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Week 14- Endocrinology > Diagnosis of Diabetes > Flashcards

Diagnosis of Diabetes Flashcards

1
Q

What is the definition of diabetes mellitus?

A
  • A metabolic disorder of multiple aetiology
  • characterised by chronic hyperglycaemia
  • with disturbances of carbohydrate, protein and fat metabolism
  • resulting from defects in insulin secretion, insulin action or both
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2
Q

What is the WHO criteria for the diagnosis of diabetes?

A

•Fasting plasma glucose ≥7.0mmol/l
•Random plasma glucose ≥11.1mmol/l
•One abnormal value is diagnostic if symptomatic
•Two abnormal values is diagnostic if asymptomatic
•HbA1c 6.5% or 48mmol/mol
•

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3
Q

When is an oral glucose tolerance test required?

A
  • Gestational diabetes mellitus

* Impaired fasting glycaemia

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4
Q

What are the diagnostic aids for diabetes?

A
  • Ketone testing ± bicarbonate
  • Pancreatic autoantibodies
  • C-peptide testing
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5
Q

What is a normal blood ketone reading?

A

<0.6mmol/l

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6
Q

Explain what is needed to be in diabetic ketoacidosis

A
  • Hyperglycaemia (>11.1mmol/l or known diabetes)
  • Hyperketonaemia (≥3.0mmol/L on fingerprick) or ketonuria (more than 2+ on urine dipstick testing)
  • Metabolic acidosis (venous bicarbonate <15 mmol/L and/or venous pH <7.3)
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7
Q

What are the islet autoantibodies?

A
  • Markers of autoimmune process associated with T1DM
  • Glutamic acid decarboxylase (GAD)
  • Insulinoma-associated antigen 2
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8
Q

When is the most useful time to test for islet autoantibodies?

A

3-5 years from diagnosis

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9
Q

What is C peptide?

A
  • Secreted in equimolar concentrations to insulin
  • Useful marker of endogenous insulin secretion
  • Can be measured in blood or urine
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10
Q

When is the most useful time to measure C-peptide?

A

3-5 years from diagnosis

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11
Q

What does type 1 diabetes result from?

A

Autoimmune destruction of the insulin producing beta cells in the islets of langerhands

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12
Q

What are the stages to type 1 diabetes?

A
  • Genetic risk
  • Immune activation
  • Immune response - development of single autoantibody
  • Stage 1 - Normal blood sugar, ≥2 autoantibodies, start of T1DM
  • Stage 2 - Abnormal blood sugar, ≥2 autoantibodies
  • Stage 3 - clinical diagnosis, ≥2 autoantibodies
  • Stage 4 - long-standing T1DM
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13
Q

Explain the pathogenesis of T1DM

A 
•Genetic 
•Environmental: 
 - viral infections
 - immunisation 
 - diet 
 - higher socioeconomic status. 
 - obesity 
 - vitamin D deficiency 
 - Perinatal factors
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14
Q

Age of presentation in Type 1 vs Type 2 Diabetes mellitus

A
  • T1 <40

* T2 >50

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15
Q

Weigh in Type 1 vs Type 2 Diabetes mellitus

A
  • T1: Normal

* T2: obese or overweight

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16
Q

Ethnicity risk in Type 1 vs Type 2 Diabetes mellitus

A
  • T1: Northern European

* T2: Asian, African, Polynesian and American Indian

17
Q

Family History of diabetes in Type 1 vs Type 2 Diabetes mellitus

A
  • T1: Uncommon

* T2: Common

18
Q

Pathogenesis in Type 1 vs Type 2 Diabetes mellitus

A
  • T1: Autoimmune

* T2: no immune

19
Q

Ketonuria/ketonemia/acidosis in Type 1 vs Type 2 Diabetes mellitus

A
  • T1: common

* T2: uncommon

20
Q

Clinical in Type 1 vs Type 2 Diabetes mellitus

A
  • T1: insulin deficiency ± Ketoacidosis, dependent on insulin for survival, other autoimmune disease common
  • T2: Partial insulin deficiency at presentation ± hyperosmolar state, may need insulin, other autoimmune uncommon
21
Q

Biochemistry/immunology in Type 1 vs Type 2 Diabetes mellitus

A
  • Type 1: C peptide inappropriate or negative (<200), usually GAD Ab positive
  • Type 2: C peptide elevated (>900) GAD Ab usually negative
22
Q

What causes pancreatic diabetes?

A
  • Pancreactectomy
  • Pancreatitis
  • Haemochromatosis (liver disease, cardiomyopathy, pituitary disease)
  • Carcinoma
  • Cystic fibrosis
23
Q

Why are risk of hypos higher in pancreatic diabetes?

A

Because there is a loss of alpha cells that produce glucagon

24
Q

What are the features of pancreatic diabetes?

A
  • History of cause
  • Exocrine dysfunction
  • May have ketones and may be acidotic
  • C peptide low but often detectable
  • Pancreatic antibodies negative
  • May require imaging
  • Managed by Sulfonylurea
25
Q

What is MODY caused by?

A
  • Change in a single gene (monogenic)

* Autosomal dominant

26
Q

What are the main features of MODY?

A
  • Often >25 years onset
  • C peptide not low
  • Pancreatic antibodies are negative
  • Runs in families from one generation to the next
  • Managed by diet, OHAs and insulin

Week 14- Endocrinology (10 decks)

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