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diabetes in a nutshell Flashcards

1
Q

What are the thresholds fro diagnosis diabetes

A

Fasting glucose >7mmol/L +
Random or 2hr OGGT =/> 11.1mmol/L +
HbA1c = 48mmol/mol +

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2
Q

What are the thresholds for diabetes based upon

A

Risk of developing diabetic retinopathy

(Apart from gestational - this one based on risk to foetus)

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3
Q

What is C-peptide

A

Is it co-secreted with insulin

Can be used to measure endogenous insulin secretion ie if c-peptide is present in the blood it must be coming from beta cells

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4
Q

What is HbA1c

A

Haemoglobin exposed to glucose

This gives a measure of glucose exposed in the last 90ish days (RBcs have a life of around 90 days)

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5
Q

Type 1A DM

A

Account for vast majority of T1DM

Involves an environmental trigger in a genetically susceptible individual - autoimmune process within the pancreatic Beta cell

This one is immune mediated

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6
Q

Type 1B DM

A

Idiopathic

Permanent insulinopenia , these people are also prone to DKA
Have no evidence of beta cell dysfunction or autoantibodies

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7
Q

Peak age to get T1DM

A

10-14 years

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8
Q

Genetic susceptibility of T1DM

A

HLA genes - DR3-DQ2 and DR4-DQ8

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9
Q

If both parents have HLA alleles - what is the risk of their offspring developing diabetes ?

A

30%

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10
Q

Virus associated with T1DM

A

Coxsackie B4

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11
Q

Describe the pathophysio of T1DM

A

T-cell mediated autoimmune response with production of autoantibodies that target and destroy Beta cells

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12
Q

Other than random/fasting glucose adn HbA1c what else can help diagnosing T1DM

A

GAD/IA2 antibodies and C-peptide

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13
Q

When would a patient be eligible for pancreas transplant

A
  • episodes of severe hypoglycaemia
  • severe and progressive long-term complications despite maximal therapy
  • uncontrolled diabetes despite maximal treatment
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14
Q

Where would pancreatic islets be injected into (as part of a transplant)

A

Into the portal vein where they seed themselves into the liver

(Theses islets are harvested from cadavers)

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15
Q

Some reading on development of insulin resistance

A
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16
Q

What is Dononhue syndrome

A

Rare autosomal genetic trait involving mutations in the insulin receptor

Development abnormalities as well eg growth reetardation, absence of SC fat = caused by defects in insulin binding or insulin receptors signalling

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17
Q

What is MODY

A

Early onset of non-insulin dependent diabetes (usually before 25)

18
Q

What are the 3 types of genetic mutation in MODY

A

Transcription factors (75%)
Glucokinase (14%)
MODY X (11%)

19
Q

Differentiate between glucokinase mutation and transcription factor mutation

A

Glucokinase does well to bring down glucose after an OGGT

Transcription factor does not do well

20
Q

Management of Glucokinase MODY mutation

A

Can be managed with diet alone

21
Q

Mxm of transcription factor mutation

A

Diet , insulin or sulphonylureas

  • these types of MODY respond well to sulphonylureas
22
Q

Autoimmune destruction of beta cells is associated with what type of diabetes

A

T1DM

23
Q

What are the abnormalities of insulin action in T2DM

A

Insulin resistance occurs when fat can no longer be stored in subcutaneous adipose tissue causing spill over FFA to viscera (not everyone who has T2DM is obese - some people have lower fat holding threshold)

Increased tyrosine kinase activity —> decreased expression of GLUT —> decreased cellular glucose uptake

Central obesity —> impaired insulin dependent glucose uptake

24
Q

What disease is associated with T2DM

A

Acanthosis nigricans

25
Q

Mxm of T2DM lifestyle wise

A

Lifestyle = weight loss (10-15% loss can result in remission)

26
Q

1st line T2DM

A

Metformin + lifestyle change

27
Q

1st line for T2DM for patients with atherosclerotic CVD

A

Metformin + GLP-1 receptor (eg exenatide)

28
Q

1st line T2DM for patients with heart failure or CKD

A

Metformin + SGLT-2 (gliclazide)

29
Q

What is the monogenic mutation in neonatal diabetes

A

Mutations in the glucose sensing mechanism - in the ATP sensitive K+ channel

30
Q

Management of neonatal diabetes

A

(<6 months)

Sulphonylureas OR diazoxide

31
Q

What other diseases are you at risk of developing if you have T1DM

A

Addisons
Graves
Coeliac

32
Q

What is T1DM

A

Autoimmune disorder where insulin - producing beta cells of the islets of Langerhans in pancreas are destroyed

This results in an absolute deficiency of insulin > raised glucose levels

33
Q

What is T2DM

A

Most common case of diabetes in developed world

Cause by relative deficiency of insulin due to an excess of adipose tissue

‘There isn’t enough insulin to go around all the excess fatty tissue, leading to glucose creeping up’

34
Q

What does HbA1c measure

A

Glycosylated haemoglobin

Represents the average blood glucose over the past 90 days

35
Q

Why is insulin administered subcutaneously

A

Due to ease of administration - also because insulin absorption and action in the subcutaneous space are much more consistent than when it is delivered as an IM injection

It is preferred over IM as if it injected deep into your muscles - the body will absorb it too quickly and so will not last as long

36
Q

Why does a cranial DI respond to desmopressin ?

A

Cranial DI results from insufficient ADH secretion —> preventing kidneys from concentrating urine

Lack of ADH result in inability to concentrate urine even if a patient is hypovolaemic therefore urine osmolality is low in water deprivation

But kidneys are unaffected by cranial DI and so will respond to desmopressin (synthetic ADH) to produce a concentrated urine

(Nephrogenic DI = low urine osmolality for both)

37
Q

Action of empagiflozin

A

SGLT-2 inhibitors reversible inhibit sodium-glucose co-transporter 2 in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion

38
Q

Target blood pressure for those with hypertension under the age of 80

A

<140/90mmHg

39
Q

What is gastroparesis

A

Complication of diabetes related to poor glycemic control

Is caused by nerve damage to the autonomic nervous system (vagus responsible for gastric motility)

  • there is delayed gastric emptying, offensive burps, early satiety and morning nausea
40
Q

1st line for diabetic neuropathy

A

Pregablin , gabapentin

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