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Endocrine > Diabetes 1 > Flashcards

Diabetes 1 Flashcards

1
Q

Why does diabetes develop?

A

Insufficient insulin to maintain glucose homeostasis

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2
Q

What type of DM has an absolute insulin deficiency?

A

T1DM

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3
Q

What type of DM has a relative insulin deficiency, which may be inadequate insulin production/secretion and/or insulin resistance?

A

T2DM

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4
Q

What type of diabetes has a failure of synthesis, release or activity?

A

MODY

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5
Q

What is a general definition of DM?

A

A group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both

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6
Q

What level of HbA1c is considered diagnostic of diabetes?

A

> =48m/m

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7
Q

What level of fasting glucose is considered diagnostic of diabetes?

A

> =7.0mmol/l

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8
Q

What level of 2 hr glucose in OGTT is considered diagnostic of diabetes?

A

> =11.1mmol/l

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9
Q

What level of random glucose is considered diagnostic of diabetes?

A

> =11.1mmol/l

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10
Q

How is T1DM defined?

A

Pancreatic beta cell destruction-insulin required for survival. Usually characterized by the presence of anti-GAD/anti-islet cell antibodies

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11
Q

What is insulitis?

A

Disease of the pancreas caused by lymphocytic infiltrate

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12
Q

What is the clinical presentation of T1DM?

A

Pre-school+ peri puberty, small peak late 30s, lean, acute, severe symptoms/wt loss, ketonuria +-met acidosis, no evidence of microvascular disease at dx, immediate+permanent need for insulin

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13
Q

What is the clinical presentation of T2DM?

A

Middle aged/elderly, usually obese, pre-diagnosis duration 6-10y, insidious onset wks/ys, ketonuria minimal/absent, evidence of microvascular disease in 20%, managed initially diet + tablets

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14
Q

What are risk factors for T2DM?

A

Obesity, FHx, gestational diabetes, age, ethnicity (Asian/Africa/afro-Caribbean), PMHx MI/Stroke, meds- e.g. antipsychotics, IGT/IFG

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15
Q

What is the overall presentation of DM?

A

Thirst, polyuria, thrush, weakness fatigue, blurred vision, wt loss, T2DM-complications: neuro/retinopathy

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16
Q

What are useful discriminatory tests in DM?

A

GAD/Anti-islet cell antibodies, ketones, c-peptide

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17
Q

What is LADA?

A

Latent AI Diabetes of Adulthood- may present as T2DM but lack age, obesity, difficulty in achieving glycaemic control using standard agents. More typical of immune markers common to T1DM

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18
Q

What pancreatic diseases can lead to Type 3 Diabetes?

A

Chronic/recurrent pancreatitis, haemochromatosis, CF

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19
Q

What endocrine diseases can lead to Type 3 Diabetes?

A

Cushing’s, Acromegaly, phaechromocytoma, glucagonoma

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20
Q

What drugs can lead to Type 3 Diabetes?

A

Glucocorticoids, diuretics, B-blockers

21
Q

What abnormalities of insulin and its receptor, thusly genetic disease, can lead to T3DM?

A

CF, myotonic dystrophy, Turner’s syndrome

22
Q

What should you look for in monogenic diabetes?

A

Strong FHx, associated features (renal cysts etc), young onset, GAD-negative, C-peptide +ve

23
Q

What is T4DM (Gestational Diabetes)?

A

Any degree of glucose intolerance arising or diagnosed during pregnancy

24
Q

What does HbA1c mean?

A

Provides a measure of glucose control over past 2-3 months

25
Q

What complications can occur in DM?

A

Macro-vascular-heart disease and stroke, micro-vascular-retino/nephro/neuropathy, psych complications

26
Q

What will be seen histologically in T1DM in islet cells?

A

Lymphocytes attacking the islet

27
Q

What will be seen histologically in T2DM in islet cells?

A

Amyloids

28
Q

What familial risk of T1DM do HLA genes represent?

A

50%

29
Q

What can be some triggers of T1DM?

A

Viral infection, maternal factors, weight gain

30
Q

What is the antibody, function, % at dx, age relation and genger relation of glutamic acid decarboxylase?

A

GAD 65b, GABA Production, 70-80%, increases with age, female

31
Q

What is the antibody, function, % at dx, age relation and genger relation of islet-antigen 2?

A

IA-2Ab, unknown function, 60-70%, decreases with age, male

32
Q

What is the antibody, function, % at dx, age relation and genger relation of insulin?

A

IAA, regulates glucose, 50%, better in children, similar

33
Q

What is the antibody, function, % at dx, age relation and genger relation of ZnT8 transporter?

A

ZnT8Ab, Zn function in B cells, 60-80%, better in older, similar

34
Q

What are the maternal risk factors associated with diabetes in foetal life?

A

Infection, age, ABO mismatch, birth order, stress

35
Q

What are the genetic disease markers for diabetes in foetal life?

A

HLA, non-HLA

36
Q

What are the AI trigger factors in Pre-Diabetic individuals?

A

Viral infection, vit D deficiency, dietary factors, environmental toxins

37
Q

What are the AI disease markers in Pre-Diabetics?

A

Autoantibodies- GAD 65, IAA and IA2, ZnT8, Candidate Antigens, Insulitis

38
Q

What are the accelerating factors for in already diagnosed diabetics?

A

Infection, insulin resistance, puberty, diet/weight, stress

39
Q

What are the disease markers in diabetics?

A

Raised glucose, ketones, decreased insulin, decreased B cell mass, decreased C-peptide

40
Q

What are the typical presenting symptoms of T1DM?

A

Polyuria (enuresis in children), polydipsia, wt loss, fatigue and somnolence, blurred vision, candidal infection(pruritis vulvae, balantis), DKA

41
Q

What is the management of a newly diagnosed T1DM patient?

A

Blood glucose/ketone monitoring, insulin: usually basal bolus regimen, carb estimation, regular DSN and dietitian contact, appropriate medical clinic review, check of glycaemic control, annual review, record episodes

42
Q

What will be contained within the annual review assessment of a newly diagnosed T2DM patient?

A

Wt, BP, bloods: HbA1c, Renal function and Lipids, Retinal Screening, Foot risk Assessment

43
Q

What insulin is recommend in adults with T1DM who are experiencing severe or nocturnal hypoglycaemia and who are using an intensified insulin regimen?

A

Basal insulin analogues

44
Q

Into what vein does insulin secrete?

A

Portal vein

45
Q

How is a diagnosis of LADA made?

A

The presence of elevated levels of pancreatic auto-antibodies in patients with recently diagnosed diabetes who do not initially require insulin

46
Q

When should you suspect LADA?

A

Young adults 25-40, male, non-obese, auto-ab +ve, associated AI conditions, non-insulin requiring at diagnosis, sub-optimal control on oral agents

47
Q

What therapy is preferred in a CF patient who develops 2’ diabetes?

A

Insulin therapy

48
Q

From when is screening with OGTT recommended in CF patients?

A

From 10yo

Endocrine (14 decks)

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