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Endocrine > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What defines diabetes?

A

Elevation of blood glucose above a diagnostic threshold

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2
Q

What are the thresholds for diagnosis of diabetes:

  • fasting glucose levels
  • 2hr plasma glucose
  • HbA1c
A

fasting = 7mmol/l

2hr plasma glucose after glucose tolerance test = 11.1mmol/l

HbA1c = 48mmol/l

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3
Q

If someone is asymptomatic what must be considered when trying to diagnose diabetes?

A

Repeat confirmatory test is required

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4
Q

The thresholds for diabetes diagnosis are based on what?

This is different in gestational diabetes. What is that threshold levels based on?

A

Risk of developing retinopathy

Gestational = risk to foetus/neonate

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5
Q

How is endogenous insulin secretion measured?

A

C-peptide levels

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6
Q

What causes type 1 diabetes?

Pancreatic autoantibodies can be used to aid diagnose. Name the 3 antibodies used

A

Autoimmune destruction of pancreatic beta cells

GAD
Znt8
IA-2

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7
Q

Diabetes can cause microvascular and macrovascular complications.

What one refers to “diabetes specific” complications?

Give 3 examples of each

A

Microvascular

  • retinopathy
  • neuropathy
  • nephropathy

Macrovascular

  • MI/ACS
  • Stroke
  • PVD
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8
Q

Diabetes can present asymptomatically esp. in type 2.

How would it present symptomatically though? (6)

A
  • Polyuria
  • Increased thirst
  • Genital thrush
  • Fatigue
  • Blurred vision
  • Weight loss
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9
Q

Why must you always rule out type 1 diabetes first in diagnosis?

A

Can be fatal if left untreated

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10
Q

What is HbA1c?

It can be used to show blood sugar levels over past 90 days. How?

A

Hb that has bound with glucose in RBC

HbA1c lasts as long as RBC lasts

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11
Q

What is used to monitor diabetes?

A

HbA1c

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12
Q

How much weight loss can result in remission in T2?

A

10-15% weight loss

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13
Q

In diabetes what is the HbA1c target?

This changes if the patient is on insulin/triple oral therapy. What does it change to?

A

7%/53 mmol/l

Triple therpay/insulin - 58mmol/l

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14
Q

For diabetic inpatients what is the desirable and what is the accepted blood glucose levels?

A

Desirable = 6-10mmol/l

Acceptable = 4-12mmol/l

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15
Q

How often should patients with subcutaneous insulin have blood glucose tested vs. IV insulin patients?

A

Subcutaneous - prior to each injection

IV - hourly

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16
Q

Who should have their blood glucose levels monitored twice daily as opposed to once daily when an inpatient. Patients on sulphonylureas or metformin?

A

Sulphonylureas - twice daily

Metformin - once

17
Q

What impact can corticosteroids have on blood glucose and why?

A

Leads to impaired insulin sensitivity -> hyperglycaemia

18
Q

Diabetic patients stay in hospital longer than non-diabetics. True or flase?

A

True

19
Q

Select from the list below the following circumstances where you would refer to diabetic team in 24hrs:

  • Complications
  • Active foot problem
  • Vomiting
  • Treatment with corticosteroid
  • Ketoacidosis
  • Pregnant
  • new T1 diabetes
  • recurrent/ severe hypoglycaemia
  • insulin initiation
  • poor control
  • sepsis
  • IV insulin use for 48hrs+
A
  • complications
  • active foot problem
  • new T1 diagnosis
  • pregnant
  • ketoacidosis
  • recurrent/severe hypoglycaemia
  • insulin initiation
  • poor control
20
Q

Where are the 4 sites of injection for insulin?

A

Abdomen
Upper outer thigh
Buttock
Upper outer arm

21
Q

Why is it important to rotate site of injection?

A

Reduce risk of lipohypertrophy

22
Q

What layer must insulin injection go into?

A

Subcutaneous tissue

23
Q

Insulin must be documented on two forms. True or false?

A

True

24
Q

What insulin should not be kept in the fridge?

A

Opened vials can be stored at room temp for up to 1month

25
Q

Describe the pathophysiology of T2 diabetes?

With link to obesity and genetics

A 
Exceed the fat storage threshold
->
Increase in FFAs and visceral fat 
->
LIPOTOXICITY
->
vulnerable beta cells *due to genetics*
->
inability to produce sufficient insulin 
->
T2 diabetes
26
Q

What tests must be done on a patient with a raised blood glucose in clinic?

A
  1. Ketones
  2. HbA1c
  3. Pancreatic autoantibodies
27
Q

Under what circumstances MUST a ketone test be done?

What number of ketones is high?

A

If patient presents with blood sugar >15mmol/l

> 3 (anything <1 is ok)

28
Q

When is a C-peptide test used?

A

3 years after diagnosis - confirms T1 diabetes

29
Q

T1DM is still producing insulin after 3-5 years - shown by still having C-peptide. What needs to now be considered?

A

Their initial diagnosis was wrong - this is very unlikely to be T1DM

30
Q

What type of diabetes is more likely to present with evidence of microvascular disease?

A

T2 due to regularly being undiagnosed for many years

31
Q

What is LADA?

A

latent autoimmune diabetes of adult (late onset T1) - often misdiagnosed as T2

32
Q

What resp disease has a strong association with diabetes?

A

CF

esp. those with (delta)508 mutation

33
Q

What is acanthosis nigricans?

In what conditions would it be seen?

A

Insulin driven epithelial overgrowth
- darkened discolouration in body folds and creases

Seen in cases with v high insulin in blood
Obesity - most common
Severe insulin resistant T2
Monogenic diabetes

34
Q

What does MODY stand for?

A

Maturity onset diabetes of the young

35
Q

MODY is caused by genetic mutations. There are two main causes of MODY, mutations in transcription factors and mutations in glucokinase. Describe them both in terms of the following factors;

  • Onset
  • Gets progressively worse?
  • Complications common?
  • Able to manage through diet alone?
  • Response to OGTT (oral glucose tolerance test)
  • Beta cells damaged?
A

Glucokinase

  • onset from birth
  • stable hyperglycaemia
  • complications rare
  • diet alone
  • manage a OGTT
  • no damage to beta cells

Transcription factors (more common)

  • onset from adolescene/YA
  • gets progressively worse
  • complications common
  • needs managed through drugs and diet
  • poor response to OGTT
  • beta cells damaged
36
Q

What are the transcription factors that can be damaged in MODY?

A

HNF-…

Endocrine (23 decks)

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