Diabetes Flashcards
1
Q
pathogenesis of Type 1 diabetes
A
b-cell failure = absolute insulin deficiency
2
Q
pathogenesis of Type 2 diabetes
A
Hyperinsulinaemia + insulin resistance
Beta Cell dysfunction
3
Q
T1DM presentation
A
pre-school/pre-puberty severe weight loss ketonuria ± metabolic acidosis Tired polydipsia + polyuria i.e. very thirsty + peeing a lot
4
Q
T2DM presentation
A
middle-aged/elderly
usually obese
insidious onset over weeks to years
5
Q
risk factors for T2DM
A
central obesity
FH
Age
Phx of MI/stroke
6
Q
symptoms of DM
A
Thirst Polyuria Thrush Weakness Fatigue Blurred Vision Infections Weight Loss T2DM- Signs of complications- neuropathy, retinopathy
7
Q
useful discriminatory tests for type 1 and type 2
A
GAD/ Anti-Islet Cell antibodies
Ketones
C-peptide (plasma)
8
Q
what is LADA
A
late-onset type 1 diabetes
9
Q
what causes Type 3 diabetes
A
Pancreatic disease
Endocrine disease
Drug-induced
Abnormalities of insulin and its receptor i.e. Genetic diseases
10
Q
what pancreatic diseases can cause diabetes
A
Chronic or recurrent pancreatitis
Haemochromatosis
Cystic Fibrosis
11
Q
what endocrine diseases can cause diabetes
A
Cushing’s syndrome
Acromegaly
Phaechromocytoma
glucagonoma
12
Q
what drugs can cause diabetes
A
Glucocorticoids
Diuretics
B-blockers
13
Q
what genetic diseases are related to diabetes
A
Cystic fibrosis
Myotonic dystrophy
Turner’s syndrome
14
Q
what is Type 4 diabetes
A
Gestational diabetes:
i.e. Any degree of glucose intolerance arising or diagnosed during pregnancy
15
Q
what is HbA1c and why do we measure it
A
glycated hemoglobin
provides a measure of glucose control over past 2-3 months
16
Q
what are complications of diabetes
A
Micro-vascular: Retinopathy, Nephropathy, Neuropathy
Macro-vascular: Heart disease and stroke
17
Q
what Ix findings are suggestive of diabetes
A
Diagnose diabetes
Fasting glucose ≥ 7.0mmol/l
Random ≥ 11.1mmol/l
and symptoms, OR repeat test
18
Q
how can the type of diabetes be differentiated
A
Often Type 1 diabetes is diagnosed on the history and presentation (e.g. DKA) alone
GAD/IA2 antibodies [and C-peptide] may help
19
Q
what antibodies are related to Type 1 DM
A
GAD
IA2 antibodies
IAA
ZnT8Ab
20
Q
what can be seen on a histology slide of type 1 diabetes
A
lymphocytes attacking the islet
21
Q
what gene is associated with T1DM
A
HLA genes
22
Q
why can C-peptide be a diagnostic test
A
C-peptide is produced when insulin is made
if there is a low volume of C-peptide suggests that insulin is not being made
23
Q
what is the classic triad of DM
A
Polyuria
- Enuresis in children
Polydipsia
Weight loss
24
Q
what is enuresis
A
involuntary urination, especially by children at night.
25
Mx of newly diagnosed Type 1 DM
Blood glucose and ketone monitoring
Insulin: usually basal [once daily] bolus [with meals] regimen
Carbohydrate estimation
Regular check of prevailing glycaemic control
26
what is the ideal range of glucose control in T1DM
HbA1c 48 to 58 mmol/mol
27
insulin therapy in Type 1; for adults
either regular human or rapid-acting insulin analogues
28
insulin therapy in Type 1; for children/teens
either insulin analogues (rapid-acting or basal), regular human insulin and NPH preparations or an appropriate combination
29
where is insulin secreted to
portal vein
30
neonatal diabetes - Children diagnosed under the age of six months are more likely to have what
Monogenic
| rather than T1DM
31
when should LADA be suspected
```
age 25-40
male more often
non-obese
auto-antibody positive
associated auto-immune conditions
```
32
CF and diabetes relationship
found in ‘severe’ mutations, i.e. ∆508
prone to complications
insulin therapy preferred
33
what is Wolfram syndrome also known as and why
DIDMOAD
```
Diabetes Insipidus
Diabetes Mellitus
Optic Atrophy
Deafness
Neurological anomalies
```
34
presentation of Bardet-Biedl Syndrome
```
Often very obese
Polydactyly
Hypogonadal
Visual impairment
Hearing impairment
Mental retardation
Diabetes
```
35
what are the associated auto-immune conditions of diabetes
```
Thyroid disease
Coeliac disease
Pernicious Anaemia
Addison’s disease
IgA deficiency
Auto-immune polyglandular syndromes [Type 1 and Type 2]
```
36
what is Pernicious Anaemia
a deficiency in the production of red blood cells through a lack of vitamin B12
37
which type of Polyglandular Endocrinopathy is associated w/ T1DM
Type 2
38
what else is type 2 Polyglandular Endocrinopathy associated with
```
T1DM
Addison’s disease
Vitiligo
Primary hypogonadism
Primary hypothyroidism
Coeliac disease
```
39
what is type 1 Polyglandular Endocrinopathy associated with
Primary hypoparathyroidism/Pernicious anaemia/alopecia
40
what is insulin resistance
receptor is not as responsive to the insulin molecule and therefore less glucose enters the cell. This results in a build up of glucose in the blood
41
what causes Insulin Resistance
Ectopic Fat Accumulation and increase FFA circulation
+ increase inflammatory mediators
>>> Inhibition of insulin via serine kinases responsible for phosphorylation of Insulin Receptor Substrate-1 (IRS-1)
>>> Reduction in insulin-stimulated glycogen synthesis due to reduced glucose transport
42
what is insulin resistance a pre-cursor for
Type 2 diabetes
43
how does the beta cells initially compensate for increasing insulin resistance
body tries to compensate by producing more insulin as insulin resistance increases
44
when do blood glucose levels increase
when the beta cells burn out
45
what cause declining beta cell function
Glucotoxicity - hyperglycaemia
Lipotoxicity - elevated FFA, TG
46
what is the Metabolic Syndrome
at least three of five of the following:
- abdominal (central) obesity,
- elevated blood pressure,
- insulin resistance
- high serum triglycerides
- low HDL levels.
47
what is the therapy staircase for Type 2 diabetes
1 - diet and exercise
2 - oral mono therapy
3 - oral combination
4 - injectable and oral therapy
48
what are the risks with alcohol consumption in diabetes
Hypoglycaemia, esp. if no food (alcohol activity of insulin) - more prone if using insulin or sulphonylureas
‘Confusing’ hypo symptoms
49
what is MODY
Maturity onset diabetes of the young
Autosomal dominant inheritance
Non-insulin dependent diabetes
Age of onset usually before age 25
50
what are the 2 phenotypes of MODY
```
transcription factor (HNF-1alpha)
glucokinase (GCK)
```
51
what are HNF1A sensitive to
SU
52
what is the treatment of GCK MODY
does not require treatment
53
what can cause neonatal diabetes
potassium channel mutation
54
what are the two types of neonatal diabetes
Transient neonatal diabetes
(TNDM)
| Permanent neonatal diabetes
(PNDM)
55
what is PNDM treated with
SU's
56
what are symptoms of hypoglycaemia
```
shaking
sweating
anxious, irritable
dizziness
tachycardia
blurred vision
weakness
fatigue
headache
hunger
```
57
what can hypoglycaemia cause
seizures, unconsciousness
58
Tx of mild hypoglycaemia
Consume 15-20 grams of glucose or simple carbohydrates
| Recheck your blood glucose after 15 minutes
59
examples of 15grams of simple carbohydrates
glucose tablets
gel tube
coke/lucazade
60
Tx of severe hypoglycaemia
Glucagon 1 mg
- Inject into buttock / arm or thigh
- May cause nausea + vomiting
61
what is impaired hypoglycemia awareness
When hypoglycaemia occurs (4.0-3.5 mmol/l) and individuals feel no or a change symptoms.
62
what are common precipitant of DKA
infection - Gastroenteritis
illicit drugs and alcohol
non-adherence w/ treatment
newly diagnosed diabetes
63
symptoms/signs of DKA
```
Thirst/Polyuria/Dehydration
Flushed
Vomiting
Abdo pain and tenderness
Breathless - Kussmaul's respiration
```
64
classic biochemistry of DKA at presentation
Glucose: Median level around 40 mmol/L [Normal 5
65
Complications of DKA
Cerebral oedema
ARDS
Hypokalemia >> Cardiac dysrhythmia
66
Mx of DKA
IV fluids
- Potassium replace
- IV insulin
Supportive care
67
what do urine ketone testing machines measure
acetoacetate levels
68
when should a T1DM be admitted into hospital
```
Unable to tolerate oral fluids
Persistent vomiting
Persistent hyperglycaemia
Persistent positive/increasing levels of ketones
Abdominal pain / breathlessness
```
69
what is Hyperglycaemic Hypersomolar Syndrome (HHS)
complication of T2DM - severe hyperglycaemia, hyperosmolality, and volume depletion, in the absence of severe ketoacidosis.
70
features of HHS
Diabetes may be known, often not
If known, then often treatment is ‘diet alone’
Usually older individuals
Associated risks - MI, stroke, sepsis, Glucocorticoids and thiazides
71
symptoms/signs of HHS
altered mental state
thirsty/polyuria/weight loss
weakness
poor skin turgor
72
Tx of HHS
IV fluids
Supportive
Insulin
Treat underlying cause
73
what is lactic acidosis
when lactic acid builds up in the bloodstream faster than it can be removed
74
clinical features of lactic acidosis
Hyperventilation
Mental confusion
Stupor or coma if severe
75
lab findings of lactic acidosis
reduced bicarbonate
raised anion gap
raised phosphate
absent of ketonaemia
76
what is the target of type 2 diabetics glucose control
HbA1c 48mmol/mol
77
complications of diabetes
Macrovascular:
IHD
Stroke
Microvascular:
Neuropathy
Nephropathy
Retinopathy
Erectile Dysfunction
78
how does diabetes cause microvascular problems
reduced blood flow
79
precipitating factors of neuropathy
poor glycemic control
T1DM > T2DM
Smoking + Alcohol
increased length of diabetes
80
what are symptoms of Peripheral nerve damage (PND)
```
Numbness/ insensitivity
Tingling/ burning
Sharp pains or cramps
Sensitivity to touch
Loss of balance and coordination
```
81
complications of PND
infections/ulcers
deformities (hammertoes)
amputations
82
Tx of PND
Analgesia
| Stronger opiods
83
symptoms of Autonomic neuropathy
Constipation/Diarrhoea
Gastroparesis - nausea, vomiting, bloating
Oesophagus nerve damage - swallowing difficulty
84
what is Charcot foot
Fractures and dislocations of bones and joints that occur with minimal or no known trauma. Occurs in patients with neuropathy.
85
what is diabetic nephropathy
damage of capillaries in glomeruli
86
consequences of diabetic nephropathy
Development of hypertension
Relentless decline in renal function - can lead to Kidney failure
Accelerated vascular disease
87
what can be a sign of impending trouble
microalbuminuria
88
risk factors of nephropathy profession
hypertension
high cholesterol
smoking
albuminuria
89
what can be very useful in Tx of diabetic nephropathy
ACE inhibitors
90
what pathology of the eyes do diabetics get
diabetic retinopathy
cataract
glaucoma
visual blurring due to acute hyperglycamia
91
what are the stages of retinopathy
Mild non-proliferative
Moderate non-proliferative
Severe non-proliferative
Proliferative
92
what is seen in pre-proliferative retinopathy
Micro aneurysms, hard exudates, haemorrages
93
what is seen in Severe Non-proliferative Retinopathy
(IRMA, venous beading, haemorrages)
94
what is seen in severe proliferative retinopathy
new vessel formation
95
complications of diabetic retinopathy
bleeding - sudden change in vision
floaters
secondary glaucoma
retinal detachment
96
Tx of diabetic retinopathy
Laser
Vitrectomy
Anti-VEGF injections
97
what are guidelines in place to reduce chance of CHD in diabetics
Lipid lowering therapy in diabetes over age 40 regardless of baseline cholesterol
BP
98
what are psychiatric complications
Depression
Eating Disorders
Bi-polar
Schizophrenia
