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Endocrinology > Diabetes? > Flashcards

Diabetes? Flashcards

1
Q

what are the 4 ways people can develop diabetes?

A
  • insufficient insulin to maintain glucose homeostasis
  • absolute insulin deficiency
  • relative insulin deficiency
  • failure of insulin synthesis, release or activity
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2
Q

explain insulin deficiency

A

inadequate insulin production/secretion &/or insulin resistance

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3
Q

in which type of diabetes do you find absolute insulin deficiency?

A

type 1 diabetes mellitus

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4
Q

in which type of diabetes do you find a relative insulin deficiency?

A

type 2 diabetes mellitus

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5
Q

in which type of diabetes is there a failure of insulin synthesis, release or activity?

A

MODY

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6
Q

what is diabetes mellitus?

A

a group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both

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7
Q

what is the normal HbA1c value?

A

41m/m & below

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8
Q

what is the impaired/prediabetes HbA1c value range?

A

42-47 mmol/mol

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9
Q

what is the diabetes HbA1c value?

A

48 m/m & above

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10
Q

what is the normal fasting glucose value?

A

6.0 mmol/L & below

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11
Q

what is the impaired/prediabetes fasting glucose value range?

A

6.1-6.9 mmol/L

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12
Q

what is the diabetes fasting glucose value?

A

7.0 mmol/L & above

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13
Q

what is the normal 2-hr glucose in OGTT value?

A

7.7 mmol/L & below

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14
Q

what is the impaired/diabetes 2-hr glucose in OGTT value range?

A

7.8 - 11.0 mmol/L

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15
Q

what is the diabetes 2-hr glucose in OGTT value?

A

11.1 mmol/L & above

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16
Q

what is the diabetes random glucose value?

A

11.1 mmol/L & above

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17
Q

what happens ins type 1 diabetes mellitus?

A

pancreatic beta cell destruction, insulin is required for survival

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18
Q

what is T1DM usually characterised by?

A

the presence of anti-GAD/anti-islet cell antibodies

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19
Q

when is a person thought to have T2DM?

A

when they don’t have T1DM, monogenic diabetes or other medical condition or treatment suggestive of secondary diabetes i.e. a diagnosis of exclusion

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20
Q

when would T1DM usually present?

A

pre-school & peri-puberty, small peak in late 30s

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21
Q

what is the normal body type of T1DM?

A

usually lean

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22
Q

describe the normal onset of T1DM?

A

acute onset with severe symptoms & severe weight loss

ketonuria +/- metabolic acidosis

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23
Q

what is usually required immediately in T1DM?

A

immediate & permanent requirement for insulin

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24
Q

when does T2DM usually present?

A

middle aged/elderly

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25
Q

what body type is usually found in T2DM?

A

usually obese

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26
Q

how long is the pre-diagnosis time normally in T2DM?

A

usually 6-10 years

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27
Q

describe the onset normally found in T2DM?

A

insidious onset over weeks to years

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28
Q

what is usually found on presentation of T2DM?

A

minimal or absent ketonuria

evidence of microvascular disease maybe

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29
Q

how is T2DM initially managed?

A

diet +/- tablets

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30
Q

what are the risk factors for T2DM?

A
  • obesity (central)
  • family history
  • gestational diabetes
  • age
  • ethnicity (asian, african, afro-caribbean)
  • past MI/stroke
  • medications
  • impaired glucose tolerance/impaired fasting glucose
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31
Q

what are the symptoms of DM?

A
  • thirst
  • polyuria
  • thrush
  • weakness fatigue
  • blurred vision
  • infections
  • T1DM - weight loss
  • T2DM - signs of complications, neuropathy/retinopathy
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32
Q

what are the useful discriminatory tests for DM?

A
  • GAD/anti-islet cell antibodies
  • ketones
  • C-peptide (plasma)
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33
Q

in which type of diabetes is ketosis found in?

A

type 1

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34
Q

what doe need to look out for to spot monogenic diabetes?

A
  • strong family history
  • associated features (renal cysts etc)
  • young onset
  • GAD-negative
  • C-peptide positive
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35
Q

gestational diabetes

A

any degree of glucose intolerance arising or diagnosed during pregnancy

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36
Q

what does HbA1c provide a measure of?

A

glucose control over past 2-3 months

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37
Q

what are the microvascular complications of diabetes?

A

heart disease & stroke

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38
Q

what are the microvascular complications of diabetes?

A

retinopathy
nephropathy
neuropathy

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39
Q

what other type of complications can occur in diabetes?

A

psychological

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40
Q

in which age group does LADA occur in?

A

young adults 25 to 40

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41
Q

in which sex is LADA more common?

A

male

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42
Q

what body type is usually found in LADA?

A

non-obese

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43
Q

are LADA patients auto-antibody positive or negative?

A

positive

44
Q

what is Wolfram Syndrome (DIDMOAD)?

A 
Diabetes Insipidus 
Diabetes Mellitus
Optic Atrophy 
Deafness
Neurological anomolies
45
Q

what are the features of Bardet-Biedl syndrome?

A 
polydactyly
hypogonadal 
visual impairment 
hearing impairment 
mental retardation 
diabetes
46
Q

which body type is usually found in barred-biedl syndrome?

A

often very obese

47
Q

what is polyglandular endocrinopathy?

A

2 types of autoimmune conditions

48
Q

what happens in type 2 polyglandular endocrinopathy?

A 
Type 1 diabetes 
addison's disease
vitiligo 
primary hypogonadism 
primary hypothyroidism 
coeliac disease
49
Q

what kind of inheritance is found in type 1 polyglandular endocrinopathy?

A

autosomal recessive

50
Q

what is found in type 1 polyglandular endocrinopathy?

A 
mild immune deficiency 
any of the conditions associated with type 2 polyglandular endocrinopathy 
primary hypoparathyroidism 
pernicious anaemia 
alopecia
51
Q

what is the target HbA1c for pregnant diabetic women?

A

43 mmol/mol

52
Q

what is the normal HbA1c level?

A

approx 42 mmol/mol

53
Q

what is the pre diabetes range of Hb1Ac?

A

42-47 mmol/mol

54
Q

what is the range of HbA1c for diabetics?

A

> 48 mmol/mol

55
Q

what is the target range for HbA1c in diabetics?

A

48-53 mmol/mol

56
Q

over what Hb1Ac value is it classed as very poor glycemic control with very high risk of complications?

A

70 mmo/mol

57
Q

what is the target range for glucose before meals in diabetics?

A

4-7

58
Q

what is the target range for glucose after meals in diabetics?

A

5-9

59
Q

what is the immediate treatment of hypoglycaemia?

A

consume 15-20g of glucose or simple carbohydrates
recheck your blood glucose after 15 mins
if hypo continues, repeat
once blood glucose returns normal, eat a small snack if your next planned meal or snack is more than an hour or two away

60
Q

what is the treatment of severe hypoglycaemia?

A

glucagon 1g: inject into the buttock/arm or thigh

61
Q

what may happen to a patient who has just regained consciousness after a hypo?

A

nausea

vomiting

62
Q

what is diabetic ketoacidosis

A

a disordered metabolic state that usually occurs in the context of an absolute or relative insulin deficiency accompanied by an increase in the counter-regulatory hormones

63
Q

what is the biochemical criteria for the diagnosis of DKA?

A

Ketonaemia > 3mmol /L, or significant ketonuria (>2+ on standard urine stick)
Blood glucose > 11.0 mmol /L or known diabetes (NB euglycaemic DKA)
Bicarbonate

64
Q

what are the common precipitants of DKA?

A 
infection 
illicit drugs 
alcohol 
non-adherence with treatment 
new diabetes diagnosis
65
Q

what are the typical osmotic related symptoms & signs of DKA?

A

thirst & polyuria

dehydration

66
Q

what are the typical ketone body related symptoms & signs of DKA?

A

flushed
vomiting
abdominal pain & tenderness
breathless

67
Q

what is the breathlessness associated with DKA known as?

A

Kussmaul’s respiration

68
Q

name 2 conditions associated with DKA?

A

underlying sepsis

gastroenteritis

69
Q

what is the classical biochemical presentation of DKA; glucose

A

median level around 40 mmol/L (normal

70
Q

what is the classical biochemical presentation of DKA; potassium

A

usually

71
Q

what is the classical biochemical presentation of DKA; creatinine

A

often raised

72
Q

what is the classical biochemical presentation of DKA; sodium

A

often reduced

73
Q

what is the classical biochemical presentation of DKA; lactate

A

raised lactate is very common

74
Q

what is the classical biochemical presentation of DKA; blood ketones

A

usually raised above 5

75
Q

what is the classical biochemical presentation of DKA; bicarbonate

A
76
Q

what is the classical biochemical presentation of DKA; amylase

A

very frequently raised

77
Q

what is the classical biochemical presentation of DKA; WCC

A

usually around 25

78
Q

what are the normal causes of death associated with DKA in adults?

A 
hypokalaemia 
aspiration 
pneumonia 
ARDS
co-morbidities
79
Q

what are the normal causes of death associated with DKA in children?

A

cerebral oedema

80
Q

which losses should be replaced in the management of DKA?

A 
fluid 
insulin 
potassium 
phosphate (rarely)
bicarbonate (almost never)
81
Q

how can ketones be monitored?

A

blood ketone testing

urine ketone testing

82
Q

what ketone is measured in the blood?

A

beta-hydroxybutyrate

83
Q

what ketone is measured in the urine?

A

acetoacetate

84
Q

what does ketonuria indicate?

A

levels of ketones 2-4 hours previously

85
Q

HHS

A

hyperglycaemic hypersomolar syndrome

86
Q

what are the risks associated with HHS?

A

CVS event
sepsis
medications: glucocorticoids & thiazides

87
Q

what is the classical biochemical presentation of HHS; glucose

A

higher than in DKA, usually around 60

88
Q

what is the classical biochemical presentation of HHS; renal

A

significant renal impairment

89
Q

what is the classical biochemical presentation of HHS; sodium

A

may be raised on admission

90
Q

what is the classical biochemical presentation of HHS; osmolality

A

often around 400

91
Q

what is osmolality?

A

2[NA+K] + urea + glucose

92
Q

what is the normal osmolality range?

A

285-295

93
Q

what is type A lactic acidosis associated with?

A

tissue hypoxaemia

94
Q

when may type B lactic acidosis occur?

A

liver disease

leukaemic states

95
Q

which type of lactic acidosis is associated with diabetes?

A

type B

96
Q

what are the clinical findings of lactic acidosis?

A

hyperventilation
mental confusion
stupor or coma if severe

97
Q

what is the classical biochemical presentation of lactic acidosis; bicarbonate

A

reduced

98
Q

what is the classical biochemical presentation of lactic acidosis; anion gap

A

raised

99
Q

what is the classical biochemical presentation of lactic acidosis; glucose

A

often raised variable

100
Q

what is the classical biochemical presentation of lactic acidosis; ketones

A

absence of ketonaemia

101
Q

what is the classical biochemical presentation of lactic acidosis; phosphate

A

raised

102
Q

is DKA common or rare?

A

common medical emergency

103
Q

which age group is DKA usually seen in?

A

young adults

104
Q

is HHS more common or rarer than DKA?

A

much rarer but higher associated mortalitiy

105
Q

is lactic acidosis a medical emergency or not?

A

it is a medical emergency

Endocrinology (23 decks)

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