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Endocrinology > Diabetes: type 1 and others > Flashcards

Diabetes: type 1 and others Flashcards

1
Q

Presenting features of type 1 diabetes?

A 
Polydipsia
Polyuria
Weight loss and fatigue
Hunger
Blurred vision
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2
Q

What type of eye problems occur in type 1 diabetes and why do they occur?

A

Altered acuity

Water and glucose uptake into lens

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3
Q

When presented with a patient with diabetes, what are the suggestive features to look for indicating they likely have type 1?

A

Younger onset
Lean body habitus
Acute onset

Autoantibodies against islets are found in the blood

Ketoacidosis: rare in type 2

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4
Q

What 3 symptoms are red flag symptoms that you should start insulin right away?

A

Weight loss
Sudden onset of symptoms
High levels of ketones

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5
Q

Pathogenesis of type 1 diabetes?

A

They start with normal beta cells

Something triggers destruction of beta cells, such as surgery, infection, often unknown

Beta cells get damaged and over time you lose function of beta cells

No beta cells = no insulin

When beta cell function gets less than 10% symptoms start

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6
Q

There are 3 antibodies known to be involved in type 1 diabetes. Name them?

A

Anti-GAD (glutamate decarboxylase)

Pancreatic islet cell antibody

Islet antigen-2 antibody

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7
Q

Does diabetes cause low or high blood glucose levels? Why?

A

Diabetes mellitus of any cause results in HYPERglycaemia

Due to dysfunction/insensitivity to insulin

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8
Q

What effect do these hormones have on blood glucose:

  • insulin
  • glucagon?
A

Insulin: LOWERS glucose

Glucagon: RAISES glucose

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9
Q

Why does lack of insulin cause blood glucose to rise?

A

Lack of insulin means muscle/other cells can’t take up the glucose in the blood stream

They send signals to liver to release/make more glucose because they’re not getting any!

So liver releases/makes more glucose

Thus, blood glucose rises

IN ADDITION

Insulin is normally involved in glucose –> glycogen, no glucose means glucose remains loose in blood stream rather than being stored

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10
Q

Why does type 1 diabetes cause weight loss?

A

Lack of insulin means cells of body are starved of glucose

So the body breaks down other things to fuel the cells, like fats

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11
Q

Describe how ketones are formed in ketoacidosis?

A

Lack of insulin means body breaks down fats into glycerol and free fatty acids

The free fatty acids go to the liver where they are used as fuel to power gluconeogenesis

During this they are oxidised to become ketones

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12
Q

What is ketoacidosis? How does it cause death?

A

Build up ketones due to diabetes

Ketones are weak organic acids, build up of them is toxic

The cause a metabolic acidosis, anorexia and vomiting

The person gets into a vicious cycle of dehydration, hyperglycaemia and increasing acidosis

Until circulatory collapse and death

Also cerebral oedema can occur

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13
Q

Ketoacidosis can be described as a triad of…

A
  1. hyperglycaemia
  2. ketones
  3. acidosis
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14
Q

Clinical features of diabetic ketoacidosis (DKA)?

A

These symptoms develop over days

Polyuria + dipsia
Nausea and vomiting
Weight loss
Abdo pain
Fruity breath

Dehydration
Hypotension + compensatory tachycardia

Coma

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15
Q

Investigations of DKA?

A

Blood:

  • hyperglycaemia
  • low HCO3-
  • raised ketones
  • low K+, Mg, P

Urine: raised ketones

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16
Q

Management of DKA?

A

ABCDE

Fluid replacement:
0.9% NaCl 100ml/kg
2 boluses

Electrolyte replacement:
K, Cl, Na

Insulin:
Actrapid
0.1 microgram/kg/hr

Replace glucose: because insulin can reduce glucose a lot, don’t want a hypo
5% dex when glucose has come down to 12mmol/L

Treat precipitating illness i.e. infection

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17
Q

What does insulin do to treat DKA?

A

Inhibits lipolysis, ketogenesis, acidosis

Reduces hepatic glucose production

Increases tissue glucose uptake

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18
Q

Other causes of ketoacidosis?

A

Alcohol

MI?

19
Q

Complications of DKA?

A

Cerebral oedema (more in kids)

Pulmonary oedema

Thromboembolism

Hypokalaemia

Iatrogenic hypoglycaemia

20
Q

What is the usually the cause of death in type 1 diabetes? Is it earlier than average?

A

CVS disease

Some patients lose 10-20 years, but these days many patients live full lives, if they are responsible with their treatment

21
Q

What microvascular complications can occur with diabetes?

A

Nephropathy

Retinopathy

Neuropathy

22
Q

Management of type 1 diabetes?

A

Insulin injection:

  • twice daily
  • basal bolus before each meal

Controlled diet

Self-monitoring of glucose

Every day!

23
Q

In diabetic patients, how does HYPOglycaemia occur?

A

If they over-inject with insulin blood sugar levels can become too low

24
Q

Clinical features of HYPOglycaemia?

A 
Shaking
Tachycardia
Sweating
Dizziness
Anxious

Cerebral dysfunction: loss of concentration, confusion, coma

25
Q

What is the HbA1c test?

A

Measure of average blood glucose levels over last 3 months

26
Q

List some other causes of diabetes?

Warning: there are tons…

A

Genetic causes:

  • MODY
  • permanent neonatal diabetes

Exocrine pancreas disease:

  • pancreatitis
  • haemochromatosis
  • pancreatic cancer
  • amyloidosis
  • cystic fibrosis

Endocrine pancreas disease:

  • acromegaly
  • Cushing’s
  • Phaeochromocytoma

Drugs

27
Q

What does MODY stand for?

A

Maturity onset diabetes of youth

28
Q

What is MODY?

A

Genetic causes of diabetes
Diagnosed in the under 25s
A single gene defect altering beta cell dysfunction

29
Q

How can you differentiate MODY from type 1 diabetes?

A

MODY:

  • non-insulin dependent
  • strong family history
  • no islet antibodies
  • no ketosis
  • C-peptide measurable

Type 1:

  • highly insulin dependent
  • not really that familial
  • islet antibodies seen
  • C-peptide not present
30
Q

Inheritance pattern of MODY?

A

Autosomal dominant

31
Q

What is C-peptide? What is its significance in diagnosing diabetes?

A

Part of the structure of insulin

Type 1 diabetes: C-peptide is not seen

Type 2 diabetes + MODY: C-peptide is seen

32
Q

Clinical presentation of permanent neonatal diabetes?

Also say why these symptoms occur!

A

Small baby: due to inability to lay down muscle and fat

Epilepsy: due to high glucose in the brain

33
Q

What is lipodystrophy?

A

Problems laying down fat
They have no fat at all
Can cause diabetes

34
Q

How does acute pancreatitis cause diabetes?

A

Transient hyperglycaemia caused by increased glucagon secretion

Glucagon RAISES blood glucose

35
Q

How does chronic pancreatitis cause diabetes?

A

Formation of protein plugs that block ducts in the pancreas

These create perfect sites for calculi to form too

The plugs and calculi prevent insulin getting out of the pancreas, lack of insulin = diabetes

36
Q

How does amyloidosis cause diabetes?

A

Deposition of amyloid in pancreas, damages it and blocks ducts

Insulin production is impaired, and ducts are blocked

Lack of insulin = diabetes

37
Q

How does haemochromatosis cause diabetes?

A

Deposition of iron in pancreas, damages it

Insulin production is impaired

Lack of insulin = diabetes

38
Q

How can pancreatic cancer cause diabetes? What other blood glucose related problem can it cause?

A

Indirectly

Treatment of pancreatic cancer often necessitates pancreas removal

They will have no insulin or glucagon production

Leading to diabetes (lack of insulin) and a proneness to hypoglycaemia (lack of glucagon)

39
Q

How does cystic fibrosis cause diabetes?

A

CTFR gene mutation, problems with transmembrane conductance and thus poor regulation of Cl- secretions

Viscous secretions clog up pancreas impairing its function

Lack of insulin = diabetes

40
Q

How does acromegaly cause diabetes?

A

Too much growth hormone causes insulin resistance!

This causes raised blood glucose, and inability of glucose to enter tissues

= diabetes

41
Q

How does Cushing’s cause diabetes?

A

Too much cortisol causes insulin resistance!

This causes raised blood glucose, and inability of glucose to enter tissues

= diabetes

42
Q

How does Phaeochromocytoma cause diabetes?

A

Tumour that secretes excess catecholamines (adrenaline, noradrenaline)

These cause increased gluconeogenesis and decreased glucose uptake by tissues

43
Q

Which drugs are known to cause diabetes?

A

Glucocorticoids

Thiazides

Protease inhibitors (used in HIV)

44
Q

How does glucocorticoid therapy cause diabetes?

A

As in Cushings, increased insulin resistance

Endocrinology (19 decks)

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