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Kumar and Clark's > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are some features of vascular disease?

A

Pale discolouration

Loss of hair

Cool temperature

Absent pulses (begin on the foot and move distally)

Reduced cap refill time

Evidence of gangrene or infection

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2
Q

What 4 things are checked for in an annual diabetic screening?

A

General health

Glycemic control

Development of complications

Cardiovascular risk

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3
Q

What causes the development of complication in diabetes?

A

Prolonged/uncontrolled hyperglycaemia

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4
Q

What are some feature of neuropathy?

A

Clawing of toes, loss of plantar arch

Neuropathic ulcers

Joint deformity (Charcot’s joint)

Glove and stocking sensory loss (check w/ monofilament)

Loss of vibration sense, proprioception and pain

Loss of ankle jerk reflex

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5
Q

Which CN is most likely to be affected in DM?

Why?

What position would the eye be in if it is affected?

A

CNIII

Due to vasculitis

Down and out

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6
Q

What are the 5 main aims in physical examination of a diabetic pt?

A

Assess for diabetic emergencies

Establishing the presence of complications

Assessment of cardiovascular risk factors

Revealing signs of auto-immune disease

Assessment of injection sites

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7
Q

What is DM?

What is it characterised by?

A

A complex metabolic disorder

Characterised by chronic hyperglycaemia due to relative insulin deficiency, resistance or both

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8
Q

What is the global incidence of DM?

A

1 in 11

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9
Q

What are the 3 major categories of complications that happen in DM?

A

Metabolic disturbance

Macrovasuclar disease

Microvascular disease

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10
Q

What are the 3 macrovascular diseases that can occur in DM?

A

Stroke

Coronary artery disease

Peripheral vascular disease

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11
Q

What are the 3 microvascular diseases that can occur in DM?

A

retinopathy

nephropathy

neuropathy

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12
Q

A diagnosis of diabetes in a man or woman at the age of 55 years reduces life expectancy by how much?

A

5-6 years

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13
Q

Being diagnosed w/ diabetes what which age has a limited impact of life expectancy?

A

80 years of age

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14
Q

What is the most common cause of death (2/3) in ppl w/ DM age 65+?

A

Heart disease

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15
Q

Where is insulin synthesised?

A

β cells of the pancreatic islets of Langerhans

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16
Q

What circulation does insulin enter after it is secreted?

A

Portal circulation

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17
Q

What is the prime target organ of insulin?

What percentage of secreted insulin is extracted and degraded by this organ?

Which organ degrades the the rest?

A

Liver

50%

Kidneys

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18
Q

Why is C-peptide a good index of the rate of insulin secretion?

A

Bc its only partially extracted by the liver

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19
Q

What is the normal pattern of insulin circulation in a 24hr cycle?

A

A constant slow background rate secreted throughout the day

A rapid increase in circulating insulin upon eating, falling back down to baseline levels after 2 hrs

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20
Q

What is the principle organ of glucose homeostasis?

A

Liver

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21
Q

What does the liver do w/ glucose?

A

It absorbs and stores glucose as glycogen in the post-absorptive state

and

releases it into circulation between meals to match the rate of glucose utilisation by peripheral tissues

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22
Q

The liver combines three-carbon molecules derived from breakdown of fat (glycerol), muscle glycogen (lactate) and protein (e.g. alanine) into the six-carbon glucose molecule by the process of what?

A

gluconeogenesis

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23
Q

More than 90% of the approximately 200 g of glucose utilised daily is derived from what? (2)

Where does the remainder come from?

A

liver glycogen and hepatic gluconeogenesis

Renal gluconeogenesis

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24
Q

Which organ is the major consumer of glucose and is not dependent on insulin?

A

The brain

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25
Q

Tissues such as muscle and fat have what kind of glucose transporters?

A

Insulin-dependant

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26
Q

How is glucose used by the muscle?

A

Stored as glycogen

or

Metabolised into lactate/CO2/H2O

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27
Q

What happens to the glucose used by the brain?

A

Its oxidised into CO2 and H2O

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28
Q

How does fat use glucose?

A

Uses glucose as a substrate for triglyceride synthesis

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29
Q

What is C-peptide?

A

A biochemically inert peptide fragment of proinsulin that splits off in the secretory process

Equimolar quantities of insulin and C-peptide are released into the circulation via the ‘regulated pathway’. A small amount of insulin is secreted by the β cell directly via the ‘constitutive pathway’ , which bypasses the secretory granules.

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30
Q

What is insulin?

A

A anabolic (building) hormone that controls intermediary metabolism - reduces blood sugar

31
Q

What does insulin do in the fasting state?

A

Regulates glucose release by the liver

32
Q

What does insulin do in the postparadinal state?

A

Promotes glucose uptake by fat and muscle

+

Regulates glucose release by the liver

33
Q

Which proteins transport glucose through the membrane and into the cell?

A

glucose-transporter (GLUT) proteins

34
Q

If glucose concentration falls below the normal range what is secret from pancreatic α-cells?

A

Glucagon

35
Q

List ‘counter-regulatory hormones’ that antagonize the action of insulin?

How do they do it?

A

Glucagon

noradrenaline (norepinephrine)

Cortisol

Growth hormone

increase hepatic glucose production and reduce its utilization in fat and muscle for any given insulin concentration.

36
Q

What is glucagon?

A

A catabolic (breakdown) hormone - that induces glycogenlysis (breakdown of stored glycogen) and gluconeogenesis

37
Q

How is DM classified?

A

Either primary (idiopathic)

or

Secondary

or

Gestational

38
Q

Primary diabetes can be classified into what?

A

Either Type 1 or Type 2

39
Q

What characterises Type 1 diabetes?

A

Usually an immune pathogenesis and severe insulin deficiency

40
Q

What characterises Type 2 diabetes?

A

A combination of insulin resistance and less severe insulin deficiency

41
Q

What are the 7 subdivisions of Secondary diabetes?

A

Diabetes secondary to;

Genetic defects

exocrine pancreatic disease

endocrine disease

drugs and chemicals

infection

uncommon forms of immune-mediated diabetes

ther genetic syndromes sometimes associated with diabetes

42
Q

Type 1 DM accounts for what % of all case f DM?

A

5-10%

43
Q

What age group is typically presents w/ Type?

A

Children and young adults - peak incidence at puberty

44
Q

Which countries have the highest rates of Type 1?

A

Northern Europe and Middle East

45
Q

Type 1 DM is subdivided into what?

A

Type 1A (immune-mediated) - majority esp. Western countries

Type 1B (non-immune-mediated)

46
Q

What is LADA?

A

A ‘slow-burning’ variant (Type 1A)

with slower progression to insulin deficiency occurs in later life and is termed latent autoimmune diabetes in adults

47
Q

Type 1 diabetes belongs to a family of immune-mediated organ-specific diseases, which include what? (4)

A

autoimmune thyroid disease

coeliac disease

Addison’s disease

pernicious anaemia

48
Q

What is the aetiology of T1DM?

A

The triggering of a selective autoimmune destruction of the insulin producing cells of a genetically predisposed individual.

autoantibodies directed against pancreatic islet constituents appear in the circulation and often predate clinical onset by many years.

This is followed by insulitis

Eventually, when the remaining β cells are no longer able to produce enough insulin to meet the body’s needs, diabetes symptoms start to develop.

49
Q

What is insulitis?

A

A phase of asymptomatic loss of β cell secretory capacity; histologically, this is characterized by a chronic inflammatory mononuclear cell infiltrate of T lymphocytes and macrophages in the islets

50
Q

What is the ‘honeymoon period’?

What do you need to do w/ the the insulin treatment?

A

Some recovery of endogenous insulin secretion may occur over the first few months after diagnosis and treatment initiation…. possibly due to trict glucose control from diagnosis can prolong β cell function.

Some recovery of endogenous insulin secretion may occur over the first few months after diagnosis and treatment initiation

51
Q

Aetiological classification of T1DM

A

Immune mediated

Idiopathic

52
Q

Aetiological classification of T2DM

A

Insulin resistance with inadequate insulin secretion

53
Q

What drugs can cause DM?

A

Glucocorticoids

Thiazide diuretics

Antipsychotics

β-adrenergic receptor blockers

54
Q

Increased susceptibility to type 1 diabetes is inherited but the disease is not genetically predetermined.

True or False?

A

True,

The identical twin of a person with type 1 diabetes has a 30–50% chance of developing the disease, which implies that non-genetic factors must also be involved.

55
Q

fluorescent antibody technique that detects binding of autoantibodies to islet cells, has much of its staining reaction due to which 2 antibodies in T1DM?

A

glutamic acid decarboxylase (GAD65)

protein tyrosine phosphatase (IA-2, also known as ICA512).

56
Q

More than 90% of people with type 1 diabetes carry which 2 genes?

A

HLA-DR3-DQ2

HLA-DR4-DQ8

or

both

57
Q

What are some environmental factors that could trigger T1DM?

A

maternal factors , such as gestational infection and older age

viral infections , including enteroviruses such as Coxsackie B4

exposures to dietary constituents , such as early introduction of cow’s milk and relative deficiency of vitamin D

environmental toxins , e.g. alloxan, Vacor

childhood obesity

psychological stress.

58
Q

What % od DM is T2?

A

90%

59
Q

Which to areas of the world have the highest rand lowest prevalence of T2DM?

A

Middle East + Pacific Islands

Africa + Europe

60
Q

Identical twins of people with type 2 diabetes have more than a 50% chance of developing diabetes T2

True or False?

A

True

61
Q

The incidence of type 2 diabetes increases with age, why?

A

Pancreatic β-cell function declines with age

62
Q

After what age are most ppl diagnosed w/ T2DM?

A

40

63
Q

1/3rd of those w/ T2DM are over what age?

A

65+

64
Q

Low birth weight predisposes you which chronic disease?

A

T2DM (poor nutrition early in life impairs β-cell development and function)

Heart disease

HTN

Osteoporosis

65
Q

What are the Risk Factors for T2DM?

A

Genes - TCF7-L2 (Europeans), KCNQ1 (Asians)

Increasing age

Low birth weight, esp w/ excessive weight gain as adult

Obesity esp central

Diet - saturated fat/red processed meat/fired food/white rice/ surgery drink

Physical in activity/sedentary lifestyle

OTHER:

Urbanisation

Poverty

Abnormal sleep patterns

Environmental toxins

Mental illness

66
Q

What dietary pattern reduces the risk of developing T2DM?

A

Wholegrains

Inc fruit + veg intake

fermented dairy

oily fish

Mediterranean

67
Q

What are the 2 primary defects that appear in T2DM pathogenesis?

A

Insulin;

Secretion

+

Action

68
Q

What are the 4 ways in which a diabetic patient can clinically present?

A

Acute

Subacute

Asymptomatic

or

w/ complication of diabetes

69
Q

What are the classic triad of symptoms Children and Yes present w/ acutely

A

2-6/52 Hx;

Polyuria

  • Due to osmotic diuresis that results when blood glucose levels exceed the renal threshold

Thirst and Polydipsia

  • Due to the resulting loss of fluid and electrolytes

Weight loss

  • Due to fluid depletion and accelerated breakdown of fat and muscle 2ndary to insulin deficinecy
70
Q

What is off present in the urine of Young Pll w/ an cute presentation of DM?

A

Ketones - Ketonuria

71
Q

What would you see in the subacute presentation of DM?

A

Over several months/years;

Classic triad

+

lack of energy

blurry vision

  • due to glucose-induced changes in refraction

pruritus vulvae

balanitis

  • due to candida infection
72
Q

Complications as the (initial) presenting feature for DM include:

A

Staphylococcal skin infections

Retinopathy noted during a visit to the optician

Polyneuropathy causing tingling and numbness in the feet

Erectile dysfunction

Arterial disease, resulting in MI or peripheral gangrene

73
Q

Asymptomatic diabetes

A

approximately half of people with diabetes are unaware of their condition

diagnoses are made as an incidental finding

several countries have introduced screening programmes

74
Q

What are the broad topic that are asked in a diabetes mellitus history?

A

Presenting complaint

Diagnosis of the diabetes

Management of the disease

Kumar and Clark's (4 decks)

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