Endo- diabetes Flashcards
what is type 1 diabetes
autoimmune destruction of pancreatic beta cells resulting in beta cell deficiency and therefore absolute insulin deficiency
type 1A diabetes is immune mediated/non-immune mediated
immune mediated
type 1B diabetes is immune mediated/non-immune mediated
non-immune mediated
type 1B diabetes common nationalities
African/asian
peak age group for type 1 diabetes
10-14 years
HLA genotypes of type 1 diabetes
DR3-DQ2 and DR4-DQ8
type 1 diabetes environmental risk factors
maternal factors (gestational infection, older age)
viral infection eg coxsackie virus b
exposure to dietary constituents such as early introduction to cows milk and vitamin d deficiency
environmental toxins
childhood obesity
psychological stress
insulin deficiency symptoms
polyuria
polydipsia
weight loss
fasting glucose in diabetes
> /= 7mmol/l
random glucose in diabetes
> /= 11.1mmol/l
basal
long acting once daily
bolus
short acting with meals
what is type 2 diabetes
combination of insulin resistance and less severe insulin deficiency
main risk factor for type 2 diabetes
obesity
first line treatment in type 2 diabetes
metformin and lifestyle management
what is MODY
early onset (<25) on non-insulin dependent diabetes
MODY is monogenetic true/false
true
glucokinase mutations in MODY clinical features
onset at birth
stable hyperglycaemia
transcription factor mutations in MODY clinical features
adolescence/YA
progressive hyperglycaemia
oral glucose tolerance test for MODY results
glucokinase mutation respond well
transcription factor do not respond well
management for glucokinase mutation MODY
diet alone
management for transcription factor mutation MODY
diet and treatment with insulin/sulphonylureas
is neonatal diabetes monogenetic
yes
T1 and T2DM complications during pregnancy
congenital malformation
prematurity
IUGR
gestational diabetes complications during pregnancy
intra uterine death
macrosomia (big baby)
polyhydromnios
diabetes complications in neonates
respiratory distress (immature lungs)
hypoglycaemia/hypocalcaemia- fits
skeletal abnormalities
CNS defects- spina bifida eg
genital and GI abnormalities
seizures
diabetes in pregnancy medication
folic acid 5mg at least 3months prior to conception
start aspirin 150mg at 12 weeks
DIDMOAD/wolfram syndrome
genetic condition characterised by-
diabetes insipidus
childhood onset diabetes mellitus
gradual loss of vision- optic atrophy
deafness
diabetic nephropathy- if ACR<30 or PCR<50=
microalbuminuria
diabetic nephropathy- if ACR>30 or PCR>50=
proteinuria
microalbuminuria treatment
ACEi/ARB
SGLT2i
diabetic neuropathy risk factors
> length diabetes
poor glycemic control
more common in T1DM
smoking
alcohol
genetics
mechanical injury
symptoms of diabetic peripheral neuropathy
pain/loss of feeling in feet/hands
‘glove and stocking’ distribution
distal symmetrical
numbness/tingling
management of painful neuropathy
amitriptyline, duloxetine, gabapentin, or pregabalin
which cell mediates the autoimmune destruction of beta cells in T1DM
T cells
if both patients have HLA alleles for T1DM, risk of offspring developing diabetes is _%?
30%
what is more strongly genetic, type 1 or type 2 diabetes
type 2 diabetes
non-modifiable risk factors of T2DM
age- increasing age
genetics
ethnicity- south asian, African, afro-carribean
modifiable risk factors of T2DM
obesity
diet- fats, red and processed meat, sugary drinks, white rice, fried food
physical inactivity and sedentary behaviour
what is acanthosis nigricans
sign seen in T2DM- insulin-driven epithelial overgrowth seen in hyperinsulinaemic states
dry dark patches on skin usually appear on neck, armpits, groin
what is the most common form of monogenetic diabetes
MODY
what is more common, glucokinase MODY or transcription factor MODY
transcription factor MODY (75%)
neonatal diabetes caused by mutation in which mechanism
glucose sensing mechanism eg atp sensitive k channel
neonatal diabetes diagnosed under how old
<6 months
associated conditions of diabetes
cystic fibrosis
DIDMOAD
barget-biedl syndrome
autoimmune conditions associated with T1DM
thyroid disease
coeliac disease
pernicious anaemia
Addisons disease
IgA deficiency
how do pregnant woman develop gestational diabetes
if mother is insulin resistant before pregnancy, developing further insulin resistance during pregnancy will raise blood glucose too high and result in gestational diabetes
normal fasting glucose in pregnant women
<5.5mmol/l
first line management for pregnant women with fasting glucose >5.6mmol/l but <7mmol/l
2 week trial diet and exercise
what is diabetic nephropathy
progressive kidney disease caused by damage to the capillaries in the glomeruli
what is diabetic nephropathy characterised by
proteinuria
diffuse scarring of glomeruli
what is diabetic neuropathy
damage to the peripheral nervous tissue
clinical features of Charcot foot (complication of peripheral neuropathy)
acute onset of hot, swollen foot +/- pain, bony destruction
which organism is commonly found in diabetic foot ulcers
pseudomonas aeruginosa
