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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
Tissues such as muscle and fat have what kind of glucose transporters?
Insulin-dependant
26
How is glucose used by the muscle?
Stored as glycogen or Metabolised into lactate/CO2/H2O
27
What happens to the glucose used by the brain?
Its oxidised into CO2 and H2O
28
How does fat use glucose?
Uses glucose as a substrate for triglyceride synthesis
29
What is C-peptide?
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.
30
What is insulin?
A anabolic (building) hormone that controls intermediary metabolism - reduces blood sugar
31
What does insulin do in the fasting state?
Regulates glucose release by the liver
32
What does insulin do in the postparadinal state?
Promotes glucose uptake by fat and muscle + Regulates glucose release by the liver
33
Which proteins transport glucose through the membrane and into the cell?
glucose-transporter (GLUT) proteins
34
If glucose concentration falls below the normal range what is secret from pancreatic α-cells?
Glucagon
35
List ‘counter-regulatory hormones’ that antagonize the action of insulin? How do they do it?
Glucagon noradrenaline (norepinephrine) Cortisol Growth hormone increase hepatic glucose production and reduce its utilization in fat and muscle for any given insulin concentration.
36
What is glucagon?
A catabolic (breakdown) hormone - that induces glycogenlysis (breakdown of stored glycogen) and gluconeogenesis
37
How is DM classified?
Either primary (idiopathic) or Secondary or Gestational
38
Primary diabetes can be classified into what?
Either Type 1 or Type 2
39
What characterises Type 1 diabetes?
Usually an immune pathogenesis and severe insulin deficiency
40
What characterises Type 2 diabetes?
A combination of insulin resistance and less severe insulin deficiency
41
What are the 7 subdivisions of Secondary diabetes?
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
Type 1 DM accounts for what % of all case f DM?
5-10%
43
What age group is typically presents w/ Type?
Children and young adults - peak incidence at puberty
44
Which countries have the highest rates of Type 1?
Northern Europe and Middle East
45
Type 1 DM is subdivided into what?
Type 1A (immune-mediated) - majority esp. Western countries Type 1B (non-immune-mediated)
46
What is LADA?
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
Type 1 diabetes belongs to a family of immune-mediated organ-specific diseases, which include what? (4)
autoimmune thyroid disease coeliac disease Addison’s disease pernicious anaemia
48
What is the aetiology of T1DM?
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
What is insulitis?
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
What is the 'honeymoon period'? What do you need to do w/ the the insulin treatment?
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
Aetiological classification of T1DM
Immune mediated Idiopathic
52
Aetiological classification of T2DM
Insulin resistance with inadequate insulin secretion
53
What drugs can cause DM?
Glucocorticoids Thiazide diuretics Antipsychotics β-adrenergic receptor blockers
54
Increased susceptibility to type 1 diabetes is inherited but the disease is not genetically predetermined. True or False?
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
fluorescent antibody technique that detects binding of autoantibodies to islet cells, has much of its staining reaction due to which 2 antibodies in T1DM?
glutamic acid decarboxylase (GAD65) protein tyrosine phosphatase (IA-2, also known as ICA512).
56
More than 90% of people with type 1 diabetes carry which 2 genes?
HLA-DR3-DQ2 HLA-DR4-DQ8 or both
57
What are some environmental factors that could trigger T1DM?
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
What % od DM is T2?
90%
59
Which to areas of the world have the highest rand lowest prevalence of T2DM?
Middle East + Pacific Islands Africa + Europe
60
Identical twins of people with type 2 diabetes have more than a 50% chance of developing diabetes T2 True or False?
True
61
The incidence of type 2 diabetes increases with age, why?
Pancreatic β-cell function declines with age
62
After what age are most ppl diagnosed w/ T2DM?
40
63
1/3rd of those w/ T2DM are over what age?
65+
64
Low birth weight predisposes you which chronic disease?
T2DM (poor nutrition early in life impairs β-cell development and function) Heart disease HTN Osteoporosis
65
What are the Risk Factors for T2DM?
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
What dietary pattern reduces the risk of developing T2DM?
Wholegrains Inc fruit + veg intake fermented dairy oily fish Mediterranean
67
What are the 2 primary defects that appear in T2DM pathogenesis?
Insulin; Secretion + Action
68
What are the 4 ways in which a diabetic patient can clinically present?
Acute Subacute Asymptomatic or w/ complication of diabetes
69
What are the classic triad of symptoms Children and Yes present w/ acutely
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
What is off present in the urine of Young Pll w/ an cute presentation of DM?
Ketones - Ketonuria
71
What would you see in the subacute presentation of DM?
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
Complications as the (initial) presenting feature for DM include:
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
Asymptomatic diabetes
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
What are the broad topic that are asked in a diabetes mellitus history?
Presenting complaint Diagnosis of the diabetes Management of the disease

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