Intro to diabetes Flashcards
How is diabetes defined?
Diabetes is defined as an elevation of blood glucose above a diagnostic threshold
What body fat distribution is associated with an increased risk of cardiovascular disease (CVD)?
Apple-shaped fat distribution
What are examples of rare, pure genetic disorders of insulin action?
Donohue syndrome and Rabson-Mendenhall syndrome
What are the common causes of insulin resistance?
Obesity, Type 2 diabetes, NAFLD
Name four endocrinopathies that can cause insulin resistance
(1) Cushing’s syndrome
(2) Acromegaly
(3) Phaeochromocytoma
(4) Glucagonoma
How can steroids induce insulin resistance?
Exogenous glucocorticoids can cause steroid-induced insulin resistance
Name a primary autoimmune cause of insulin secretion disorder
Type 1 diabetes
What are two genetic disorders affecting insulin secretion?
MODY and neonatal diabetes
List five pancreatic diseases that can impair insulin secretion
(1) Alcoholic and chronic pancreatitis
(2) Acute pancreatitis
(3) Pancreatectomy
(4) Pancreatic cancer
(5) Cystic fibrosis
(6) Haemochromatosis
Which type of diabetes can range from predominant beta-cell deficiency to predominant insulin resistance?
Type 2 diabetes
What is the main difference between Type 1 and Type 2 diabetes?
Type 1 diabetes is an autoimmune disease where the body stops making insulin. Type 2 diabetes is when the body still makes insulin but doesn’t use it properly
How does diabetes commonly present?
It is often asymptomatic, especially in Type 2 diabetes
type 1 - weight loss, polydipsia, polyuria
type 2 - polydipsia, polyuria, often picked up accidentally on routine blood tests
List five symptoms of high blood glucose
(1) Polyuria
(2) Thirst/polydipsia
(3) Blurred vision
(4) Genital thrush
(5) Fatigue + Weight loss
How does hyperglycaemia cause blurred vision?
Changes osmotic pressures in the anterior chamber of the eye
What are the two main diabetic emergencies?
(1) Diabetic ketoacidosis (T1DM)
(2) Hyperosmolar hyperglycaemic state (T2DM)
What is a rare way diabetes complications can present?
(1) Loss of vision
(2) Retinal bleeds
(3) Retinal changes found by an optician.
What is the diagnostic threshold for fasting glucose in diabetes?
≥7.0 mmol/L
What is the diagnostic threshold for random or 2-hour post-OGTT glucose in diabetes?
≥11.1 mmol/L
What is the diagnostic threshold for HbA1c in diabetes?
≥48 mmol/mol
When is a repeat confirmatory test required for diabetes diagnosis?
If the patient is asymptomatic
What is the purpose of C-peptide testing?
To measure endogenous insulin secretion, as C-peptide is co-secreted with insulin but not present in injected insulin
Why is HbA1c useful for diabetes monitoring?
It reflects glucose exposure over the last ~90 days due to glycation of haemoglobin
In which conditions is HbA1c interpretation less reliable?
Conditions affecting RBC turnover
(eg) haemolytic anaemia
What is the role of insulin in glycogen synthesis?
Insulin increases glycogen synthesis
What are the three main microvascular complications of diabetes?
(1) Retinopathy
(2) Neuropathy
(3) Nephropathy
What is the target HbA1c to prevent microvascular complications?
<53 mmol/mol
What are the major macrovascular complications of diabetes?
(1) MI/ACS
(2) Stroke
(3) Peripheral vascular disease
How can macrovascular complications be prevented?
Cholesterol control, BP control, antiplatelet therapy
How are diabetic complications screened for?
(1) Eye disease → laser treatment.
(2) Neuropathy → podiatry assessment.
(3) Kidney disease → BP control, ACE inhibitors
Which type of diabetes is most commonly associated with DKA?
Type 1 diabetes
What is an extreme presentation of new Type 2 diabetes?
Hyperosmolar hyperglycaemic state (HHS)
