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
2
Q
explain insulin deficiency
A
inadequate insulin production/secretion &/or insulin resistance
3
Q
in which type of diabetes do you find absolute insulin deficiency?
A
type 1 diabetes mellitus
4
Q
in which type of diabetes do you find a relative insulin deficiency?
A
type 2 diabetes mellitus
5
Q
in which type of diabetes is there a failure of insulin synthesis, release or activity?
A
MODY
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
7
Q
what is the normal HbA1c value?
A
41m/m & below
8
Q
what is the impaired/prediabetes HbA1c value range?
A
42-47 mmol/mol
9
Q
what is the diabetes HbA1c value?
A
48 m/m & above
10
Q
what is the normal fasting glucose value?
A
6.0 mmol/L & below
11
Q
what is the impaired/prediabetes fasting glucose value range?
A
6.1-6.9 mmol/L
12
Q
what is the diabetes fasting glucose value?
A
7.0 mmol/L & above
13
Q
what is the normal 2-hr glucose in OGTT value?
A
7.7 mmol/L & below
14
Q
what is the impaired/diabetes 2-hr glucose in OGTT value range?
A
7.8 - 11.0 mmol/L
15
Q
what is the diabetes 2-hr glucose in OGTT value?
A
11.1 mmol/L & above
16
Q
what is the diabetes random glucose value?
A
11.1 mmol/L & above
17
Q
what happens ins type 1 diabetes mellitus?
A
pancreatic beta cell destruction, insulin is required for survival
18
Q
what is T1DM usually characterised by?
A
the presence of anti-GAD/anti-islet cell antibodies
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
20
Q
when would T1DM usually present?
A
pre-school & peri-puberty, small peak in late 30s
21
Q
what is the normal body type of T1DM?
A
usually lean
22
Q
describe the normal onset of T1DM?
A
acute onset with severe symptoms & severe weight loss
ketonuria +/- metabolic acidosis
23
Q
what is usually required immediately in T1DM?
A
immediate & permanent requirement for insulin
24
Q
when does T2DM usually present?
A
middle aged/elderly
25
what body type is usually found in T2DM?
usually obese
26
how long is the pre-diagnosis time normally in T2DM?
usually 6-10 years
27
describe the onset normally found in T2DM?
insidious onset over weeks to years
28
what is usually found on presentation of T2DM?
minimal or absent ketonuria
| evidence of microvascular disease maybe
29
how is T2DM initially managed?
diet +/- tablets
30
what are the risk factors for T2DM?
- obesity (central)
- family history
- gestational diabetes
- age
- ethnicity (asian, african, afro-caribbean)
- past MI/stroke
- medications
- impaired glucose tolerance/impaired fasting glucose
31
what are the symptoms of DM?
- thirst
- polyuria
- thrush
- weakness fatigue
- blurred vision
- infections
- T1DM - weight loss
- T2DM - signs of complications, neuropathy/retinopathy
32
what are the useful discriminatory tests for DM?
- GAD/anti-islet cell antibodies
- ketones
- C-peptide (plasma)
33
in which type of diabetes is ketosis found in?
type 1
34
what doe need to look out for to spot monogenic diabetes?
- strong family history
- associated features (renal cysts etc)
- young onset
- GAD-negative
- C-peptide positive
35
gestational diabetes
any degree of glucose intolerance arising or diagnosed during pregnancy
36
what does HbA1c provide a measure of?
glucose control over past 2-3 months
37
what are the microvascular complications of diabetes?
heart disease & stroke
38
what are the microvascular complications of diabetes?
retinopathy
nephropathy
neuropathy
39
what other type of complications can occur in diabetes?
psychological
40
in which age group does LADA occur in?
young adults 25 to 40
41
in which sex is LADA more common?
male
42
what body type is usually found in LADA?
non-obese
43
are LADA patients auto-antibody positive or negative?
positive
44
what is Wolfram Syndrome (DIDMOAD)?
```
Diabetes Insipidus
Diabetes Mellitus
Optic Atrophy
Deafness
Neurological anomolies
```
45
what are the features of Bardet-Biedl syndrome?
```
polydactyly
hypogonadal
visual impairment
hearing impairment
mental retardation
diabetes
```
46
which body type is usually found in barred-biedl syndrome?
often very obese
47
what is polyglandular endocrinopathy?
2 types of autoimmune conditions
48
what happens in type 2 polyglandular endocrinopathy?
```
Type 1 diabetes
addison's disease
vitiligo
primary hypogonadism
primary hypothyroidism
coeliac disease
```
49
what kind of inheritance is found in type 1 polyglandular endocrinopathy?
autosomal recessive
50
what is found in type 1 polyglandular endocrinopathy?
```
mild immune deficiency
any of the conditions associated with type 2 polyglandular endocrinopathy
primary hypoparathyroidism
pernicious anaemia
alopecia
```
51
what is the target HbA1c for pregnant diabetic women?
43 mmol/mol
52
what is the normal HbA1c level?
approx 42 mmol/mol
53
what is the pre diabetes range of Hb1Ac?
42-47 mmol/mol
54
what is the range of HbA1c for diabetics?
> 48 mmol/mol
55
what is the target range for HbA1c in diabetics?
48-53 mmol/mol
56
over what Hb1Ac value is it classed as very poor glycemic control with very high risk of complications?
70 mmo/mol
57
what is the target range for glucose before meals in diabetics?
4-7
58
what is the target range for glucose after meals in diabetics?
5-9
59
what is the immediate treatment of hypoglycaemia?
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
what is the treatment of severe hypoglycaemia?
glucagon 1g: inject into the buttock/arm or thigh
61
what may happen to a patient who has just regained consciousness after a hypo?
nausea
| vomiting
62
what is diabetic ketoacidosis
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
what is the biochemical criteria for the diagnosis of DKA?
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
what are the common precipitants of DKA?
```
infection
illicit drugs
alcohol
non-adherence with treatment
new diabetes diagnosis
```
65
what are the typical osmotic related symptoms & signs of DKA?
thirst & polyuria
| dehydration
66
what are the typical ketone body related symptoms & signs of DKA?
flushed
vomiting
abdominal pain & tenderness
breathless
67
what is the breathlessness associated with DKA known as?
Kussmaul's respiration
68
name 2 conditions associated with DKA?
underlying sepsis
| gastroenteritis
69
what is the classical biochemical presentation of DKA; glucose
median level around 40 mmol/L (normal
70
what is the classical biochemical presentation of DKA; potassium
usually
71
what is the classical biochemical presentation of DKA; creatinine
often raised
72
what is the classical biochemical presentation of DKA; sodium
often reduced
73
what is the classical biochemical presentation of DKA; lactate
raised lactate is very common
74
what is the classical biochemical presentation of DKA; blood ketones
usually raised above 5
75
what is the classical biochemical presentation of DKA; bicarbonate
76
what is the classical biochemical presentation of DKA; amylase
very frequently raised
77
what is the classical biochemical presentation of DKA; WCC
usually around 25
78
what are the normal causes of death associated with DKA in adults?
```
hypokalaemia
aspiration
pneumonia
ARDS
co-morbidities
```
79
what are the normal causes of death associated with DKA in children?
cerebral oedema
80
which losses should be replaced in the management of DKA?
```
fluid
insulin
potassium
phosphate (rarely)
bicarbonate (almost never)
```
81
how can ketones be monitored?
blood ketone testing
| urine ketone testing
82
what ketone is measured in the blood?
beta-hydroxybutyrate
83
what ketone is measured in the urine?
acetoacetate
84
what does ketonuria indicate?
levels of ketones 2-4 hours previously
85
HHS
hyperglycaemic hypersomolar syndrome
86
what are the risks associated with HHS?
CVS event
sepsis
medications: glucocorticoids & thiazides
87
what is the classical biochemical presentation of HHS; glucose
higher than in DKA, usually around 60
88
what is the classical biochemical presentation of HHS; renal
significant renal impairment
89
what is the classical biochemical presentation of HHS; sodium
may be raised on admission
90
what is the classical biochemical presentation of HHS; osmolality
often around 400
91
what is osmolality?
2[NA+K] + urea + glucose
92
what is the normal osmolality range?
285-295
93
what is type A lactic acidosis associated with?
tissue hypoxaemia
94
when may type B lactic acidosis occur?
liver disease
| leukaemic states
95
which type of lactic acidosis is associated with diabetes?
type B
96
what are the clinical findings of lactic acidosis?
hyperventilation
mental confusion
stupor or coma if severe
97
what is the classical biochemical presentation of lactic acidosis; bicarbonate
reduced
98
what is the classical biochemical presentation of lactic acidosis; anion gap
raised
99
what is the classical biochemical presentation of lactic acidosis; glucose
often raised variable
100
what is the classical biochemical presentation of lactic acidosis; ketones
absence of ketonaemia
101
what is the classical biochemical presentation of lactic acidosis; phosphate
raised
102
is DKA common or rare?
common medical emergency
103
which age group is DKA usually seen in?
young adults
104
is HHS more common or rarer than DKA?
much rarer but higher associated mortalitiy
105
is lactic acidosis a medical emergency or not?
it is a medical emergency
