Diabetes Flashcards
The incidence of Type 1 diabetes is rising. TRUE/FALSE
TRUE
the incidence of both type 1 and 2 diabetes are rising, however type 2 is rising at a faster rate
What blood tests can be used to diagnose diabetes?
HbA1c
Fasting Glucose
2hr OGTT
What are the ranges of HbA1c that would indicate pre-diabetes or diabetes?
<41m/m = NORMAL 42-47m/m = Pre-Diabetes >48m/m = Diabetes
Above what fasting glucose is diabetes thought to be the cause?
7mmol/L
Compare the normal, pre-diabetic and diabetic values of a 2hr OGTT result
NORMAL <7.7 mmol/L
Pre-Diabetes 7.8-11.0 mmol/L
Diabetes >11.1 mmol/L
What is considered “fasting” for a fasting glucose test?
no caloric intake for at least 8 hrs
What is the name given to diabetes which is diagnosed in the second or third trimester of pregnancy which was not evident beforehand?
Gestational diabetes mellitus (GDM)
What auto-antibodies are often found present in Type 1 Diabetes?
anti-GAD (GAD)
anti-islet cell (IA-2)
ZnT8
What kind of people usually present with Type 1 diabetes?
Pre-school and peri-puberty
Small peak in late 30’s
Usually lean
What symptoms do people present with in Type 1 diabetes?
Acute Onset
severe symptoms
severe weight loss
ketonuria / metabolic acidosis
What type of people usually present with Type 2 diabetes?
middle-aged/elderly
usually obese
pre-diagnosis duration of probably 6-10 years
What symptoms do people with type 2 diabetes present with?
insidious onset over weeks to years
ketonuria minimal or absent
evidence of micro-vascular disease
Testing should be considered in overweight/ obese patients who also display what possible risk factors?
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
How often and for how long should women who developed gestational diabetes be checked for development of Type 2 diabetes?
lifelong testing at least every 3 years.
What symptoms are common to both the presentations of Type 1 and 2 diabetes mellitus?
Thirst Polyuria Thrush Weakness Fatigue Blurred Vision Infections
Name the 4 main groups that can potentially cause Type 4 diabetes?
Pancreatic disease
Endocrine disease
Drug-induced
Abnormalities of insulin and its receptor (Genetic)
What is type 4 diabetes?
Diabetes caused by the presence of other health conditions
What pancreatic diseases contribute to Type 4 diabetes?
- Chronic/ recurrent pancreatitis
- Haemochromatosis
- Cystic Fibrosis
What endocrine disorders can cause Type 4 diabetes?
- Cushing’s syndrome
- Acromegaly
- Phaechromocytoma
- glucagonoma
What drugs can induce Type 4 Diabetes
Glucocorticoids
Diuretics
B-blockers
What genetic disorders cause the insulin receptor to malfunction, therefore creating Type 4 diabetes?
Cystic fibrosis
Myotonic dystrophy
Turner’s syndrome
What features are most important to look out for in monogenic diabetes?
Strong Family History Associated Features (renal cysts etc) Young Onset GAD-negative C-peptide positive
Give examples of rapid acting insulin
Humalog
Novorapid
Apidra
Give examples of intermediately acting insulin
Insulatard, Humulin I
Give examples of long acting insulin
Lantus
Levemir
What types of insulin combines a rapid analogue and a intermediate formulation of insulin?
Humalog Mix 25
Humalog Mix 50
Novomix 30
Give examples of short acting insulin preparations
Humulin S
Actrapid
Insuman Rapid
What type of insulin combines a short acting and intermediate acting insulin?
Humulin M3
Insuman Comb 15, 25, 50
Describe the difference between Macrovascular and Microvascular complications
MACROVASCULAR: Heart Disease and Stroke
MICROVASCULAR: Retinopathy, Nephropathy, Neuropathy
What can hyperglycaemia in Type 2 diabetes effectively decrease?
Insulin secretion
Glucose uptake
Incretin effect
What processes are increased by hyperglycaemia in Type 2 Diabetes?
Lipolysis
Glucose reabsorption
Hepatic Glucose Production
Glucagon secretion
At what BMI do females start to become at risk of Type 2 Diabetes?
25
this can be lower in certain ethnicities
How many hours does a patient need to have not eaten for a Fasting glucose test to take place?
8-12 hours
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
When is it appropriate for insulin to be omitted?
Insulin should NEVER be omitted due to the risk ofDiabetic Ketoacidosis (DKA)
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
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
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
How does Type 1 diabetes present histologically?
Lymphocytes attacking the islet
How does Type 2 diabetes usually present histologically?
Amyloid deposits
If a parent has Type 1 diabetes, what is the likelihood of their child inheriting Type 1 diabetes?
Mother 3-4%
Father 8-10%
What gene mutations account for 50% cases of T1DM?
HLA genes
What gene mutations pose the highest risk of developing T1DM?
DR3-DQ2
DR4-DQ8
What environmental factors have been identified to trigger T1DM?
Viral infection
Maternal factors
Weight gain
What are the 4 Ts to clinically diagnose Type 1 Diabetes?
Toilet (polyuria)
Thirsty (polydipsia)
Thinning (weight loss)
Tired (fatigue)
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
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
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
What percentage of patients with Cystic Fibrosis develop CF related diabetes
20%
What does LADA stand for and how is it defined?
Latent Onset Diabetes of the Adult
A slowly progressive subtype of Type 1 Diabetes
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
Prior to what age does Neonatal diabetes occur?
6 months
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
What type of therapy is preferred in CF related diabetes?
Insulin therapy
What features are often seen in Bardet-Biedl Syndrome?
- Often very obese
- Polydactyly
- Hypogonadal
- Visual and hearing impairment
- Mental retardation
- Diabetes
What other autoimmune conditions are associated with T1DM?
Thyroid disease Coeliac disease Pernicious Anaemia Addison’s disease IgA deficiency