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ENDOCRINE > Diabetes > Flashcards

Diabetes Flashcards

1
Q

The incidence of Type 1 diabetes is rising. TRUE/FALSE

A

TRUE

the incidence of both type 1 and 2 diabetes are rising, however type 2 is rising at a faster rate

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2
Q

What blood tests can be used to diagnose diabetes?

A

HbA1c
Fasting Glucose
2hr OGTT

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3
Q

What are the ranges of HbA1c that would indicate pre-diabetes or diabetes?

A 
<41m/m = NORMAL
42-47m/m = Pre-Diabetes
>48m/m = Diabetes
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4
Q

Above what fasting glucose is diabetes thought to be the cause?

A

7mmol/L

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5
Q

Compare the normal, pre-diabetic and diabetic values of a 2hr OGTT result

A

NORMAL <7.7 mmol/L
Pre-Diabetes 7.8-11.0 mmol/L
Diabetes >11.1 mmol/L

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6
Q

What is considered “fasting” for a fasting glucose test?

A

no calorie intake for at least 8 hrs

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7
Q

What is the name given to diabetes which is diagnosed in the second or third trimester of pregnancy which was not evident beforehand?

A

Gestational diabetes mellitus (GDM)

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8
Q

What auto-antibodies are often found present in Type 1 Diabetes?

A

anti-GAD (GAD)
anti-islet cell (IA-2)
ZnT8

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9
Q

What kind of people usually present with Type 1 diabetes?

A

Pre-school and peri-puberty
Small peak in late 30’s
Usually lean

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10
Q

What symptoms do people present with in Type 1 diabetes?

A

Acute Onset
severe symptoms
severe weight loss
ketonuria / metabolic acidosis

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11
Q

What type of people usually present with Type 2 diabetes?

A

middle-aged/elderly
usually obese
pre-diagnosis duration of probably 6-10 years

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12
Q

What symptoms do people with type 2 diabetes present with?

A

insidious onset over weeks to years
ketonuria minimal or absent
evidence of micro-vascular disease

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13
Q

Testing should be considered in overweight/ obese patients who also display what possible risk factors?

A

1st-degree relative with diabetes
High-risk race/ethnicity (e.g African American, Latino)
History of CVD
Hypertension
High triglyceride/ HDL cholesterol level
Women with polycystic ovary syndrome
Physical inactivity

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14
Q

How often and for how long should women who developed gestational diabetes be checked for development of Type 2 diabetes?

A

lifelong testing at least every 3 years.

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15
Q

What symptoms are common to both the presentations of Type 1 and 2 diabetes mellitus?

A 
Thirst 
Polyuria
Thrush
Weakness Fatigue
Blurred Vision
Infections
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16
Q

Name the 4 main groups that can potentially cause Type 4 diabetes?

A

Pancreatic disease

Endocrine disease

Drug-induced

Abnormalities of insulin and its receptor (Genetic)

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17
Q

What is type 4 diabetes?

A

Diabetes caused by the presence of other health conditions

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18
Q

What pancreatic diseases contribute to Type 4 diabetes?

A
  • Chronic/ recurrent pancreatitis
  • Haemochromatosis
  • Cystic Fibrosis
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19
Q

What endocrine disorders can cause Type 4 diabetes?

A
  • Cushing’s syndrome
  • Acromegaly
  • Phaechromocytoma
  • glucagonoma
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20
Q

What drugs can induce Type 4 Diabetes

A

Glucocorticoids
Diuretics
B-blockers

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21
Q

What genetic disorders cause the insulin receptor to malfunction, therefore creating Type 4 diabetes?

A

Cystic fibrosis
Myotonic dystrophy
Turner’s syndrome

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22
Q

What features are most important to look out for in monogenic diabetes?

A 
Strong Family History
Associated Features (renal cysts etc)
Young Onset
GAD-negative
C-peptide positive
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23
Q

Give examples of rapid acting insulin

A

Humalog
Novorapid
Apidra

24
Q

Give examples of intermediately acting insulin

A

Insulatard, Humulin I

25
Q

Give examples of long acting insulin

A

Lantus

Levemir

26
Q

What types of insulin combines a rapid analogue and a intermediate formulation of insulin?

A

Humalog Mix 25
Humalog Mix 50
Novomix 30

27
Q

Give examples of short acting insulin preparations

A

Humulin S
Actrapid
Insuman Rapid

28
Q

What type of insulin combines a short acting and intermediate acting insulin?

A

Humulin M3

Insuman Comb 15, 25, 50

29
Q

Describe the difference between Macrovascular and Microvascular complications

A

MACROVASCULAR: Heart Disease and Stroke

MICROVASCULAR: Retinopathy, Nephropathy, Neuropathy

30
Q

What can hyperglycaemia in Type 2 diabetes effectively decrease?

A

Insulin secretion
Glucose uptake
Incretin effect

31
Q

What processes are increased by hyperglycaemia in Type 2 Diabetes?

A

Lipolysis
Glucose reabsorption
Hepatic Glucose Production
Glucagon secretion

32
Q

At what BMI do females start to become at risk of Type 2 Diabetes?

A

25

this can be lower in certain ethnicities

33
Q

How many hours does a patient need to have not eaten for a Fasting glucose test to take place?

A

8-12 hours

34
Q

Describe the format of an Oral Glucose Tolerance Test?

A

No food or drink for 8-12 hours prior to test
Glucose drink given
Blood glucose tested after 2 hours

35
Q

When is it appropriate for insulin to be omitted?

A

Insulin should NEVER be omitted due to the risk ofDiabetic Ketoacidosis (DKA)

36
Q

How does DKA usually present?

A

Inability to swallow or keep fluids down

Persistant vomiting and diarrhoea

Strongly positive ketonuria/ketonaemia +/- hyperglycaemia

Dehydration

Abdominal pain

Rapid or laboured respirations

37
Q

What medications are documented on Diabetes “Sick Day” cards and how long should they be stopped for when unwell?

A 
ACE
ARB
Diuretics
Metformin
NSAIDs

stop for 24-48hrs

38
Q

If a diagnosis of Type 1 diabetes isn’t obvious in clinic, what test can be done to confirm that this is the correct diagnosis?

A

Test for autoantibodies => GAD/IA2

Test for C-peptide

39
Q

How does Type 1 diabetes present histologically?

A

Lymphocytes attacking the islet

40
Q

How does Type 2 diabetes usually present histologically?

A

Amyloid deposits

41
Q

If a parent has Type 1 diabetes, what is the likelihood of their child inheriting Type 1 diabetes?

A

Mother 3-4%

Father 8-10%

42
Q

What gene mutations account for 50% cases of T1DM?

A

HLA genes

43
Q

What gene mutations pose the highest risk of developing T1DM?

A

DR3-DQ2

DR4-DQ8

44
Q

What environmental factors have been identified to trigger T1DM?

A

Viral infection
Maternal factors
Weight gain

45
Q

What are the 4 Ts to clinically diagnose Type 1 Diabetes?

A

Toilet (polyuria)
Thirsty (polydipsia)
Thinning (weight loss)
Tired (fatigue)

46
Q

What infections are usually present in patients presenting with diabetes, and why?

A

Candidal infection:

  • Pruritis vulvae
  • Balanitis

Due to excreting glucose in urine which irritates the end of the urinary tract

47
Q

Explain the basis of T1DM treatment

A
  • Blood glucose and ketone monitoring
  • Insulin: usually basal [once daily] and bolus [with meals]
  • Carbohydrate estimation for accurate insulin use
48
Q

What should be checked in a diabetes annual review consultation?

A 
Weight
Blood pressure
Bloods: HbA1c, Renal Function and Lipids
Retinal screening
Foot risk assessment

Record severe hypoglycaemic episodes or admission with diabetic ketoacidosis

49
Q

What percentage of patients with Cystic Fibrosis develop CF related diabetes

A

20%

50
Q

What does LADA stand for and how is it defined?

A

Latent Onset Diabetes of the Adult

A slowly progressive subtype of Type 1 Diabetes

51
Q

How long does it normally take for each phase of insulin to be released?

A

Rapid phase of pre-formed insulin lasts 5 to 10 mins

Slow phase over 1 to 2 hours

52
Q

Prior to what age does Neonatal diabetes occur?

A

6 months

53
Q

When should LADA be suspected?

A
  • young adults 25 to 40
  • Male
  • Non-obese
  • Auto-antibody positive
  • Associated auto-immune conditions
  • Non-insulin requiring at diagnosis
54
Q

What type of therapy is preferred in CF related diabetes?

A

Insulin therapy

55
Q

What features are often seen in Bardet-Biedl Syndrome?

A
  • Often very obese
  • Polydactyly
  • Hypogonadal
  • Visual and hearing impairment
  • Mental retardation
  • Diabetes
56
Q

What other autoimmune conditions are associated with T1DM?

A 
Thyroid disease
Coeliac disease
Pernicious Anaemia
Addison’s disease
IgA deficiency

ENDOCRINE (22 decks)

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