a seasonal onset?

A

T1

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9
Q

Which genes are involved in T1DM?

A

HLA DR3 or HLA DR4

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10
Q

Which type of diabetes can result in ketonuria/ketonemia?

A

T1

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11
Q

Describe C-Peptide blood tests in T1/T2DM?

A

T1: C-peptide is negative
T2: Positive.

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12
Q

What should ketone level in the blood normally be?

A

Below 0.6mmol/L

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13
Q

What is the range for ketones in the blood that is abnormal but not DKA?

A

0.6-1.5mmol/L.

May require medical assistance, call healthcare team.

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14
Q

What valve of ketones in the blood indicates DKA?

A

Above 1.5mmol/L

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15
Q

What can be measured as markers of the immune process associated with T1DM?

A

Islet autoantibodies.

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16
Q

What are the most common islet autoantibodies measured?

A

Glutamic acid decarboxylase (GAD)

Insulinoma-associated antigen-2 (IA2).

17
Q

Why is measuring C-peptide useful?

A

It is secreted in equimolar concentrations to insulin, so is a useful marker of endogenous insulin secretion.

18
Q

When is c-peptide most useful?

A

3-5 years from diagnosis.

19
Q

When is autoantibody testing most useful?

A

3-5 years from diagnosis.

20
Q

How can C-peptide be measured?

A

Blood

Urine (Urine C peptide:creatinine ratio).

21
Q

What % of all DM is T1DM?

A

5%

22
Q

Define T1DM?

A

Chronic, progressive metabolic disorder characterized by hyperglycemia and the absence of insulin secretion.
It results in autoimmune destruction of the insulin-producing B cells in the islets of langerhans.
Occurs in genetically susceptible subjects and is probably triggered by one or more environmental agents.

23
Q

Describe the disease progression of T1DM?

A

Start with a genetic susceptibility.
Immune activation can occur due to something environmental e.g. an infection, and B cells are attacked.
There is an immune response and development of a single autoantibody.
Stage 1: Normal blood sugar, >2 autoantibodies, start of T1DM.
Stage 2: Abnormal blood sugar, >2 autoantibodies.
Stage 3: Clinical diagnosis, glucose rises and you get symptoms, >2 autoantibodies.
Stage 4: Long standing T1DM.

24
Q

What environmental factors could pre-dispose to T1DM?

A
  • Viral infections: e.g. enterovirus.
  • Immunisations
  • Diet: especially exposure to cows milk at an early age.
  • Higher socio-economic status.
  • Obesity
  • Vitamin D deficiency
  • Perinatal factors: maternal age, history of pre-eclampsia, neonatal jaundice and low birth weight.
25
Q

What is the lifetime risk of someone developing T1DM with no family history?

A

0.4%

26
Q

What is the lifetime risk of someone developing T1DM if their mother has it? Father has it? Both parents have it?

A

Mother: 1-4%
Father: 3-8%
Both: 30%

27
Q

What is the lifetime risk of developing T1DM if a sibling has it? Dyzygotic twin? Monozygotic twin?

A

Sibling: 3-6%
Dizygotic twin: 8%
Monozygotic twin: 30% within 10 years of each other.

28
Q

What % of DM is T2DM?

A

90%

29
Q

Define T2DM?

A

Chronic, progressive metabolic disorder characterized by hyperglycemia, insulin resistance and relative insulin deficiency.
Common, with a prevalence that rises markedly with increasing levels of obesity.
Most likely arises through a complex interaction among many genes and environmental factors.

30
Q

What is MODY?

A

DM caused by a change in a single gene (monogenic).

31
Q

Describe inheritance in MODY?

A

Autosomal dominant so 50% chance of inheritance.

32
Q

What is the most comely involved gene in MODY?

A

HNF1-alpha

33
Q

What is the prevalence of MODY?

A

1-2% of DM (often unrecognized)

34
Q

What are the main features of MODY?

A

Often <25 yo onset
Runs in families
Managed by diet, Oral agents and insulin.

35
Q

What is gestational diabetes?

A

Carbohydrate intolerance resulting in hyperglycemia, with onset, or diagnosis during pregnancy.

36
Q

What risk factors are there for GDM?

A
  • high BMI
  • previous macroscopic baby or gestational diabetes
  • family history or diabetes
  • ethnic prevalence of DM
37
Q

How is GDM tested for?

A

All women with risk factors should have an OGTT at 24-28 weeks.

Using 75g oral glucose:

  • Fasting venous plasma glucose: >5.1mmol/L
  • One hour value: >10mmol/L
  • 2 hour value: >8.5mmol/L
38
Q

List causes of secondary diabetes?

A
  • Genetic defects of B cell function.
  • Genetic defect in insulin action.
  • Disease of exocrine pancreas: pancreatitis, carcinoma
  • Endocrinopathies: Acromegaly, bushings, phaeochromocytoma.
  • Immunosuppressive agents: Glucocorticoids.
  • Anti-psychotics: Olanzipine.
  • Genetic syndromes associated with DM: Downs syndrome, Turners, Myotonic dystrophy, Kleinfelters.

Week 9 - Phase 3 (8 decks)

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