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endocrine > Diabetes > Flashcards

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
Q

what is the most common association with insulin sensitivity

A

obesity

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26
Q

name some risk factors for insulin sensitivity

A

inactivity, FHx of diabetes, PCOS, hypertension, heart disease, smoking

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27
Q

cause of insulin resistance in skeletal muscle

A

impairment of insulin signalling

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28
Q

cause of insulin resistance in adipose tissue

A

obesity-induced inflammation as adipose tissue secretes pro-inflammatory cytokines e.g. TNF-⍺

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29
Q

pathway-selective hepatic insulin resistance

A

hepatic lipogenesis remains elevated as insulin signalling to lipid metabolism is intact

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30
Q

what is leprechaunism

A

rare autosomal genetic trait involving mutations in the insulin receptor

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31
Q

what is another name for leprechaunism

A

Donohue syndrome

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32
Q

clinical presentation of leprechaunism

A

severe insulin resistance
developmental abnormalities: elfin facial appearance, growth retardation, absence of SC fat, decreased muscle mass

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33
Q

what is rabson medenhall syndrome

A

rare autosomal recessive trait which presents with severe insulin resistance, hyperglycaemia and compensatory hyperinsulinemia

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34
Q

name a skin change seen in rabson medenhall syndrome

A

acanthosis nigricans (hyperpigmentation)

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35
Q

how do we measure insulin sensitivity

A

hyperinsulinemic-euglycemic clamp

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36
Q

management of insulin resistance

A

eat less, move more
meds: metformin, TZDs

37
Q

name some complications of insulin resistance

A

diabetes, Alzheimer’s, chronic kidney disease, gout, acne, PCOS, cancer

38
Q

what causes type 2 diabetes

A

insulin resistance with relative insulin deficiency

39
Q

name some non-modifiable risk factors of T2DM

A

increasing age - β-cell function declines with age
genetics
ethnicity - south asian, african and afro-caribbean descent

40
Q

modifiable risk factors for T2DM

A

obestiy
diet - high dietary fat, red and processed meat
physical inactivity

41
Q

symptoms of T2DM

A

gradual onset
symptoms of complications may be the first clinical encounter
thirst, polyuria, blurred vision, weight loss, recurrent infections and tiredness

42
Q

clinical sign of T2DM

A

acanthosis nigricans

43
Q

investigations of T2DM

A

fasting glucose > 7
random glucose >11.1
HbA1C > 48

44
Q

first line pharm management of T2DM

A

metformin

45
Q

what should a T2DM patient with atherosclerotic CVD be given

A

metformin + GLP1 receptor antagonist

46
Q

what should a T2DM patient with heart failure or CKD be given

A

metformin + SGLT2i first line
or
GLP-1 receptor antagonist second line

47
Q

HbA1C target for T2DM patients

A

53

48
Q

how can we prevent T2DM

A

weight loss in patient with a BMI >30

49
Q

what does MODY stand for

A

maturity onset diabetes of the young

50
Q

what is MODY

A

early onset of non-insulin dependent diabetes

51
Q

what is the most common form of monogenetic diabetes

A

MODY

52
Q

inheritance seen in MODY

A

autosomal dominant

53
Q

name the most common type of mutation seen in MODY

A

transcription factors

54
Q

what are the 3 main types of mutations seen in MODY

A

transcription factors
glucokinase
MODY X

55
Q

pathophysiology of MODY

A

Genetic defective glucose sensing in the pancreas and/or loss of insulin secretion

56
Q

glucokinase mutation in MODY

A

glucose sensing defect - blood glucose threshold for insulin secretion is increased

57
Q

name the main transcription factor mutations seen in MODY

A

HNF-1⍺, HNF-1β, HNF-4⍺

58
Q

clinical presentation of glucokinase mutations in MODY

A

onset at birth
stable hyperglycaemia

59
Q

clinical presentation of transcription factor mutations in MODY

A

adolescence/ YA onset
progressive hyperglycaemia

60
Q

investigations used to diagnose MODY

A

oral glucose test
genetic testing to confirm the type of mutation

61
Q

oral glucose test result for a patient with glucokinase mutation MODY

A

high fasting blood glucose but bring their glucose down when given oral challenge

62
Q

oral glucose test result for a patient with transcription factor mutation MODY

A

normal fasting blood glucose but doesn’t respond well to glucose challenge

63
Q

management of glucokinase mutation MODY

A

can be managed with diet alone

64
Q

management of transcription factor mutation MODY

A

DIET + insulin or sulphonylureas

65
Q

what kind of diabetes is neonatal diabetes

A

monogenetic diabtetes

66
Q

name a mutation that commonly causes neonatal diabetes

A

Kir6.2

67
Q

pathophysiology of neonatal diabetes

A

mutations in the glucose sensing mechanism e.g. in the ATP sensitive K channel

68
Q

clinical presentation of neonatal diabetes

A

diabetes diagnosed < 6 months
polydipsia, polyuria
dehydration
DKA

69
Q

investigation of neonatal diabetes

A

blood glucose

70
Q

management of neonatal diabetes

A

sulphonylureas

71
Q

what is congenital hyperinsulinism

A

inappropriate and unregulated insulin secretion, which results in severe, persistent hypoglycaemia in new born babies, infants, and children

72
Q

management of congenital hyperinsulinism

A

diazoxide

73
Q

name 3 conditions associated with diabetes

A

cystic fibrosis
wolfram syndrome
barget-biedl syndrome

74
Q

what is gestational diabetes

A

diabetes that is diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation

75
Q

what causes gestational diabetes

A

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
Q

management of pre-existing diabetes during pregnancy

A

pre-pregnancy counselling
folic acid 5mg
consider change of meds
start aspirin 150mg at 12 weeks

77
Q

why do we give high risk pregnancies aspirin

A

reduce the risk of pregnancy-induced hypertension

78
Q

drug treatment of T1D during pregnancy

A

insulin
may require an increased dose

79
Q

drug treatment of T2D during pregnancy

A

metformin
will probably need to add insulin

80
Q

management of gestational diabetes

A

lifestyle, metformin
may need to add insulin

81
Q

management of gestational diabetes after birth

A

6 week post natal fasting glucose or GTT to ensure resolution

82
Q

gestational diabetes that persists post-natally

A

type 2 diabetes

83
Q

how to prevent type 2 diabetes after gestational diabetes

A

healthy weight and diet
annual fasting glucose

84
Q

complications associated with type 1+2 diabetes in pregnancy

A

congenital malformation
prematurity
intra-uterine growth retardation

85
Q

name some complications of gestational diabetes

A

macrosomia
polyhydramnios
interuterine death

86
Q

what is macrosomia

A

very large baby - > 90th centile

87
Q

what causes macrosomia in gestational diabetes

A

maternal hypoglycaemia is transferred across the placenta, resulting in foetal hyperglycaemia
causes foetal hyperinsulinemia

88
Q

what is polyhydramnios

A

too much fluid around the foetus

89
Q

complications in a neonate following gestational diabetes

A

respiratory distress
caudal regression syndrome
ureteric duplications

endocrine (15 decks)

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