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Metabolism, Endocrinology, Haematology > Endocrinology Session 2 CLINICAL > Flashcards

Endocrinology Session 2 CLINICAL Flashcards

1
Q

What is diabetes?

A

When blood glucose is too high (hyperglycaemia) and over the years, leads to damage of small and large blood vessels causing premature death from cardiovascular diseases.

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2
Q

What caused an epidemic in diabetes?

A

Environment (obesity, reduced activity)

- Not necessarily genetics

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3
Q

What is the pathophysiology of diabetes?*

A
  • Food is broken down into glucose
  • Rising blood glucose signals the pancreas to start releasing insulin
  • Insulin binds to a place on the cell wall/insulin receptor
  • Unlocks the cell so that glucose can enter the cell
  • Most glucose used immediately
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4
Q

What are pancreatic islet cells?*

A
  • Endocrine cells in pancreas

- Responsible for glucagon and insulin production (blood glucose control)

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5
Q

What are the 2 reasons for rises in blood glucose?

A
  • Inability to produce insulin (beta cell failure)

- Insulin production is adequate but insulin resistance prevents insulin working effectively (linked to obesity)

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6
Q

What is the normal range for blood glucose?

A

3.9-7.1 mmol/L

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7
Q

What causes type 1 diabetes?

A

AUTOIMMUNE BETA CELL DESTRUCTION

  • Autoantibodies made against beta cells
  • Cells destroyed
  • Absolute insulin deficiency (not enough insulin)
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8
Q

What causes T1 diabetes?

A
  • Genetic predisposition (HLA-DQB1)

- Environmental trigger and genetic susceptibility combined

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9
Q

What causes type 2 diabetes?

A
  • Pancreas may not produce enough insulin

- Cells may not be able to use insulin to unlock the cells and allow glucose to enter (resistance)

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10
Q

What is the presentation of diabetes mellitus (above 10 mmol/L)?

A
  • Polyuria
  • Polydipsia
  • Blurring vision
  • Urogenital infections
  • Dehydration
  • Lethargy and weakness
  • Weight loss
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11
Q

How is diabetes diagnosed?

A
  • Fasting glucose test
  • Oral glucose tolerance test
  • HbA1c (glycosylated haemoglobin test)
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12
Q

What is needed to diagnose diabetes?

A
  • Symptomatic: 1 abnormal test

- Asymptomatic: 2 abnormal tests

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13
Q

What is the potential aetiology of type 1 diabetes?

A
  • Twin studies (higher risk if sibling has it)

- Hygiene hypothesis - immature immune system produces antibodies against own cells accidentally

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14
Q

When is T1 diabetes most commonly diagnosed?

A

90% under 30 years of age, but can occur at any time. 1

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15
Q

What is the presentation of type 1 diabetes?

A

PATIENT:

  • Usually young
  • Ketone presence

SYMPTOMS:

  • Rapid onset weight loss, polyuria and polydipsia
  • Ketoacidosis when late presentation
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16
Q

How is type 1 diabetes treated?

A
  • Exogenous insulin the only treatment
  • Started immediately
  • Given by subcutaneous injection several times a day
17
Q

Why are ketones important in diabetes?

A
  • Insulin suppresses the production of ketones, unless in starvation
  • Activated in absence of insulin
  • Presence indicates immediate need for insulin therapy
18
Q

What are ketones?

A

Breakdown products of free fatty acid metabolism

acetone, acetoacetic acid and 3-beta-hydroxybutarate

19
Q

What is ketoacidosis?

A

A life threatening condition requiring immediate treatment and hospitalisation. Characterised by hyperglycaemia and ketonaemia, which leads to acidosis.

20
Q

What causes ketoacidosis?

A

Enhanced lipolysis

21
Q

How is ketoacidosis diagnosed?

A
  • Ketonaemia >3.0 mmol/L or significant ketonuria (2+ on standard urine sticks)1
22
Q

What are some statistics about type 2 diabetes?

A
  • 90% of sufferers are overweight or obese
  • Many are asymptomatic and diagnosis made
  • Managed by diet and tablets
  • Most 40+ but increasing prevalence in children
23
Q

What causes the development of insulin resistance?

A
  • Central obesity (85%)
  • Fat deposition in muscle and liver
  • High circulating free fatty acids
  • Physical inactivity
  • Genetic influences
24
Q

What happens after gastric bypass surgery?

A
  • Glucose metabolism normalises
  • No longer in diabetic range 1-2 weeks post-surgery
  • Normalises even before any weight loss
  • Fall in liver fat content
  • Return to NORMAL insulin sensitivity
25
Q

What are the symptoms of type 2 diabetes?

A
  • Polyuria/polydipsia/weight loss
  • No urinary ketones
  • A lot are asymptomatic and found by routine screens
  • Very variable due to slower rises in blood glucose
  • Most patients over 40
  • 90% obese
26
Q

How should type 2 diabetes be managed?

A
  • Weight loss (lifestyle)
  • Non-insulin therapy
  • Reducing other vascular risk factors (high BP, lipids, exercise, smoking)
  • Surveillance for chronic complications
27
Q

What drugs are used to treat diabetes?

A
  • Biguanides (METFORMIN)
  • Sulphonyureas
  • SGLT2s
  • GLP1 analogues
28
Q

What are acute complications of hyperglycaemia?

A
  • Massive metabolic decompensation
  • Diabetic ketoacidosis (T1)
  • Damage to micro and macrovasculature over time
  • Hyperosmolar non-ketoic syndrome (T2)
29
Q

What are acute complications of hypoglycaemia?

A
  • Coma (brain deprived of glucose)

- Often iatrogenic by hypoglycaemic therapy

30
Q

What are chronic complications of diabetes related to macrovasculature?

A
  • Cerebrovascular, cardiovascular and peripheral vascular disease
  • Stroke, heart attack, intermittent claudication, gangrene
31
Q

What are chronic complications of diabetes relating to microvasculature?*

A
  • Retinopathy (blindness due to damage to retinal blood vessels)
  • Nephropathy (renal replacement therapy needed; thickened glomerular basement membrane reduces effectiveness of filtration)
  • Neuropathy (foot ulceration, peripheral neuropathy)
  • Constipation/diarrhoea
32
Q

What is metabolic syndrome?

A

Cluster of the most dangerous risk factors associated with cardiovascular disease (diabetes, raised fasting plasma glucose, abdominal obesity, high BP and cholesterol)

33
Q

What are the criteria for metabolic syndrome?

A
  • Waist measurement > 94 cm men and > 80 cm women

+ 2 of:

  • Reduced HDL <1.0 men and <1.2 mmol/L women
  • Raised BP (>135/85)
  • Raised fasting blood glucose >5.6mmol/L or treated diabetes
34
Q

What causes metabolic syndrome?

A
  • Insulin resistance
  • Central obesity
  • Genetics
  • Physical inactivity
  • Ageing

Metabolism, Endocrinology, Haematology (16 decks)

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