Diabetes and hypoglycaemia Flashcards
what is the problem in type I diabetes?
A pancreatic beta cell deficiency
what is the problem in type II diabetes?
Insulin resistance or a beta cell secretory defect of insulin
what is MODY?
maturity onset diabetes of the young
what is the age of onset of MODY?
under 25
how many parents are affected in MODY?
1
Is there insulin treatment given for MODY?
Not for the initial few years
what is the inheritance pattern for MODY?
autosomal dominant
what genes are involved in MODY?
NF1A HNF4A glucokinase HNF1B IPF1 NeuroD1
who are the at risk groups for gestational diabetes?
- obese
- previous GD
- previous baby birthweight >4.5kg
- fh of diabetes
- south Asian, black or African Caribbean or middle eastern
what is the fasting plasma glucose above in gestational diabetes?
5.6
what is the 2 hour plasma glucose above in gestational diabetes?
7.8
what is the fasting glucose in diabetes?
Above 7.00mmol/l
what is the random glucose above in diabetes?
11.1
what are advantages of HBA1C testing?
- standardised
- better index of overall glycaemic exposure
- less pre-analytical instability
- no need for fasting
- relatively unaffected by acute changes
what factors affect HBA1c levels?
- abnormal haemoglobin
- altered life span of RBC
- a recent blood transfusion
- anaemia
- ethnicity
- aging
when is HBA1c not appropriate for diagnosing diabetes?
- All young people
- suspected type 1
- symptoms under 2 months duration
- acutely ill
- medications that increase glucose such as steroids
- acute pancreatic damage
- pregnancy
what are clinical features of HONK?
- insidious onset
- vomiting
- confusion
- hypercoaguable state
- venous thrombosis
what is the biochemical diagnosis for HONK?
- hyperglycaemia
- high serum osmolality
- no acidosis or ketonaemia
what prevents ketone production in HONK?
Its due to insulin deficiency, but there is a small amount still that stops ketone production
what causes HONK?
- high sugar drinks
- intercurrent infection
- MI
- initial diagnosis
- medications such as glucocorticoids
what is the management for HONK?
- rehydration
- prophylactic heparin
- gentle insulin regime
- broad spectrum antibiotics
what are the microvascular complications of diabetes?
- nephropathy
- retinopathy
- neuropathy
what are the macrovascular complications of diabetes?
- heart
- head
- legs (peripheral vascular disease)
what are the three stages of diabetic retinopathy?
- background retinopathy
- diabetic maculopathy
- proliferative retinopathy
