Diabetes Type 1 and Type 2 Flashcards
What investigation can be completed to differentiate DM Type 1 from Type 2?
Ab testing (anti-GAD, anti-insulin, anti-islet cell); these will be positive in Type 1 DM. A C-peptide can also be completed. The C-peptide will be positive in Type 2 diabetes and low in Type 1 diabetes. C-peptide is a marker of production of endogenous insulin.
What diseases are associated with Type 1 DM?
Type 1 DM is associated with organ specific autoimmune conditions. Th most common ones are celiac disease and hypothyroidism. Others include: addison’s, alopecia, vitiligo.
What are the RFs for Type 2 DM?
RFs for Type 2 DM:
- Older age
- Family history
- Genetics ex. MODY
- Gestational diabetes, macrosomia
- Polycystic Ovarian Syndrome
- Male pattern body hair, caudal hair loss
- Sedentary behaviour
- Aboriginal, Hispanic, S. Asian, Asian, African descent
- Drugs ex. GLUCOCORTICOIDS
- Acanthosis nigricans
What are the microvascular complications of DM?
Microvascular complications of uncontrolled DM include: retinopathy, nephropathy, neuropathy, autonomic symptoms (ex. gastroparesis, postural HTN), erectile dysfunction.
A patient comes in for a regular physical exam and due to his family history of T2DM you decide to complete a random glucose. The glucose is 17 mmol/L. You recall that the patient had mentioned that they had just come from a lunch date. You decide to follow this up with a fasting glucose which comes back as 6.5 mmol/L. What is your explanation for the two measurements?
This patient likely has “pre” diabetes. In this phase of the disease the first phase insulin response is lost and therefore a post-prandial glucose will be HIGH. His fasting glucose is tottering near the diagnostic criteria (>7.0 mmol/L) but is still below. This is indicative of the “pre” diabetic phase.
What is the diagnostic criteria for DM?
Diagnostic criteria of DM:
- Fasting glucose >/= 7.0 mmol/L OR
- Any plasma glucose >/= 11.1 mmol/L with symptoms OR
- 2 hr plasma glucose >/= 11.1 mmol/L during a 75 g OGTT
- HbA1C >/= 6.5
- Note that you need two confirmatory tests to diagnose DM unless you have >/= 11.1 mmol/L with symptoms or in other words in an asymptomatic hyperglycaemic patient you need to test them twice!
Describe the natural history of diabetic nephropathy.
Diabetic nephropathy onset occurs around 5 years post onset of diabetes. During the course of the disease there will be an increase in microalbuminuria before the GFR starts to tank. Once the GFR tanks, the development of nephrosis, proteinuria and azotemia (uraemia) occurs. These signs may not become apparent until 5-20 years post diabetes onset.
A 42 yr old man who has had IDDM for 25 years has begun to lose his usual warning signs of hypoglycaemia; the first thing that happens is that he gets confused when he is hypoglycaemic. His wife has had to call the paramedics twice in the past 2 months because she found him unconscious and unarousable at home at different times of the day. True or False?
He has lost his normal endogenous epinephrine response to hypoglycaemia.
True. In a normal person with hypoglycaemia insulin will decline and then glucagon will increase and then epinephrine will increase. This patient likely has an autonomic neuropathy and so no longer has the surge of epinephrine. If the surge in epinephrine was apparent then he would have had symptoms of shaking, sweating, anxiety, palpitations (sympathetic overdrive, adrenergic symptoms). He went straight to the confusion stage.
A 42 yr old man who has had IDDM for 25 years has begun to lose his usual warning signs of hypoglycaemia; the first thing that happens is that he gets confused when he is hypoglycaemic. His wife has had to call the paramedics twice in the past 2 months because she found him unconscious and unarousable at home at different times of the day. True or False?
He has lost his normal endogenous glucagon response to hypoglycaemia.
True
A 42 yr old man who has had IDDM for 25 years has begun to lose his usual warning signs of hypoglycaemia; the first thing that happens is that he gets confused when he is hypoglycaemic. His wife has had to call the paramedics twice in the past 2 months because she found him unconscious and unarousable at home at different times of the day. True or False?
He should be taught how to self-administer glucagon.
False. Somebody else around him should be taught how to administer the glucagon.
A 42 yr old man who has had IDDM for 25 years has begun to lose his usual warning signs of hypoglycaemia; the first thing that happens is that he gets confused when he is hypoglycaemic. His wife has had to call the paramedics twice in the past 2 months because she found him unconscious and unarousable at home at different times of the day. True or False?
His glucose targets should be altered.
True. The glucose target should be increased. This is to reset the ‘glucostat’ and try to bring back the increase in glucagon in response to decreased insulin.
Following a party celebrating the end of course 4, your classmate was found seizing at 7am. He has T1DM and his BG at the time was 2.5mmol/L. All of the following would explain this acute medical problem EXCEPT:
a. Increased activity from dancing
b. Forgetting to administer his bedtime insulin
c. Ingestion of significant alcohol intake
d. Increased frequency of mild hypoglycaemia during the week of exams prior to this episode
b. Forgetting to administer his bedtime insulin
Each of the following is thought to be a cause of late, secondary failure to respond to oral hypoglycaemic agents EXCEPT:
a. weight gain
b. progressive loss of insulin secretory function
c. anti-insulin receptor antibodies
d. glucose toxicity
c. anti-insulin receptor antibodies
Which of the following is associated tis the highest risk of T1DM?
a. insulin gene
b. human leukocyte antigen (HLA) Class II
c. Vit D receptor gene
d. insulin receptor gene
b. HLA Class II
A 7 yr old boy is just diagnosed with T1DM. Both his grandfathers have T2DM. His parents wish to know what is the risk of his fraternal twin developing T1DM?
a. 80 percent
b. 50 percent
c. 5 percent
d. 0.1 percent
c. 5 percent
