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BDS2: Endocrine Diseases > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Describe diabetes mellitus in one sentence

A

Abnormality of glucose regulation

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2
Q

What percentage of diabetes cases are type 1 or type 2?

A

10% are type 1
85% are type 2
5% are neither 1 or 2 - monogenic

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3
Q

Describe diabetes insipidus in one sentence

A

Abnormality of renal function (water)

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4
Q

What is a major characteristic of a series of metabolic conditions which are represented by Diabetes mellitus?

A

Hyperglycaemia

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5
Q

What are the consequences of exposure to chronic hyperglycaemia?

A

•Increased risk of micro vascular complications (small capillaries supplying areas such as the skin)
- can result in conditions such as atherosclerosis

•Long term macro vascular disease (such as heart attacks and strokes)

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6
Q

What test is best to help with diagnosing diabetes mellitus?

A

Glucose tolerance test

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7
Q

Why is plasma glucose not the best method to establish a diagnosis?

A

Plasma glucose levels vary throughout the day

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8
Q

What test measures residual glucose stuck to the surface of haemoglobin and gives an indication of glucose control over the past few weeks?

A

HbA1C test

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9
Q

What glycosylated haemoglobin test (HbA1C) value does not require a fasting sample?

A

> 48mmol/mol(6.5%)

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10
Q

What random plasma glucose (RPG) value, when measured on 2 occasions is diagnostic of diabetes?

A

> 11.1 mmol/L

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11
Q

What fasting plasma glucose levels are considered normal, impaired and diabetic before a Glucose tolerance test is carried out?

A
  1. Normal:
    FPG<6.1
  2. Impaired fasting glucose:
    FPG 6.1-7.0
  3. Diabetes:
    FPG>7.0
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12
Q

What are the significant values for plasma glucose 2 hours after GTT (i.e after 75g of glucose is given after fasting) and what do they mean?

A
  • <7.8 = normal
  • 7.8-11.1= impaired glucose tolerance (IGT)
  • > 11.1 = diabetes
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13
Q

What causes type 1 diabetes?

A
  1. Type 1 is an insulin deficiency
    - caused by autoimmune destruction of pancreatic B cells
  • genetic causes also evident
    • type 1 diabetes in sibling = 6% risk vs 0.4% in gen pop
    • monozygotic twins = 40%
    • dizygotic twins = 10%

-Environmental causes evident
• migrants adopt incidence rate closer to that of new country

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14
Q

What factor determines the clinical presentation of type 1 diabetes?

A
  1. Rate of destruction of pancreatic B cells
  • slow destruction can lead to confusion with type 2 diagnosis in a late presenting T1DM
  • 80-95% of pancreatic B cells destroyed by time of presentation
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15
Q

What is the childhood incidence of type 1 diabetes?

A

25 in 100,000

  • increasing by 4% each year
  • higher in Europe, lower in Asia
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16
Q

What condition will usually be present in children with type 1 diabetes and why?

A
  1. Ketoacidosis
    - body cells cannot access glucose for metabolism so they start to metabolise fat which results in ketones as the end product
17
Q

What do low C-peptide levels indicate?

A

Low insulin secretion

18
Q

What circulating antibodies can be present in type 1 diabetes?

A
  1. GAD - glutamic acid decarboxylase
  2. ICA - islet cell antibodies
  3. IAA - insulin autoantibodies
19
Q

Describe childhood/adolescent onset of diabetes in terms of:

  • peak incidence
  • antibodies normally present
A
  1. Peak incidence at 10-14 years
    - however up to 60% of cases occur after age 16
  2. Classic antibodies present in children/young adults
    - higher ICA
    - higher IAA
20
Q

Describe adult onset of diabetes

A
  1. LADA - latent autoimmune diabetes in adults (>25 yrs of age)
  2. GAD associated - generally lower AB levels
  3. Less weight loss, less ketoacidosis
  4. May masquerade as non-obese type 2
  5. Variable period until insulin required
21
Q

What are the symptoms of type 1 diabetes?

A
  1. Polyuria
  2. Polydipsia
  3. Tiredness
22
Q

What is the acute presentation of type 1 diabetes?

A
  1. Hyperglycaemia with diabetic symptoms

2. Ketoacidosis (medical emergency)

23
Q

What is the incidence of type 2 diabetes and what are associated factors of the disease?

What is the most common age threshold?

A
  1. 90% of all cases - prevalence tripled in 30 years
    - strongly associated with obesity and inactivity
    - 12% of US population estimated to have it
  2. Usually found in patients over 40yrs old
    - transition through impaired glucose tolerance
    - maturity onset diabetes in the young is possible

• strong family history
- 100% concordance in identical twins with identical lifestyles

24
Q

What is type 2 diabetes characterised by?

A

Defective and delayed insulin secretion and abnormal postprandial suppression of glucagon

25
Q

What treatment has showing promising results in terms of remission of type 2 diabetes?

A

Bariatric surgery

26
Q

What is an external factor that contributes to type 2 diabetes

A

Medication

- a large number of medications can cause hyperglycaemia and lead to development of diabetes

27
Q

What metabolic changes occur in type 2 diabetes that involve insulin?

A
  1. Defect in insulin synthesis, secretion and action
    - B cell response to hyperglycaemia is inadequate
    - elevated basal insulin levels
    - failure of gluconeogenesis suppression
    - insulin stimulated glucose uptake is reduced
28
Q

What other metabolic changes occur in type 2 diabetes?

A
  1. Inadequate release of incretins (GLP-1, GIP)
    - Increased absorption of glucose from GI tract due to increased transporter
  2. Defect in pulsatile insulin secretion
    - portal vein and liver are the key targets
  3. Strong association with High levels of visceral fat - unclear why
29
Q

What is the collective term for all of the metabolic changes that occur in type 2 diabetes?

A

Insulin resistance

30
Q

List physiological and metabolic consequences of type 2 diabetes

A
  1. Impaired glucose tolerance
  2. Hyperinsulinaemia
  3. Hypertension
  4. Obesity with abdominal distribution
  5. Dyslipidaemia (High VLDL, Low HDL)
  6. Procoagulant epithelial markers
  7. Early and accelerated atherosclerosis
31
Q

Describe the onset of type 2 diabetes

A
  1. Gradual onset over many years
    - usually IGT for some time
    - often retinal damage at diagnosis (7-10yrs IGT)
    - ability to secrete insulin falls with time
32
Q

Describe the acute presentation of type 2 diabetes (this is rare)

A
  1. Rarely acute presentation
    - polyuria, polydipsia, tiredness (usually present)
    - unusual infections
    - diabetic complications (cardiovascular)
33
Q

What is the best way to slow the progression of type 2 diabetes?

A

Strict diet and exercise slows decline from impaired glucose tolerance (IGT)

34
Q

What medications induce diabetes?

A
  1. Medicines that interfere with the secretion of insulin or glucagon
    - medicines which alter tissue uptake of glucose

Examples:

  • corticosteroids
  • immune suppressants (cyclosporin, calcineurin inhibitors)
  • cancer medication - imatinib, nilotinib
  • antipsychotic medicines - clozapine, olanzipine, quetiapine
  • antiviral - protease inhibitors
35
Q

What other medical conditions can induce diabetes?

A
  1. Endocrine disease
    - cushings disease/syndrome
    - phaeochromocytoma (adrenaline tumour)
    - acromegaly
  2. Pregnancy - gestational diabetes
    • risk factors
    - overweight
    - family history of diabetes
    - some ethnic groups - Asian, Middle Eastern
    - gestational diabetes in a previous pregnancy
    • risk of developing type 2 diabetes mellitus in the future

BDS2: Endocrine Diseases (5 decks)

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