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Phase 2a Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Define Type 1 Diabetes

A

Hyperglycaemia due to absolute insulin deficiency

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2
Q

Epidemiology of Type 1 DM

A
  1. childhood.
  2. lean
  3. northern europe
  4. under 30
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3
Q

Aetiology of Type 1 DM

A
  1. Autoimmune - Auto-antibodies against insulin and islet beta cells.
  2. idopathic
  3. genetics - hla-dr3/dr4
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4
Q

Risk Factors of Type 1 DM

A
  1. Northern Europe
  2. Family history
  3. Associated autoimmune disease eg: autoimmune thyroid, coeliac, Addison’s ( excess cortisol), pernicious anaemia
  4. environment: diet, enteroviruses eg coxsackie b4, vitamin d deficiency, cleaner environment may increase t1 susceptibility
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5
Q

Name a key presentation of T1DM

A

Pt leaner than T2DM

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6
Q

Give 8 Signs for T1DM

A
  1. BMI <25kg/m2
  2. glycosuria
  3. ketonuria
  4. failure to thrive in children: dropping off height and weight centiles
  5. glove and stocking sensory loss
  6. reduced visual acuity
  7. diabetic retinopathy
  8. diabetic foot disease: 1. reduced peripheral pulses, calluses, ulceration, Charcot joint
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7
Q

Give 7 Signs for T1DM

A
  1. Polydypsia
  2. polyuria
  3. Nocturia
  4. Weight Loss
  5. Lethargy
  6. Recurrent infections eg : pt. complains of balanitis or pruritis vulvae due to repeat candida infections.
  7. evidence of complications: blurred vision or parasthesia
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8
Q

Name the 1st line primary investigations for T1DM

A
  1. random blood glucose: 11 or more is diagnostic
  2. fasting blood glucose: 7 mmol/L or more is diagnostic.

For borderline cases:
1. oral glucose tolerance test : > 11mol/L 2 hours after a 75g oral glucose load. 7.8-11 mmol/L suggests pre-diabetes.

  1. hba1c - measures amount of glycated haemoglobin - >48 mmol/mol suggests hyperglycaemia over preceding 3 months.
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9
Q

Criteria for reviewing results for investigations of T1DM

A

1 abnormal value is diagnostic in symptomatic individuals and 2 abnormal values are required in asymptomatic individuals.

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10
Q

Investigations for possible consideration for T1DM

A
  1. c peptide : in atypical presentations like over 50 or bmi over 25.
  2. vbg - if concerned about DKA eg systemically unwell/vomiting.
  3. autoantibodies : if atypical features present, and if positive, suggests autoimmune beta-cell destruction. autoantibodies against the following can be found:
    glutamic - acid decarboxylase (GAD), insulin, islet cell, islet antigens, zinc transporter (ZnT8).
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11
Q

Explain the pathophysiology of T1DM.

A
  1. Autoimmune Destruction of autoantibodies of pancreatic insulin secreting beta cells in islet of Langerhans.
  2. = insulin def
  3. breakdown of liver glycogen = glucose + ketones = glycosuria and ketonuria . more glucose in blood

in skeletal muscle and fats there is impaired glucose clearance : BG increased - when it reaches 10 mmol/L, body cant absorb glucose so you get thirsty and get polyuria - removal of excess glucose.

  1. eventual complete beta cell destruction - absence of serum c peptide
  2. present very late with only 10% of beta cells left
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12
Q

Why must the pt. have insulin when they are a t1 diabetic?

A

Diabetic Ketoacidosis - due to lack of glucose supply to cells because lack of insulin. Fatty acids break down into ketone bodies.
Ketones are strong acids, lower ph of blood.
Impairs ability of Hb to bind to 02. can cause AKI.

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13
Q

Explain the diagnostic criteria for T1DM

A

NICE says take into account clinical features and evidence of hyperglycaemia eg RBG over 11.1 mmol/L.
T1 DIABETICS will have 1 of following:
1. ketosis
2. rapid weight loss
3. age of onset under 50
4. BMI under 25.
5. Personal/FHX of autoimmune disease

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14
Q

Name 4 differentials for T1DM

A
  1. Monogenic Diabetes - mature onset. - non-obese, young, fhx of diabetes 2+ generations. c peptide present. no autoantibodies.
  2. Neonatal Diabetes - under 6 months.
  3. T2DM - older, slow onset, strong fhx , no dka, initial response to oral anti-hyperglycaemic drugs typical of t2dm. c peptide present. no autoantibodies.
  4. Latent autoimmune diabetes in adults (LADA) - over 30. non-obese. respond to lifestyle mods and oral agents. production of insulin gradually decreases between 6 mths and 5 years such that insulin is required. low to normal initial c peptide level.
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15
Q

What is the 1st line management of T1DM?

A
  1. Lifestyle : keep lean, stop smoking, take care of feet. carb counting.
  2. Basal - Bolus : 1st line!
    long acting - basal - levemir (determir) - give twice daily. lantus (glargine) once daily alternative.
    fast acting - bolus - before every meal usually 3 times. - humalog (lispro) or novorapid (aspart)
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16
Q

Name 2 other regimens possible for treatment for t1dm?

A
  1. Mixed Insulin regimen: mix of short and intermediate acting insulin. twice daily. for pts that cant tolerate multiple injections.
  2. Continuous insulin infusion: if pt. has disabling hypoglycaemia or persistently hyperglycaemic (hba1c >69 mmol/mol) on multiple injection insulin therapy.
17
Q

Name 4 complications of insulin therapy

A
  1. Hypoglycaemia - most common (also caused by sulfonylurea - antidiabetic)
  2. Injection Site - lipohypertrophy
  3. Insulin resistance - mild, associated with obesity
  4. Weight Gain - insulin makes people hungry
18
Q

Name 6 Complications of T1DM

A
  1. DKA
  2. Hypoglycaemia - comp of insulin treatment esp insulin without a meal.
  3. Diabetic kidney disease - involves glomerular mesangial sclerosis leading to proteinuria and progressive decline in glomerular filtration.
  4. Retinopathy
  5. peripheral or autonomic neuropathy
  6. cvd - increased atherosclerosis risk, hyaline arteriolosclerosis
19
Q

Name 4 macrovascular complications of T1DM

A

Cardio: ischaemic heart disease, heart failure, peripheral vascular disease.
cerebrovascular : stroke

20
Q

Name 7 microvascular complications of T1DM

A

neuropathy - mononeuropathy
polyneuropathy - glove and stocking
amyotrophy - painful proximal lower limb muscle wasting
autonomic neuropathy - gastroperesis, erectile dysfunction, postural hypotension

renal: nephropathy and ckd

retinopathy - non-proliferative vs proliferative
maculopathy

21
Q

How would you monitor T1DM?

A

monitor hba1c levels every 3-6 months target of less than 48mmol/mol

self monitor: test min 4 times a day. - before meals and before bed.
targets:
on waking - 5-7 mmol/L
during day ie before meal: 4-7
bed: personalised depending on meal time.

annually: diabetic review includes:
injection site problems, retinopathy (annually), nephropathy ( renal function (eGFR) and albumin: creatinine ratio (ACR), diabetic foot problems (full exam including footwear), cv risk factors and thyroid disease (blood screen)

Phase 2a Medicine (22 decks)

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