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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 caloric 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
Give examples of long acting insulin
Lantus | Levemir
26
What types of insulin combines a rapid analogue and a intermediate formulation of insulin?
Humalog Mix 25 Humalog Mix 50 Novomix 30
27
Give examples of short acting insulin preparations
Humulin S Actrapid Insuman Rapid
28
What type of insulin combines a short acting and intermediate acting insulin?
Humulin M3 | Insuman Comb 15, 25, 50
29
Describe the difference between Macrovascular and Microvascular complications
MACROVASCULAR: Heart Disease and Stroke MICROVASCULAR: Retinopathy, Nephropathy, Neuropathy
30
What can hyperglycaemia in Type 2 diabetes effectively decrease?
Insulin secretion Glucose uptake Incretin effect
31
What processes are increased by hyperglycaemia in Type 2 Diabetes?
Lipolysis Glucose reabsorption Hepatic Glucose Production Glucagon secretion
32
At what BMI do females start to become at risk of Type 2 Diabetes?
25 | this can be lower in certain ethnicities
33
How many hours does a patient need to have not eaten for a Fasting glucose test to take place?
8-12 hours
34
Describe the format of an Oral Glucose Tolerance Test?
No food or drink for 8-12 hours prior to test Glucose drink given Blood glucose tested after 2 hours
35
When is it appropriate for insulin to be omitted?
Insulin should NEVER be omitted due to the risk of Diabetic Ketoacidosis (DKA)
36
How does DKA usually present?
Inability to swallow or keep fluids down Persistant vomiting and diarrhoea Strongly positive ketonuria/ketonaemia +/- hyperglycaemia Dehydration Abdominal pain Rapid or laboured respirations
37
What medications are documented on Diabetes "Sick Day" cards and how long should they be stopped for when unwell?
``` ACE ARB Diuretics Metformin NSAIDs ``` **stop for 24-48hrs**
38
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?
Test for autoantibodies => GAD/IA2 Test for C-peptide
39
How does Type 1 diabetes present histologically?
Lymphocytes attacking the islet
40
How does Type 2 diabetes usually present histologically?
Amyloid deposits
41
If a parent has Type 1 diabetes, what is the likelihood of their child inheriting Type 1 diabetes?
Mother 3-4% | Father 8-10%
42
What gene mutations account for 50% cases of T1DM?
HLA genes
43
What gene mutations pose the highest risk of developing T1DM?
DR3-DQ2 | DR4-DQ8
44
What environmental factors have been identified to trigger T1DM?
Viral infection Maternal factors Weight gain
45
What are the 4 Ts to clinically diagnose Type 1 Diabetes?
Toilet (polyuria) Thirsty (polydipsia) Thinning (weight loss) Tired (fatigue)
46
What infections are usually present in patients presenting with diabetes, and why?
Candidal infection: - Pruritis vulvae - Balanitis Due to excreting glucose in urine which irritates the end of the urinary tract
47
Explain the basis of T1DM treatment
- Blood glucose and ketone monitoring - Insulin: usually basal [once daily] and bolus [with meals] - Carbohydrate estimation for accurate insulin use
48
What should be checked in a diabetes annual review consultation?
``` Weight Blood pressure Bloods: HbA1c, Renal Function and Lipids Retinal screening Foot risk assessment ``` **Record severe hypoglycaemic episodes or admission with diabetic ketoacidosis**
49
What percentage of patients with Cystic Fibrosis develop CF related diabetes
20%
50
What does LADA stand for and how is it defined?
Latent Onset Diabetes of the Adult | A slowly progressive subtype of Type 1 Diabetes
51
How long does it normally take for each phase of insulin to be released?
Rapid phase of pre-formed insulin lasts 5 to 10 mins Slow phase over 1 to 2 hours
52
Prior to what age does Neonatal diabetes occur?
6 months
53
When should LADA be suspected?
- young adults 25 to 40 - Male - Non-obese - Auto-antibody positive - Associated auto-immune conditions - Non-insulin requiring at diagnosis
54
What type of therapy is preferred in CF related diabetes?
Insulin therapy
55
What features are often seen in Bardet-Biedl Syndrome?
- Often very obese - Polydactyly - Hypogonadal - Visual and hearing impairment - Mental retardation - Diabetes
56
What other autoimmune conditions are associated with T1DM?
``` Thyroid disease Coeliac disease Pernicious Anaemia Addison’s disease IgA deficiency ```

Endocrine (24 decks)

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