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Endocrinology > Endo 14 - Pathophysiology and Treatment of Type 1 Diabetes Mellitus > Flashcards

Endo 14 - Pathophysiology and Treatment of Type 1 Diabetes Mellitus Flashcards

1
Q

Name a form of Type 1 diabetes that presents late

A

latent Autoimmune Diabetes in adults - LADA

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2
Q

State 2 monogenic causes of diabetes

A
  • Mitochondrial diabetes

- Maturity onset diabetes of the young - MODY

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3
Q

Which 3 endocrine disorders can diabetes also present with?

A

Phaeochromacytoma
Cushing’s
Acromegaly

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4
Q

How do phaechromacytoma, cushing’s and acromegaly cause diabetes?

A

cause hyperglycaemia

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5
Q

What triggers type 1 diabetes?

A

Environmental trigger with a genetic predisposition

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6
Q

What is the mechanism of T1DM?

A

autoimmune destruction of islet cells

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7
Q

Which type of diabetes has a bigger genetic component?

A

T2DM

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8
Q

What can be measured in the blood to give an indication of insulin function?

A

C-peptide

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9
Q

Low C-peptide =

A

insulin deficient

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10
Q

Describe the pathogenesis of T1DM?

A

Gradual autoimmune destruction of beta cells
so gradual fall in insulin and c-peptide

Loss of first phase insulin

eventual destruction of all beta cells from auto-antibodies

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11
Q

Why is T1DM described as a relapsing-remitting disease?

A

beta cell mass reduces then stabilises

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12
Q

What is the importance of the autoimmune basis of T1SM?

A

Increased prevalence of other autoimmune disease e.g. thyroid

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13
Q

What are the histological features of T1DM?

A

Lymphocyte infiltration of beta cells

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14
Q

On which chromosome is HLA found?

A

Chromosome 6

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15
Q

Which alleles on HLA convey a risk of diabetes?

A

DR alleles

DR3/4 MOST RISK

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16
Q

What are the two most significant markers of diabetes?

A

Islet cell autoantibodies

Insulinoma-associated-2-autoantibodies

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17
Q

State some of the symptoms of T1DM?

A 
Polyuria
Nocturia
Polydipsia
Blurring of vision
Thrush
Weight Loss
Fatigue
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18
Q

What are the signs of T1DM?

A 
Dehydration
Cachexia 
Hyperventilation
Smell of ketones
Glycosuria
Ketonuria
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19
Q

What are trigylcerides broken down into?

A

Glycerol + Fatty acids

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20
Q

What does insulin have a negative effect on?

A
  • hepatic glucose output
  • protein breakdown in muscle
  • ketone body generation in liver
  • glucerol release from fat cells
21
Q

What does insulin have a positive effect on?

A

Glucose uptake by tissues

22
Q

So what happens to glucose in insulin deficiency?

A

Hyperglycaemia as glucose in circulation not taken up by tissues

23
Q

State 4 other hormones that increase hepatic glucose output?

A
  • Catecholamine - adrenaline/noradrenaline
  • cortisol
  • glucagon
  • growth hormone
24
Q

Describe how insulin deficiency leads to diabetic ketoacidosis?

A

insulin has a suppressive effect on hepatic ketone body generation

without insulin, fatty acids go to liver where they are used to produce ketone bodies

25
Q

What is the defining feature of insuline deficiency?

A

Ketone bodies

26
Q

State some long term complications of T1DM

A

Neuropathy
Nephropathy
Retinopathy
Vascular disease

27
Q

What is the main treatment for T1DM?

A

Exogenous insulin

28
Q

What defines insulin deficiency?

A

Ketones

29
Q

Describe the dietary changes that are recommended in T1DM?

A
  • reduce calories as fat
  • reduce calories as refined carbohydrates
  • increase calories as complex carbs
  • increased fibre
30
Q

State the type of insulin that is given with meals?

A
  • short acting

- human insulin

31
Q

State the names of the type of insulin given with meals?

A

Lipsro
Aspart
Glulisine

32
Q

Describe the features of background insulin

A

long acting

33
Q

State the names of the type of insulin given in the background

A

Glargine
Detemir
Degludec

34
Q

What do insulin pumps do?

A

continuous insulin delivery
pre-programmed basal levels to mimic background insulin
boluses for meals

35
Q

Describe the use of islet cell transplants?

A

islet cells harvested from donors and injected into the liver

36
Q

How is capillary monitoring done?

A

prick finger and test blood drawn

37
Q

What is HbA1c level used to gage?

A

glycaemic control over the past 3 months as red cell life span is 120 days

38
Q

How does HbA1c level work?

A

more glucose in blood stream = more haemoglobin glycosylated

39
Q

What HbA1c level are T1DM patients trying to get to?

A

<7%

40
Q

When might HbA1c level not be accurate?

A

haemolytic anaemia

41
Q

What are the main acute complications of T1DM?

A

Metabolic acidosis

Hypoglycaemia

42
Q

What are the two main ketones that circulate in metabolic acidosis caused by T1DM?

A

Acetoacetone

Hydroxybutyrate

43
Q

Define hypoglycaemia?

A

Blood glucose < 3.6mmol/L

44
Q

Define severe hypoglycaemia

A

any level that requires another person to treat it

45
Q

What can recurrent hypos result in?

A

Loss of warning

porr glycaemic control

46
Q

At what times do hypos tend to happen?

A

pre lunch and nocturnal

47
Q

What can trigger a hypo?

A

Unaccustomed exercise, missed meals, inadequate snacks, poor insulin regime

48
Q

State some signs and symptoms of a hypo?

A

increased sympathetic activity

  • tremor
  • palpitations
  • sweating
  • anxiety
  • confusion
49
Q

How is hypoglycaemia treated?

A

oral glucose
complex carb to maintain blood glucose after initial treatment
parenteral - if unconcious - IV dextrose 1mg glucagon IM

Endocrinology (18 decks)

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