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Endocrinology Dundee Y2 > Diabetes > Flashcards

Diabetes Flashcards

1
Q

Diagnosis of Diabetes

A

HbA1c ≥ 6.5% //
FPG ≥ 7.0 mmol/L (no caloric intake for at least 8 hours) //
2-h PG ≥ 11.1 mmol/L during OGTT (75g glucose in water) //
random plasma glucose ≥ 11.1 mmol/L + symptoms of hyperglycaemia or hyperglycemic crisis

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2
Q

Type 1 Diabetes

A

Autoimmune T-cell mediated disease that causes Beta cell destruction, usually leading to absolute insulin deficiency

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3
Q

Type 2 Diabetes

A

Progressive insulin secretory defect on the background of insulin resistance

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4
Q

Gestational diabetes mellitus

A

Diabetes diagnosed in the 2nd or 3rd trimester that is clearly not overt diabetes

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5
Q

Other causes of diabetes

A

MODY
Neonatal diabetes
Disease of exocrine pancreas - CF
drug/chemical induced diabetes - treatment of HIV/organt transplantation

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6
Q

T1DM association

A

Thyroid, Coeliac (1:20), Addison/s, pernicious anaemia, vitiligo

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7
Q

Eisenbarth 1996

A

Genetic susceptibility
Environmental trigger
Prolonged prodrome (months-years)
80-90% loss of beta cell function before marked hyperglycaemia

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8
Q

What is LADA

A 
Latent Autoimmune Diabetes of Adulthood
20% of T2DM
slowly-progressive
non-obese, no FHx T2DM, >35y, mild IR, low c-peptide, HLA positive
insulin independence in 6y
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9
Q

Polyglandular endocrinopathy type 2

A

Type 1 diabetes may be associated with any/all of: Addison/s disease, Hypothyroidism, Hypogonadism, Vitiligo, Coeliac

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10
Q

Type 1 endocrinopathy

A

mild immune deficiancy (mucocutaneous candidiasis) + T1DM associated with Addisons/ Hypothyroidism/ Hypogonadism/ Vitiligo/ Coeliac/ + Alopecia/ Pernicious Anaemia/ Hypoparathyroidism

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11
Q

T1DM in Scotland

A 
>228,000
1:25 
Many undiagnosed
12% of diabetic population
other diabetes types account for 0.6%
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12
Q

Islet antibodies

A

IA-2
IA-2β
GAD
Zn-T8

Autoantibodies typically present in 70-80% of newly diagnosed

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13
Q

5y risk of T1D if antibody positive

A

1 Ab: 20-25%
2 Ab: 50-60%
3 Ab: 70%

(IA2,GAD, Znt8)

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14
Q

What is GAD

A

Glutamate Decarboxylase Antibody

  • converts glutamate to GABA
  • 75-84% of recent onset T1DM
  • F>M
  • 10-15% of T2DM
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15
Q

Genetics of T1DM

A

HLA-DR3 and HLA-DR4 genes

Chromosome 6

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16
Q

what does c-peptide tell you

A

insulin in the blood

17
Q

Insulin actions

A

stimulate glucose uptake in the skeletal muscle
inhibit gluconeogenesis
inhibit lipolysis

18
Q

Glucagon actions

A

stimulate gluconeogenesis

stimulate lipolysis

19
Q

Accelerated starvation in insulin deficiency

A 
Decreased glucose uptake
-hyperglycaemia
-glycosuria
Increased protein catabolism
-increased plasma AAs
-urinary nitrogen loss
Increased lipolysis
-increased plasma FFA
-ketogenesis
-ketonuria
20
Q

Counter-regulatory failure in T1DM

A

glucagon not really increased in hypoglycaemia

21
Q

Type 1 Diabetes Clinical Presentation

A

Polyuria
Polydipsia
Weight loss
General Malaise

22
Q

Diabetic Ketoacidosis

A 
Vomiting, Abdominal pain
Altered consciousness,
Acidotic breathing
Kussmaul's breathing
pH < 7.3
urine ketones +++
dehydrated
severe or untreated leads to coma and death
23
Q

T1DM presentation - textbook scenario

A 
Acute onset
DKA / severe symptoms
peak: pre-school and peri-puberty
non-obese
insulin dependent
FHx uncommon
24
Q

T2DM presentation -textbook scenario

A 
Slow onset - 6-10y before presentation
middle-aged / elderly
obese &amp; sedentary
non-insulin dependent
FHx common
25
Q

T1DM diagnosis

A

GAD, IA2, ZnT8 used in diagnosis - make sure you don’t misdiagnose
<30 years in 60%

26
Q

short acting insulin

A

lispro - 15 minutes before meal

27
Q

long acting insulin

A

glargine - single bedtime dose

28
Q

% of insulin granules are in RRP

A

5

29
Q

KATP channel consists of

A

SUR1 Kir6

30
Q

sulphonylureas & mechanisms of action

A 
inhibits KATP (SUR1)
tolbutamide, glibenclamide
31
Q

diazoxide

A

stimulates KATP

helps congenital hyperinsulinism

Endocrinology Dundee Y2 (2 decks)

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