Endocrine Flashcards
What is type 1 diabetes?
A state of absolute insulin deficiency
Type 1 diabetes risk factors?
85% under 20's, peak 10-14 years HLA class II antigen
How many people with susceptible HLA antigens develop DM?
5%
Triggers for developing DM with HLA?
Viral infection Maternal factors Weight gain Vitamin D deficiency Environmental/nutritional factors
What is normal glucose/insulin physiology?
Insulin is secreted at a low basal rate accounting 50% of insulin produced. Post prandial insulin is secreted in relation to post meal glucose
Pathophysiology of type 1 diabetes?
Auto-immune destruction of insulin producing islet cells
Pathophysiology of Type 2 diabetes?
Amyloid protein deposition and chronic destruction. Initial insulin resistance, then islet cell destruction and loss of B cell mass.
What are the islet auto-antibodies?
IA-2
IAA
GAD65
ZnT8
Type 1 diabetes diagnosis?
Fasting glucose >7.0mmol
Random >11.1 mmol
and symptoms
Antibodies characterising T1DM?
anti-GAD/anti islet cell bodies
T1DM clinical presentation?
Pre-school/peri-puberty Small peak in late 30's Usually skinny Acute onset Severe urinary symptoms Severe weight loss Ketonuria +/ - metabolic acidosis
T2DM clinical presentation?
Middle aged/elderly Insidious onset Usually obese Ketonuria minimal or absent Evidence of micro-vascular disease
What is Type 3 Diabetes?
Gestational diabetes
What is Type 4 Diabetes?
Pancreatic disease endocrine disease, drug induced , abnormalities of insulin and its receptor, genetic diseases
What to look out for to diagnose MODY?
Strong family history, young onset (<30), GAD negative, C peptide positive
HbA1c in T2DM
48m/m
Normal HbA1c
41m/m
Presentation of diabetes mellitus
Thirst Polyuria Thrush Fatigue Blurred vision Infections
Aims of therapy in Type 1 diabetes?
Prevent hyperglycaemia
Avoid hypoglycaemia
Reduce chronic complications
signs of hypoglycaemia?
pallor, sweating, tremor, palpitations, confusion, nausea, hunger, coma
name some microvascular complications of diabetes?
Retinopathy
Nephropathy
Neuropathy
Erectile dysfunction
name some macrovascular complications of diabetes?
TIA and stroke Angina MI Cardiac failure Peripheral vascular disease
Where does metformin work?
liver and muscle
where does insulin work?
liver and muscle
where do glitazones work?
liver, muscle and adipose tissue
where do incretins works?
pancreas and liver
What is the 1st choice drug in T2DM?
Metformin
