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MD4001 Pathology > Clinical Aspects of Diabetes > Flashcards

Clinical Aspects of Diabetes Flashcards

1
Q

What indicates diabetes / how can diabetes be diagnosed?

A
  • Glycated Haemoglobin > 48 mmol/mol
  • Fasting blood glucose > 7 mmol/l
  • 2 hour blood glucose > 11.1 mmol/l following OGTT
  • Random blood glucose > 11.1 mmol/l in presence of symptoms
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2
Q

What can type 2 diabetes be classified into?

A
  • Insulin resistance with relative insulin deficiency

- Secretory defect with insulin resistance

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3
Q

What are other types of diabetes? (outside of type 1 and 2)

A
  • Genetic (MODY etc)
  • Pancreatic disease (alcohol, gallstones)
  • Endocrine disease (acromegaly)
  • Drugs
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4
Q

What percentage of diabetes patients are not type 1 or 2?

A

~ 5%

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5
Q

What is gestational diabetes?

A

Feto-placental unit tries to push glucose towards baby - mother is relatively insulin resistant so glucose moves towards baby

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6
Q

What do black dots represent on B-cell histology?

A

Lymphocytes

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7
Q

What autoantibodies are involved in diabetes?

A
  • Iselt cell
  • Insulin
  • GAD (GAD65)
  • Tyrosine phsophatases
  • Positive in 85-90%
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8
Q

What does GAD stand for?

A

Glutamic acid decarboxylase

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9
Q

What genes is HLA associated with in the development of type 1 diabetes?

A
  • DQA and DQB genes

- Influenced by the DRB genes

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10
Q

How do patients monitor blood glucose?

A

Capillary blood glucose

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11
Q

What is a “basal bolus” regime?

A
  • Bolus of long-acting insulin taken once a day (usually night time) adjusted nased on morning blood sugar
  • Then vary amount of insulin given before main meals based on pre-test blood sugar
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12
Q

What is CS 2?

A
  • Pump therapy

- Continous subcutaneous infusion of insulin therapy - permenant glucose monitor measures blood glucose

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13
Q

What genetic factors lead to type 2 diabetes?

A
  • Defect of Beta cell

- Insulin resistance

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14
Q

What environmental factors lead to type 2 diabetes?

A
  • Obesity
  • Stress
  • Reduced physical activity
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15
Q

How can type 2 diabetes classically present itself?

A
  • Thirst, polyuria
  • Malaise, fatigue
  • Infections (e.g candidiasis)
  • Blurred vision
  • Complications
  • Incidental finding
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16
Q

What type of drug is metformin?

A

Biguanide

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17
Q

What are examples of sulphonylureas?

A
  • Chlorpropamide
  • Glipizide
  • Gliclazide
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18
Q

What are the acute complications of diabetes mellitus?

A
  • Diabetic ketoacidosis
  • Hypoglycaemia
  • Other emergencies
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19
Q

What are the chronic complications of diabetes mellitus?

A 
Microvascular
- Eyes
- Kidneys 
- Nerves (feet)
Macrovascular 
- Hear 
- Brain 
- Feet
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20
Q

What does low Na+, low bicarbonate and high glucose indicate on a blood sample in a ward?

A

Diabetic ketoacidosis

21
Q

What are the clinical features of diabetic Ketoacidosis?

A 
Hyperglycaemia 
- dehydration 
- Tachycardia 
- Hypotension 
- Clouding of consciousness
Acidosis 
- Kussmaul's respiration 
- Acetone on breath 
- Abdominal pain 
- Vomitting 
SEPSIS?
22
Q

How does the body create ketones?

A

Amino acids (leucine, lysine) and adipose tissue (free fatty acids) liver breaks down into ketones

23
Q

What are examples of ketone bodies in the blood whcih the liver has created?

A
  • Acetoacetate (acetone + carboxyl group)
  • 3 Beta - Hydroxybutyrate
  • Acetone
    They are organic acids
24
Q

What electrolyte loss is most concerning in ketoacidosis?

A

K+ (200-700 mmol loss) can lead to arrhythmias and death

25
Q

How many litres of water can be lost in diabetic ketoacidosis?

A

5 - 10 litres

26
Q

What ketone levels are worrying?

A

Anything above 1 mmol/L

27
Q

How is DKA treated?

A
  • Insulin IV 6U/hour then by sliding scale
  • IV sailine (4-6 L)
  • Dextrose subsequently to replace water loss
  • K+ monitored and replaced as required
28
Q

What are symptoms of hypoglycemia?

A 
Adrenergic
- Tachycardia 
- Palpitations 
- Sweating 
- Tremor
- Hunger 
Neuroglycopaenic 
- Dizziness 
- Confusion 
- Sleepiness 
- Coma 
- Seizure
29
Q

What are neuroglycopaenic symptoms of hypoglycemia?

A

Lack of glucose to brain

30
Q

What are the causes of hypoglycaemia?

A
  • Too much insulin
  • Too little food
  • Unusual exercise
31
Q

What is the formal definition of hypoglycemia?

A

Blood glucose <= 2.2 mmol/l

32
Q

What blood glucose is considered low?

A

4 mmol/L

- Aim to keep blood glucose above 4

33
Q

What mechanisms cause an increase in blood glucose in response to hypoglycaemia?

A

Parasympathetic glucagon release and sympathetic adrenaline release whcih both stimulate glycogen release by the liver

34
Q

How is hypoglycaemia treated?

A
  • IV 50% dextrose (by expert, can cause sclerosis in subcutaneous tissue)
  • Glucogel
35
Q

What other emergencies other than DKA and hypoglycaemia are involved with diabetes mellitus?

A
  • HyperOsmolar Hyperglycemic state or Hyper osmolar Non-Ketonic coma (HONK)
  • Metformin Associated Lactic Acidosis (MALA)
36
Q

What is HyperOsmolar Hyperglycemic state (HONK)?

A

Enough insulin to produce ketones but not enough to stop them becomeing hypoglycaemic (become dehydrated)
- Elderly patients (MI and Chest infection associated)

37
Q

What does Metformin Associated Lactic Acidosis (MALA) cause?

A
  • Have renal impairment

- Metformin builds up and uncouples mitochondria causes build up of lactic acid

38
Q

When should metformin be avoided?

A

In patients with kidney disease (can cause MALA

39
Q

What is glycation?

A
  • Non-enzymatic binding of glucose to proteins (can cause rearrangement and cross linking, proteins become stick and brown)
  • Amadori rearrangement
  • Schiff base
  • Ketoamine
  • 5_hydroxy-methylfurfural
40
Q

What is a classic nephropathy as a result of diabetes?

A

Kimmelsteil-Wilson lesion

41
Q

Kimmelsteil-Wilson lesion on histology

A

Extra purpal staining

42
Q

What are the different stages of nephropathy?

A
  • Hyperfiltration
  • Normal
  • Microalbinuria
  • Overt Nephropathy
  • Chronic renal failure
43
Q

How is nephropathy managed?

A
  • Screening (albustix, microalbinuria, creatinine)
  • BP (ACEi, ARBs) (130/80 or lower)
  • Hyperlipidaemia (statins)
  • Good glycaemic control
  • Diet
44
Q

How does diabetes effect nerves?

A

Lumen more closed over ischaemic nerve

45
Q

What should be examined on the foot?

A
  • General appearence
  • Architecture
  • Pulses
  • Sensation (monofilament, neurosthesiometer)
46
Q

How is diabetic retinopathy managed?

A
  • Screening (once a year)
  • Opthalmascope or retinal camera
  • Blindess audit
47
Q

What is maculopathy?

A

Protein and fat deposition around macula (migrates on to macula causing loss of fine vision and vision)

48
Q

How is diabetic maculopathy treated?

A
  • Periphery of retina burned with laser reducing ischaemic area
  • Preserves macula vision
49
Q

What does a pre-retinal haemorrhage look like?

A

Huge black area on retina

MD4001 Pathology (18 decks)

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