Diabetes 1 Flashcards
Why does diabetes develop?
Insufficient insulin to maintain glucose homeostasis
What type of DM has an absolute insulin deficiency?
T1DM
What type of DM has a relative insulin deficiency, which may be inadequate insulin production/secretion and/or insulin resistance?
T2DM
What type of diabetes has a failure of synthesis, release or activity?
MODY
What is a general definition of DM?
A group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both
What level of HbA1c is considered diagnostic of diabetes?
> =48m/m
What level of fasting glucose is considered diagnostic of diabetes?
> =7.0mmol/l
What level of 2 hr glucose in OGTT is considered diagnostic of diabetes?
> =11.1mmol/l
What level of random glucose is considered diagnostic of diabetes?
> =11.1mmol/l
How is T1DM defined?
Pancreatic beta cell destruction-insulin required for survival. Usually characterized by the presence of anti-GAD/anti-islet cell antibodies
What is insulitis?
Disease of the pancreas caused by lymphocytic infiltrate
What is the clinical presentation of T1DM?
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
What is the clinical presentation of T2DM?
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
What are risk factors for T2DM?
Obesity, FHx, gestational diabetes, age, ethnicity (Asian/Africa/afro-Caribbean), PMHx MI/Stroke, meds- e.g. antipsychotics, IGT/IFG
What is the overall presentation of DM?
Thirst, polyuria, thrush, weakness fatigue, blurred vision, wt loss, T2DM-complications: neuro/retinopathy
What are useful discriminatory tests in DM?
GAD/Anti-islet cell antibodies, ketones, c-peptide
What is LADA?
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
What pancreatic diseases can lead to Type 3 Diabetes?
Chronic/recurrent pancreatitis, haemochromatosis, CF
What endocrine diseases can lead to Type 3 Diabetes?
Cushing’s, Acromegaly, phaechromocytoma, glucagonoma
What drugs can lead to Type 3 Diabetes?
Glucocorticoids, diuretics, B-blockers
What abnormalities of insulin and its receptor, thusly genetic disease, can lead to T3DM?
CF, myotonic dystrophy, Turner’s syndrome
What should you look for in monogenic diabetes?
Strong FHx, associated features (renal cysts etc), young onset, GAD-negative, C-peptide +ve
What is T4DM (Gestational Diabetes)?
Any degree of glucose intolerance arising or diagnosed during pregnancy
What does HbA1c mean?
Provides a measure of glucose control over past 2-3 months
What complications can occur in DM?
Macro-vascular-heart disease and stroke, micro-vascular-retino/nephro/neuropathy, psych complications
What will be seen histologically in T1DM in islet cells?
Lymphocytes attacking the islet
What will be seen histologically in T2DM in islet cells?
Amyloids
What familial risk of T1DM do HLA genes represent?
50%
What can be some triggers of T1DM?
Viral infection, maternal factors, weight gain
What is the antibody, function, % at dx, age relation and genger relation of glutamic acid decarboxylase?
GAD 65b, GABA Production, 70-80%, increases with age, female
What is the antibody, function, % at dx, age relation and genger relation of islet-antigen 2?
IA-2Ab, unknown function, 60-70%, decreases with age, male
What is the antibody, function, % at dx, age relation and genger relation of insulin?
IAA, regulates glucose, 50%, better in children, similar
What is the antibody, function, % at dx, age relation and genger relation of ZnT8 transporter?
ZnT8Ab, Zn function in B cells, 60-80%, better in older, similar
What are the maternal risk factors associated with diabetes in foetal life?
Infection, age, ABO mismatch, birth order, stress
What are the genetic disease markers for diabetes in foetal life?
HLA, non-HLA
What are the AI trigger factors in Pre-Diabetic individuals?
Viral infection, vit D deficiency, dietary factors, environmental toxins
What are the AI disease markers in Pre-Diabetics?
Autoantibodies- GAD 65, IAA and IA2, ZnT8, Candidate Antigens, Insulitis
What are the accelerating factors for in already diagnosed diabetics?
Infection, insulin resistance, puberty, diet/weight, stress
What are the disease markers in diabetics?
Raised glucose, ketones, decreased insulin, decreased B cell mass, decreased C-peptide
What are the typical presenting symptoms of T1DM?
Polyuria (enuresis in children), polydipsia, wt loss, fatigue and somnolence, blurred vision, candidal infection(pruritis vulvae, balantis), DKA
What is the management of a newly diagnosed T1DM patient?
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
What will be contained within the annual review assessment of a newly diagnosed T2DM patient?
Wt, BP, bloods: HbA1c, Renal function and Lipids, Retinal Screening, Foot risk Assessment
What insulin is recommend in adults with T1DM who are experiencing severe or nocturnal hypoglycaemia and who are using an intensified insulin regimen?
Basal insulin analogues
Into what vein does insulin secrete?
Portal vein
How is a diagnosis of LADA made?
The presence of elevated levels of pancreatic auto-antibodies in patients with recently diagnosed diabetes who do not initially require insulin
When should you suspect LADA?
Young adults 25-40, male, non-obese, auto-ab +ve, associated AI conditions, non-insulin requiring at diagnosis, sub-optimal control on oral agents
What therapy is preferred in a CF patient who develops 2’ diabetes?
Insulin therapy
From when is screening with OGTT recommended in CF patients?
From 10yo
