Diabetes Flashcards
Is is important to think of diabetes as what type of disease?
Vascular
What is insulin dependent diabetes?
Damage to beta cells is the cause
What is insulin independent diabetes + give 2 examples?
Beta cells are functional so condition caused by other factors
Resistance
Channel mutations
What is HbA1c and what + what is the normal level + what is the level diabetes is diagnosed at + target level for reducing microvascular complications?
Average blood glucose over 3 months
< 41 mmol/l
> 48 mmol/l
< 53 mmol/l
Name 3 tests for diagnosing diabetes.
Fasting glucose
Random glucose
Oral glucose tolerance test
How long is a fasting glucose + how long and how much glucose for an OGTT?
Fasting = 8 hours OGTT = 75g and 2 hours
How many venous glucose samples for symptomatic and non-symptomatic DM patients?
1 for symptomatic
2 for non-symptomatic
Diagnosis of DM for symptomatic patients?
Presence of classic symptoms
Fasting glucose > 7
Random or OGTT > 11.1
Diagnosis of DM for non-symptomatic patients?
2 separate findings of:
Fasting glucose > 7
Random or OGTT > 11.1
HbA1c > 48 mol/l
What is T1DM?
Autoimmune beta cell loss causing insulin deficiency
Is T1DM associated with other autoimmune conditions. If so, what is the genetic link?
Yes
DR3, DR4, DQ2 and DQ8 genes
How can T1DM present?
Young Weight loss Fatigue Polyuria/dipsia DKA
Name 3 islet cell autoantibodies associated with T1DM + do they appear before or after symptoms?.
GAD65
IA-2
ZnT8
Before symptoms
What is the general treatment for T1DM?
MDI or insulin pump (CSI)
DAFNE education
What 4 things can be tested in the blood for T1DM and will they be high/low/present/absent?
Autoantibodies = present
C-peptide = low
HbA1c = high
Blood glucose = high
Name a complication of MDI.
Lipohypertrophy
Name 2 common MDI regimes for T1DM.
BD - 2 x mixed insulin
QD - bedtime long acting + rapid acting before meals
What is LADA?
T1DM subtype presenting later in life
What are the SICK day rules + which 2 DM drugs need to be stopped + 3 other drugs which need to be stopped?
S (sugar) = check BG every 2-3 hours I (insulin) = keep taking insulin C (carbs) = keep eating and drinking K (ketones) = check ketones every 4 hours Metformin and SGLT2i ACEi/ARB, NSAIDs, diuretics
T1DM has a … concordance in twins and T2DM has a … concordance meaning … is more genetically influenced?
30%
80%
T2DM
What is T2DM?
Reduced insulin sensitivity causing hyperinsulinemia
How can T2DM present?
Older Obese Polydipsia/uria Fatigue Thrush/UTI Visual blurring Mental health issues Erectile dysfunction
Will C-peptide be high or low in T1DM + T2DM?
T1DM = low T2DM = high
Name a cutaneous sign of insulin resistant diabetes.
Acanthosis nigricans
Name 7 risk factors for T2DM.
Smoking Obesity Alcohol Anti-psychotics Asian CVD POS
How often should people with HbA1c > 39 or IGTT/IFG be screened?
Every year
Name 3 tests that diagnosed diabetics should have every year.
Retinal screening
Foot screening
Kidney screening
What is the stepwise treatment for T2DM?
Lifestyle changes Metformin (or SU) Metformin + 1 Metformin + 2 Insulin therapy
What 2 other drugs should be considered in the treatment of T2DM to reduce CVD disease?
Statin if > 40
Anti-hypertensives
What is metabolic syndrome (syndrome X)?
Having a range of risk factors for stroke, CVD and diabetes
Name the 5 features of metabolic syndrome.
Visceral obesity Insulin resistance Hypertension Hypertriglyceridemia Low HDL
What is MODY + inheritance + age of onset?
AD monogenetic diabetes
< 25
Which 2 features of T1DM does MODY lack?
Auto-antibdies
DKA
Name the 3 types of MODY in order of prevalence + mutation.
MODY 1,3 and 5 = HNF TF
MODY 2 = glucokinase
MODY X = none
Name the 3 differences between MODY 2 and MODY 1, 3 and 5.
MODY 2 = birth onset, complications rare, stable hyperglycaemia
MODY 1, 3 and 5 = young adult onset, complications common and unstable hyperglycaemia
What is the treatment and for MODY 2?
Diet modification
What is the treatment for MODY 1, 3 and 5?
Diet + SU + insulin
Name 2 conditions caused by Kir6.1 and SUR1 subunit mutations.
Congenital hyperinsulinism
Neonatal diabetes
Name the 2 subtypes of neonatal diabetes and how they are treated.
Transient = periodic insulin Permanent = lifelong insulin + SU
What is the target BG before a meal and 1-2 hours after?
Before = 3.9-7.2 mmol/l After = < 10 mmol/l
