diabetes mellitus - clinical features 2 W6

Question 1

type 1 diabetes symptoms at presentation?

Answer 1

polyuria, thirst
fatigue, malaise
weight loss
blurred vision
nausea, vomiting

Question 2

what happens if type 1 diabetes is not diagnosed early? what symptoms is this associated with and why?

Answer 2

diabetic ketoacidosis can occur (life threatening metabolic complication)

associated with nausea and vomiting due to the acidosis

Question 3

type 1 diabetes commonly presents in which age groups?

Answer 3

usually in childhood, adolescence or young adulthood

Question 4

type 1 diabetes - presentation - history?

Answer 4

short history (weeks) of florid osmotic symptoms and rapid weight loss.
ketonuria/ketonemia usually present

Question 5

how can type 1 diabetes lead to diabetic ketoacidosis?

Answer 5

because of insulin deficiency, glucose cannot enter fat and muscle cells as GLUT4 transportation doesn’t occur. this means tissues starved of glucose so fat and protein are used as alternative metabolic fuels, forming ketones which are acidotic.

Question 6

genetic element of type 1 diabetes?

Answer 6

strong genetic predisposition
genes concerned with autoimmunity.

environmental trigger (we don’t know what!) to autoimmune process in genetically susceptible individuals. leads to destruction of beta cells (generally T cell mediated)

can measure autoimmune antibodies in the blood.

Question 7

development of type 1 diabetes?

Answer 7

stage 1 - insulitis (inflammatory cell infiltration into islet), normal BG levels.

stage 2 - progression of autoimmune dysfunction. deficiency of insulin, blood glucose levels affected (pre-diabetic state).

stage 3 - clinical onset, 80% islets destroyed. hyperglycaemia.

Question 8

genetic risk of type 1 diabetes?

Answer 8

30x more likely if both parents have diabetes

Question 9

autoimmune disorders associated with diabetes?

Answer 9

thyroid disease (graves disease, Hashimoto’s)
pernicious anaemia
coeliac disease
Addison’s disease
vitiligo

Question 10

impact of type 1 diabetes on daily life?

Answer 10

hypoglycaemia - driving, employment
risks of diabetic ketoacidosis
pregnancy
childhood and adolescence
complications

Question 11

what is secondary diabetes? common grouping?

Answer 11

diabetes secondary to other health problems
exocrine pancreas disorders

Question 12

exocrine pancreas disorders?

Answer 12

pancreatectomy
trauma
tumours

Question 13

endocrinopathies?

Answer 13

endocrine disorders -
acromegaly
pheochromocytoma
Cushing’s disease

Question 14

exogenous glucocorticoids? link to diabetes?

Answer 14

eg prednisolone
steroid therapy exacerbates insulin resistance, higher risk of diabetes

Question 15

what is monogenic diabetes caused by

Answer 15

single gene defect altering beta-cell function

Question 16

maturity-onset diabetes of the young (MODY)?

Answer 16

type of monogenic diabetes
early-onset diabetes
non insulin-dependant diabetes
autosomal dominant inheritance
obesity unusual
caused by single gene defect altering beta-cell function
1-2% of ‘type 2’ diabetes (not really type 2 diabetes, separate form)