Diabetes Introduction Flashcards
Why does diabetes develop?
Insufficient insulin to maintain glucose homeostasis
What type of insulin deficiency is type 1 diabetes?
Absolute
What type of insulin deficiency is type 2 diabetes?
Relative
What is MODY?
Failure of insulin synthesis, release or activity
What are 2 causes of type 2 diabetes?
Inadequate insulin production, or insulin resistance
Overall, DM is a group of disorders characterised by what?
Hyperglycaemia
What HbA1c is diagnostic of diabetes? What is normal?
48mmol/mol or more (normal 41 or less)
What fasting glucose is diagnostic of diabetes? What is normal?
7mmol/l or more (normal 6 or less)
What 2 hour glucose in OGTT is diagnostic of diabetes? What is normal?
11.1mmol/l or more (normal 7.7 or less)
What random glucose is diagnostic of diabetes?
11mmol/l or more
With regards to HbA1c, fasting glucose and 2 hour glucose in OGTT, if a patient does not have the score which is diagnostic of diabetes, but are not within normal limits, what are they said to have?
Pre-diabetes
Briefly describe pre-diabetes?
A stage which can last for 15-20 years, with increased CV risk
What can be the causes of type 1 diabetes?
Autoimmune or idiopathic
There is destruction of what in type 1 diabetes? What does this result in?
Destruction of pancreatic beta cells, resulting in loss of insulin production
Type 1 diabetes can be characterised by the presence of what antibodies?
Anti-GAD // Anti-islet cell
What must you rule out in order to diagnose type 2 diabetes?
Type 1, MODY, any condition or treatments which would cause secondary diabetes
What are some pancreatic diseases which can cause secondary diabetes?
Pancreatitis, haemochromatosis
What are some endocrine diseases which can cause secondary diabetes?
Cushing’s, acromegaly, phaeochromocytoma, glucagonoma
What are some drugs which can cause secondary diabetes?
Glucocorticoids, diuretics, beta blockers
What are some genetic diseases which can cause secondary diabetes?
Turner’s, CF, myotonic dystrophy
Who does MODY occur in?
Generally young people (neonate to adulthood) with a strong family history
Will people with MODY have antibodies? Will they have C-peptide?
No antibodies, yes C-peptide
Neonatal diabetes occurs before what age?
< 6 months
What is gestational diabetes?
Any degree of glucose intolerance arising or diagnosed during pregnancy
What are the 4 main clinical features of diabetes? (4 T’s)
Tired, thirsty, toilet, thinner
As well as the 4 Ts, what are some other clinical features of diabetes?
Polyuria, weakness, blurred vision, infections
What else may patients present with, specific to type 2 diabetes?
Signs of complications
Weight loss is most likely a presentation of what type of diabetes?
Type 1
Ketonuria is seen in what types of diabetes?
Mainly type 1, sometimes secondary
What are 3 useful tests for type 1 diabetes?
GAD/islet cell antibodies, ketones, C-peptide
Is C-peptide always a sensitive test for type 1? Why/why not?
No- some people with type 1 will retain C-peptide for a few years after they stop producing insulin
What are the diagnostic tests for diabetes?
Random lab BG, fasting BG, OGTT, HbA1c
What does HbA1c provide?
A measure of glycemic control over the past 2-3 months
An HbA1c score of what implies bad control?
> 75mmolmol
Explain the oral glucose tolerance test?
Measure fasting BG. Take a very sweet tasting glucose drink. Take further BGs at 30 or 60 minute intervals for at least 2 hours.
In individuals without diabetes, what should happen to BG levels after 2 hours in the OGTT?
BG should have lowered, similar to the fasting state again (action of insulin)
In individuals with diabetes, what will happen to BG levels after 2 hours in the OGTT?
The BG will remain high, as there is no insulin allowing it to enter cells
Give 2 examples of macroscopic complications?
Heart disease and stroke (atheroma)
What are the 3 types of microvascular complications?
Retinopathy, nephropathy, neuropathy
Retinopathy can ultimately cause what? Nephropathy can ultimately cause what?
Ret = blindness, neph = kidney failure (preventable with screening)
