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Diabetes Flashcards

1
Q

what is diabetes

A

an elevation of blood glucose above a diagnostic threshold

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2
Q

what is type 1 diabetes

A

autoimmune destruction of the pancreatic beta-cells resulting in absolute insulin deficiency

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3
Q

what are the 2 main subdivisions of type 1 diabetes

A

1A: immune mediated
1B: non-immune mediated

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4
Q

what is the most common subtype of type 1 diabetes

A

type 1A

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5
Q

type 1A T1DM

A

involves an environmental trigger in a genetically susceptible individual mediated by an auto-immune process within the pancreatic β-cell

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6
Q

what does LADA stand for

A

latent autoimmune disease in adults

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7
Q

what is LADA

A

a ‘slow-burning’ variant of type 1A with slower progression to insulin deficiency occurs in later life

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8
Q

type 1B T1DM

A

involves patients with permanent insulinopenia and who are prone to DKA but have no evidence of β-cell dysfunction or autoantibodies

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9
Q

ethnicity associated with type 1B T1DM

A

African or Asian ancestry

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10
Q

peak incidence of diagnosis of T1DM

A

10-14 yrs

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11
Q

name the 2 high risk genotypes associated with T1DM

A

HLA
DR3-DQ2 and DR4-DQ8

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12
Q

what is the cause of symptoms of T1DM in patients under 1

A

MODY

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13
Q

why cant children under 1 be diagnosed with type 1 diabetes

A

you need an immune system to develop T1DM

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14
Q

pathophysiology of T1DM (4)

A
  1. genetic susceptibility
  2. environmental trigger
  3. T-cell mediated autoimmune response with production of autoantibodies that destroy b-cells
  4. absolute insulin deficiency
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15
Q

clinical presentation of T1DM

A

acute onset
severe weight loss
polydipsia, polyuria
weakness, fatigue

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16
Q

diagnostic criteria for T1DM

A

fasting glucose >7 with symptoms
random glucose >11 with symptoms
if asymptomatic repeat test

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17
Q

use of HbA1C in type 1 diabetes

A

used to monitor disease NOT as a diagnostic tool

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18
Q

management of T1DM

A

basal bolus insulin regimen

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19
Q

name the 4 main antigens linked to T1DM

A

glutamic acid decarboxylase
islet antigen 2
insulin
ZnT8 transporter

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20
Q

complication of injecting insulin into the same place

A

lipohypertrophy

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21
Q

name the 2 surgical management options for type 1 diabetes

A

pancreatic islet transplantation
whole pancreas transplantation

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22
Q

who usually gets a pancreatic islet transplantation

A

people with really badly controlled diabetes + complications despite maximal treatment

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23
Q

when do people with T1DM usually get a whole pancreas transplant

A

end-stage kidney disease at the same time as a kidney transplant

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24
Q

what is insulin resistance

A

reduced ability of organs to respond to ‘physiological’ insulin levels due to reduced insulin sensing and/or signalling

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25
what is the most common association with insulin sensitivity
obesity
26
name some risk factors for insulin sensitivity
inactivity, FHx of diabetes, PCOS, hypertension, heart disease, smoking
27
cause of insulin resistance in skeletal muscle
impairment of insulin signalling
28
cause of insulin resistance in adipose tissue
obesity-induced inflammation as adipose tissue secretes pro-inflammatory cytokines e.g. TNF-⍺
29
pathway-selective hepatic insulin resistance
hepatic lipogenesis remains elevated as insulin signalling to lipid metabolism is intact
30
what is leprechaunism
rare autosomal genetic trait involving mutations in the insulin receptor
31
what is another name for leprechaunism
Donohue syndrome
32
clinical presentation of leprechaunism
severe insulin resistance developmental abnormalities: elfin facial appearance, growth retardation, absence of SC fat, decreased muscle mass
33
what is rabson medenhall syndrome
rare autosomal recessive trait which presents with severe insulin resistance, hyperglycaemia and compensatory hyperinsulinemia
34
name a skin change seen in rabson medenhall syndrome
acanthosis nigricans (hyperpigmentation)
35
how do we measure insulin sensitivity
hyperinsulinemic-euglycemic clamp
36
management of insulin resistance
eat less, move more meds: metformin, TZDs
37
name some complications of insulin resistance
diabetes, Alzheimer's, chronic kidney disease, gout, acne, PCOS, cancer
38
what causes type 2 diabetes
insulin resistance with relative insulin deficiency
39
name some non-modifiable risk factors of T2DM
increasing age - β-cell function declines with age genetics ethnicity - south asian, african and afro-caribbean descent
40
modifiable risk factors for T2DM
obestiy diet - high dietary fat, red and processed meat physical inactivity
41
symptoms of T2DM
gradual onset symptoms of complications may be the first clinical encounter thirst, polyuria, blurred vision, weight loss, recurrent infections and tiredness
42
clinical sign of T2DM
acanthosis nigricans
43
investigations of T2DM
fasting glucose > 7 random glucose >11.1 HbA1C > 48
44
first line pharm management of T2DM
metformin
45
what should a T2DM patient with atherosclerotic CVD be given
metformin + GLP1 receptor antagonist
46
what should a T2DM patient with heart failure or CKD be given
metformin + SGLT2i first line or GLP-1 receptor antagonist second line
47
HbA1C target for T2DM patients
53
48
how can we prevent T2DM
weight loss in patient with a BMI >30
49
what does MODY stand for
maturity onset diabetes of the young
50
what is MODY
early onset of non-insulin dependent diabetes
51
what is the most common form of monogenetic diabetes
MODY
52
inheritance seen in MODY
autosomal dominant
53
name the most common type of mutation seen in MODY
transcription factors
54
what are the 3 main types of mutations seen in MODY
transcription factors glucokinase MODY X
55
pathophysiology of MODY
Genetic defective glucose sensing in the pancreas and/or loss of insulin secretion
56
glucokinase mutation in MODY
glucose sensing defect - blood glucose threshold for insulin secretion is increased
57
name the main transcription factor mutations seen in MODY
HNF-1⍺, HNF-1β, HNF-4⍺
58
clinical presentation of glucokinase mutations in MODY
onset at birth stable hyperglycaemia
59
clinical presentation of transcription factor mutations in MODY
adolescence/ YA onset progressive hyperglycaemia
60
investigations used to diagnose MODY
oral glucose test genetic testing to confirm the type of mutation
61
oral glucose test result for a patient with glucokinase mutation MODY
high fasting blood glucose but bring their glucose down when given oral challenge
62
oral glucose test result for a patient with transcription factor mutation MODY
normal fasting blood glucose but doesn't respond well to glucose challenge
63
management of glucokinase mutation MODY
can be managed with diet alone
64
management of transcription factor mutation MODY
DIET + insulin or sulphonylureas
65
what kind of diabetes is neonatal diabetes
monogenetic diabtetes
66
name a mutation that commonly causes neonatal diabetes
Kir6.2
67
pathophysiology of neonatal diabetes
mutations in the glucose sensing mechanism e.g. in the ATP sensitive K channel
68
clinical presentation of neonatal diabetes
diabetes diagnosed < 6 months polydipsia, polyuria dehydration DKA
69
investigation of neonatal diabetes
blood glucose
70
management of neonatal diabetes
sulphonylureas
71
what is congenital hyperinsulinism
inappropriate and unregulated insulin secretion, which results in severe, persistent hypoglycaemia in new born babies, infants, and children
72
management of congenital hyperinsulinism
diazoxide
73
name 3 conditions associated with diabetes
cystic fibrosis wolfram syndrome barget-biedl syndrome
74
what is gestational diabetes
diabetes that is diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation
75
what causes gestational diabetes
Placental progesterones and hPL produce insulin resistance in the mother, meaning more nutrients diverted to foetus in patients with insulin resistance before pregnancy, this raises blood glucose too high
76
management of pre-existing diabetes during pregnancy
pre-pregnancy counselling folic acid 5mg consider change of meds start aspirin 150mg at 12 weeks
77
why do we give high risk pregnancies aspirin
reduce the risk of pregnancy-induced hypertension
78
drug treatment of T1D during pregnancy
insulin may require an increased dose
79
drug treatment of T2D during pregnancy
metformin will probably need to add insulin
80
management of gestational diabetes
lifestyle, metformin may need to add insulin
81
management of gestational diabetes after birth
6 week post natal fasting glucose or GTT to ensure resolution
82
gestational diabetes that persists post-natally
type 2 diabetes
83
how to prevent type 2 diabetes after gestational diabetes
healthy weight and diet annual fasting glucose
84
complications associated with type 1+2 diabetes in pregnancy
congenital malformation prematurity intra-uterine growth retardation
85
name some complications of gestational diabetes
macrosomia polyhydramnios interuterine death
86
what is macrosomia
very large baby - > 90th centile
87
what causes macrosomia in gestational diabetes
maternal hypoglycaemia is transferred across the placenta, resulting in foetal hyperglycaemia causes foetal hyperinsulinemia
88
what is polyhydramnios
too much fluid around the foetus
89
complications in a neonate following gestational diabetes
respiratory distress caudal regression syndrome ureteric duplications

endocrine (15 decks)

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