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Endocrine > Diabetes type 1 > Flashcards

Diabetes type 1 Flashcards

1
Q

What level of fasting glucose is needed to diagnose diabetes?

A

> 7.0 mmol/L

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2
Q

What random glucose levels are required to diagnose diabetes?

A

> 11.1 mmol/L

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3
Q

True or Fale

DKA is more common in type 2 diabetics

A

False.

DKA is only present in type 1

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4
Q

What can be seen on histology of an islet in type 1?

A

Lymphocytes

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5
Q

What are ICA?

A

Islet cell antibodies

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6
Q

What infection can be present in those with type 1?

A

Candiasis

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7
Q

What is balanitis?

A

Inflammation of the head of the penis

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8
Q

What is the only treatment for type 1?

A

Insulin (basally and bolus)

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9
Q

What is the ideal HbA1c range?

A

Below 59 mmol/L

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10
Q

What is studied at annual review?

A 
Weight
BP
Bloods- HbA1c, renal, lipids
Retinal screening
foot exam
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11
Q

True or False

There is often ketonuria in type 2

A

False.

Present in type 1

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12
Q

What are children under the age of 6 diagnosed with, rather than type 1?

A

Monogenic diabetes

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13
Q

What is type 1.5 diabetes?

A

Latent onset diabetes of adulthood.
LADA
This is type 1 diabetes.

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14
Q

What is LADA?

A

Elevated levels of pancreatic auto-bodies in patients who do not require insulin

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15
Q

When is LADA suspected?

A

Young males
Non-obese
Auto-antibodies +ve
Other autoimmune conditions

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16
Q

True or False

Diabetes is common in cystic fibrosis.

A

True

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17
Q

What are the symptoms of Wolfram syndrome?

A 
Diabetes insipidus
DM
optic atrophy
deafness
neurological abnormalities
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18
Q

What acronym can be used for Wolfram syndrome?

A

DIDMOAD

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19
Q

What causes Wolfram syndrome?

A

Genetic default in the wolfram gene which is present in the pancreas, inner ear and brain

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20
Q

What are the symptoms for Bardet-Biedl syndrome?

A 
Obese
Polydactyly
Hypogonadal
Visually/audally impaired
Mental retarded
Diabetes
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21
Q

What makes Bardet-Biedl syndrome more likely?

A

Parents who are related.

Consanguineous

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22
Q

In what types of diabetes are antibodies negative?

A

MODY

Type 2

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23
Q

Which autoimmune conditions are related to diabetes?

A

thyroid disease
coeliac
Pernicious anaemia
Addisons

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24
Q

How common is it to have coeliac disease in type 1?

A

1:20

Compared to 1% in population

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25
Q

What antibody is present in coeliac disease?

A

Anti TTG

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26
Q

What antibodies are present in diabetes type 1?

A

Anti-GAD

Anti islet

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27
Q

What other GP available tests can be done to exclude diabetes 2?

A

C peptide

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28
Q

What kind of tumour can cause diabetes?

A

Glucagonoma

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29
Q

Which drugs can induce diabetes?

A

Glucocorticoids
B blockers
Diuretics

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30
Q

What does HbA1c measure?

A

Control of glucose over the past few months

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31
Q

Which infection of the bone may be present in diabetic neuropathy?

A

Osteomyelitis

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32
Q

What antibodies may be present in type 1?

A

IA2
IAA
GAD
ZnT8

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33
Q

What relation does type 1 have with DVLA?

A

Must inform DVLA of diagnosis

34
Q

What HbA1c is ideal for a diagnosed type 1?

A

48-58 mmol/L

35
Q

How much does carbohydrate loading need to be changed by when exercising?

A

1g CHO per kg of body weight per hour exercising.

36
Q

What is DKA?

A

Absolute insulin deficiency with an increase in counter-regulatory hormone

37
Q

What is the danger of a DKA in young children?

A

Cerebral oedema

38
Q

What are the four possible regimes for insulin release?

A

SCII pumps
Basal bolus which mimics endogenous release
Twice daily
Once daily

39
Q

What factors need to be taken into account when calculating insulin dosages?

A

Carb intake
Pre-meal glucose
Anticipated activity

40
Q

Give an example of rapid acting analogue insulin

A

Humalog

Novorapid

41
Q

Give an example of short acting insulin/soluble

A

Humulin S

42
Q

Give an example of intermediate acting (isophane)

A

Insulatard

Humulin I

43
Q

Give an example of a long acting analogue

A

lantus

44
Q

How do rapid-intermediate analogue mixtures work?

A

Novomix30 - 30% short action. 70% basal insulin

45
Q

When is a once daily insulin inj. given?

A

Nursing homes, mental retardation.

46
Q

What is the standard treatment for T1D?

A

MDI 3/4 or CSII

47
Q

What is the target glucose levels pre-meal?

A

4-7mmol/L

48
Q

What is the target glucose levels post-meal?

A

less than 9

49
Q

What are the education programmes called on insulin management?

A

DAFNE (dose adjustment for normal eating)

TIM (tayside insulin management)

50
Q

What can cause DKAs?

A 
pregnancy
illicit drugs/alcohol
infection
non-compliance
pancreatitis
51
Q

What kind of symptoms can ketone bodies cause?

A 
Flushing
vomiting
abdo pain
Kussmaul's breathing
Ketones on breath
52
Q

What ketone is tested for in bloods?

A

Beta-hydroxybutate

53
Q

What is the normal amount of ketone?

A

Less than 0.6

54
Q

Beware! How far can the ketone meter read?

A

Only to 8 so if above 8 you’d never know.

55
Q

What is the danger of measuring ketones in urine?

A

Shows ketones 2 hours previously.

56
Q

Biochemically, how is lactate produced?

A

Anaerobically produced from pyruvate

57
Q

How is lactic acidosis different to hyperlactaemia?

A

Lactic acidosis involves a high ion gap with low ketone level.

58
Q

When does type A lactic acidosis occur?

A

Tissue hypoxaemia e.g. infarcted tissue, hypovolemic shock

59
Q

When does type B lactic acidosis occur?

A

Diabetes

Liver disease

60
Q

What is the equation for working out anion gap?

A

[Na+ +K+] - [HCO3 + Cl-]

61
Q

How can endogenous insulin be measured?

A

Plasma C-peptide

62
Q

Which antibodies are clinically tested for?

A

GAD

Anti-islet cells

63
Q

At what blood glucose level is coma associated?

A

Less than 2mmol/L

64
Q

What percent should someones HbA1c be?

A

Around 6.5% is 48mmol/L

65
Q

What 3 things must be present to diagnose DKA?

A

High glucose
presence of ketones
Acidosis

66
Q

What is involved in the management of DKA?

A

IV fluids
Potassium
Insulin

67
Q

In what medical procedures should metformin be avoided?

A

Anything involving contrasts e.g. angiogram

68
Q

What is hyperglycaemic hyperosmolar syndrome?

A

Hyperglycaemia but no ketones in blood

69
Q

What can cause HHS?

A

Dehydration
Diuretics/ steroids
Poor glycaemic control

70
Q

What may precipitate HHS?

A

Infection

Other illness- MI, stroke

71
Q

Why are fluids added more slowly in HHS?

A

Higher risk of cerebral oedema

72
Q

How is osmolality calculated?

A

2Na+ + glucose + urea

73
Q

What is the reference value for osmolality?

A

275-295

74
Q

What osmolality is diagnostic of HHS?

A

> 320mosmol/kg

75
Q

What must blood glucose be to diagnose HHS?

A

> 30mmol/L

76
Q

What should be given as treatment for HHS?

A

Saline with potassium

77
Q

What HbA1c level should be obtained before an elective procedure?

A

less than 75mmol/L

78
Q

What is the risk of fluid resuscitation of DKA in children?

A

Cerebral oedema

79
Q

What is the target HbA1c in children?

A

less than 58mmol/L

80
Q

What is cheriarthropathy?

A

Thickening of skin over joints

81
Q

In DKA when should potassium be given?

A

When serum K falls below 5

Endocrine (20 decks)

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