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Endocrine > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What causes type II diabetes

A

Repeated exposure to glucose and insulin makes the cells in the body become resistant to the effects of insulin. It therefore requires more and more insulin to produce a response from the cells to get them to take up and use glucose.

Overtime the pancreas (beta cells) become fatigued and damaged (damaged by lipotoxicity and glucotoxicity) from producing so much insulin and they start to produce less.

A continued onslaught of glucose on the body in light of insulin resistance and pancreatic fatigue leads to chronic hyperglycaemia.

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2
Q

What are the diagnostic tests for diabetes

A

Blood Glucose
HbA1c
Oral glucose tolerance test (OGTT

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3
Q

What is genetics of type II diabetes

A

Identical twin 90-100% risk

One parent 15%

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4
Q

What range of impaired fasting glucose is considered intermediate hyperglycaemia

A

Impaired fasting glucose 6.1-7 mmol/l

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5
Q

What decides what the diagnostic criteria are for diabetes

A

Diabetes diagnostic criteria are selected because above those criteria there is a significantly increased premature mortality and increased risk of microvascular and cardiovascular complications

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6
Q

What is intermediate hyperglycaemia

A

When someone has an impaired fasting glucose or impaired glucose tolerance.

People are identified a group at higher risk of future diabetes and adverse outcomes such as cardiovascular disease

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7
Q

What is secondary diabetes

A

Diabetes caused by something else:

Drug therapy e.g corticosteroids

Pancreatic destruction

Recognised genetic syndromes-

Rare endocrine disorders

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8
Q

What are found on examination of type 1 diabetes presentation

A

Ketones on breath
Dehydration

May have increased respiratory rate, tachycardia, hypotension.

Low grade infections, thrush / balanitis

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9
Q

What is a diagnostic level of HBA1c for type 2 diabetes

A

HbA1c ≥ 48 mmol/mol.

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10
Q

What rare endocrine disorders can cause secondary diabetes

A

Cushings syndrome,

Acromegaly,

Pheochromocytoma

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11
Q

What are the genetics of type 1 diabetes

A

Monozygotic twins 30-50% concordance

If both parents have Type 1: 30% risk

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12
Q

What is pre-diabetes

A

Pre-Diabetes is an indication that the patient is heading towards diabetes. They do not fit the full diabetic diagnostic criteria but should be educated regarding diabetes abd implement lifestyle changes to reduce their risk of becoming diabetic. They are not currently recommended to start the treatment.

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13
Q

What are diagnostic levels of fasting and random glucose levels

A

fasting 7.0 mmol/l,

random 11.1 mmol/l

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14
Q

What is the diagnostic levels of HbA1c for Pre-diabetes

A

HBA1C >42-47mmol/mol

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15
Q

What is gestational diabetes

A

Hyperglycaemia of pregnancy

Increasing insulin resistance in pregnancy

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16
Q

When can’t you use HBA1C (x8)

A

All children and young people.

Pregnancy—current or recent (< 2 months).

Short duration of diabetes symptoms.

Patients at high risk of diabetes who are acutely ill

Patients taking medication that may cause rapid glucose rise; for example, corticosteroids, antipsychotic drugs (2 months or less).

Acute pancreatic damage or pancreatic surgery.

Renal failure.

HIV

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17
Q

What are Diagnostic glucose levels (venous plasma) for type II diabetes

A

Fasting 7.0 mmol/l,

Random 11.1 mmol/l

18
Q

When do you diagnose someone with diabetes

A

ONE diagnostic lab glucose plus symptoms

TWO diagnostic lab glucose or HbA1c levels without symptoms.

19
Q

What is a Diagnostic HbA1c for diabetes

A

Diagnostic HbA1c ≥ 48 mmol/mol.

20
Q

What age do people get type II diabetes

A

Incidence increases with age, maxing at 60 then declining – aging population

21
Q

What is the diagnostic levels of IFG for Pre-diabetes

A

Impaired fasting glucose – 6.1-6.9 mmol/l

22
Q

When do you diagnose someone with type II diabetes

A

Should consider Diagnosis of diabetes if there are are 2 Risk factors present

ONE diagnostic lab glucose plus symptoms

TWO diagnostic lab glucose or HbA1c levels without symptoms.

23
Q

Why do patients get diabetic ketoacidosis

A

When there is no insulin driving glucose into the cells the body thinks it is starving. It starts producing ketones as a temporary fuel for the brain. The body does not need this however, and the Ph of the blood starts to rise. Initially this is buffered by bicarbonate but eventually this runs out and the PH increases lots.

24
Q

What is MODY

A

Autosomal dominant

? 5% of people with diabetes

Impaired beta-cell function

Single gene defect

25
Q

How is an oral glucose tolerance test taken

A

Oral glucose tolerance test is performed in the morning prior to having breakfast. It involves taking a baseline fasting plasma glucose result, giving a 75g glucose drink and then measuring plasma gluose 2 hours later.

26
Q

What is Impaired glucose tolerance

A

Body struggles to cope with processing a carbohydrate meal.

27
Q

What happens if someone is hyperglycaemic acutely

A 
polydipsia, 
polyuria, 
blurred vision,
weight loss
Infections
28
Q

What are presenting symptoms of type 1 diabetes

A

Short duration of:

Thirst
Tiredness
Polyuria / Nocturia
Weight loss 
Blurred vision
Abdominal pain
29
Q

What are the risk factors for type II diabetes

A

Family history

Over age 30 years if Maori ⁄ Asian (Indian subcontinent)⁄ Pacific Island descent

Over age 40 years if European

Previous history of diabetes in pregnancy (Gestational Diabetes)

Inactive lifestyle, lack of exercise

Previous high blood glucose ⁄ impaired glucose tolerance

Overweight

30
Q

What are symptoms included in the diagnostic criteria for diabetes

A

Polydipsia, polyuria, blurred vision, weight loss, infections (candida)

31
Q

What is the screening test for type II diabetes

A

Hba1C – easy screening test

32
Q

What is impaired fasting glucose

A

Body struggles to get their blood glucose levels into normal range even after a prolonged period without eating carbohtdrates.

33
Q

Define Diabetes

A

A group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.

34
Q

What are signs of type II diabetes

A

Not ketotic

Usually overweight but not always

Low grade infections, thrush / balanitis

In type 2 DM may have micro vascular or macrovascular complications at Dx

35
Q

What range of HbA1c is considered intermediate hyperglycaemia

A

HbA1c 42-47mmol/mol

36
Q

What range of impaired glucose tolerance is considered intermediate hyperglycaemia

A

Impaired glucose tolerance 2h glucose ≥7.8 and <11mmol/l

37
Q

What are other types of diabetes (apart from I and II)

A

Recognised genetic syndromes : MODY

Gestational diabetes

Secondary diabetes

38
Q

What is the diagnostic levels of IGT for Pre-diabetes

A

Plasma glucose at 2 hours 7.8 – 11.1 mmol/l on a OGTT.

39
Q

What are symptoms of type II diabetes

A

May have no symptoms

Thirst

TirednessPolyuria / nocturia

Sometimes weight loss

Blurred vision

Symptoms of complications e.g. CVD

40
Q

What can be a trigger for diabetes

A

viral infection

  • Coxsackie B virus
  • Enterovirus
41
Q

What happens if someone is hyperglycaemic chronically

A

Microvascular issues -retinopathy,

  • neuropathy,
  • nephropathy,

Macrovascular

  • stroke,
  • MI,
  • PVD

Endocrine (14 decks)

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