Key concepts Flashcards
_______ is a form of type 1 DM, with slower progression to insulin dependence in later life
Latent autoimmune diabetes of adults (LADA)
In T1DM _______ gene detrmines Islets sensitivity to damage from viruses or cross-reactivity from cows’ milk-induced antibodies.
6Q
Maturity onset diabetes of the young (MODY) is a rare autosomal dominant form of ____ affecting young people
T2DM
What are the indicators of Impaired glucose tolerance?
- Fasting plasma glucose <7mmol/L
- OGTT (oral glucose tolerance) 2h glucose ≥7.8mmol/L but <11.1mmol/L.
There may be lower risk of progression to DM in IFG than ___.
Impaired glucose tolerance (IGT).
Glycated haemoglobin (HbA1c) relates to mean glucose level over previous____ period
8 weeks.
Cotton wool spots and Blot haemorrhages are caused by _______.
Microvascular occlusion at the interfaces with perfused retina
What is Rubeosis iridis seen in diabetes ?
New vessels on iris that occurs late in the disease and may lead to glaucoma
What are the BP Tx indications in T1DM ? (NICE 2015)
Treat BP if >135/85mmHg, unless albuminuria or two or more features of metabolic syndrome, in which case it should be 130/80mmHg
What are the BP targets in T2DM ? (NICE 2015)
Target BP <140/80mmHg or <130/80mmHg if kidney, eye, or cerebrovascular damage.
in diabetes loss of transverse arch and
rocker-bottom soles are caused by ?
loss of pain sensation, leading to > mechanical stress and repeated joint injury leading to these two deformities.
what are the steps of diabetic foot care?
1 Neuropathy (clinically).
2 Ischaemia (clinically + Doppler ± angiography).
3 Bony deformity, eg Charcot joint (clinically + X-ray).
4 Infection (swabs, blood culture, X-ray for osteomyelitis, probe ulcer to reveal depth)
what are the non-diabetic causes of Charoct’s joints ?
Tabes dorsalis, spina bifi da, syringomyelia, and leprosy.
what is the course of drug therapy escalation in diabetic neuropathy ?
paracetamol
tricyclic (amitriptyline 10–25mg nocteurnal ; gradually > to 150mg)
duloxetine, gabapentin, or pregabalin
opiates
What is diabetic amyotrophy ?
Painful wasting of
quadriceps and other pelvifemoral muscles
What is gustatory sweating?
Gustatory hyperhidrosis is a form of focal hyperhidrosis that presents with facial flushing and excessive sweating of the forehead, face, and scalp after smelling or ingesting certain food products, such as sour or spicy foods, coffee, and chocolate. The causes are diabetes and fray syndrome.
What are the features of diabetic autonomic neuropathy ?
Postural BP drop
< cerebro vascular autoregulation
loss of respiratory sinus arrhythmia (vagal neuropathy)
gastroparesis, urine retention; erectile dysfunction; and gustatory sweating
What is the acronym EXPLAIN stands for in non- diabetic hypoglycaemia?
*Exogenous drugs
*Pituitary insuffi ciency.
*Liver failure, + some inherited enzyme defects.
*Addison’s disease.
*Islet cell tumours (insulinoma) and immune hypoglycaemia (eg anti-insulin
receptor antibodies in Hodgkin’s disease).
*Non-pancreatic neoplasms, eg fibrosarcomas and haem angiopericytomas
what is Whipple’s triad of hypoglycaemia?
symptoms or signs of hypoglycemia +
low plasma glucose + resolution of symptoms or signs post glucose rise.
What are the findings in hypoglycaemia due to non-pancreatic neoplasm/ anti-insulin receptor antibodies?
Insulin low or undetectable with no excess ketones
What causes hypoglycaemia with low insulin and increased ketones ?
alcohol, pituitary insuffi ciency, or Addison’s disease
In Hypoglycaemic hyperinsulinaemia ____ only detectable, if the insulin is endogenously released.
C-peptide.
What are the causes of ? Hypoglycaemic hyperinsulinaemia
- Insulinoma ( C-peptides elevated).
- sulfonylureas ( C-peptide elevated)
*insulin injection ( C-peptide undetectable).
What are the causes of dumping syndrome or post prandial hypoglycaemia ?
- gastric/bariatric surgery.
- T2DM
What is insulinoma ?
*This often benign (90–95%) pancreatic islet cell tumour is sporadic or seen with MEN-1.
What is the screening test for insulinoma ?
Hypoglycaemia + > plasma insulin during a long fast.
What is the C-peptide suppression test in insulinoma ?
Give IV insulin and measure C-peptide. Normally exogenous insulin suppresses C-peptide production, but this does not occur in insulinoma.
What is nesidioblastosis ?
It is a hyperinsulinaemic hypoglycaemia in which there is no evidence of insulinoma but beta cells of the islets of Langerhans hyperplasia and the treatment is distal pancreatectomy which is curative.
Most T3 and T4
in plasma is bound to what protein ?
thyroxine-binding globulin (TBG)
Free T4 and T3 are more useful than total T4 and T3 as the latter are affected by____ concentration.
TBG
What are the causes of reduction in TBG?
*nephrotic syndrome and malnutrition
* chronic liver disease, and acromegaly
* drugs (androgens, corticosteroids, phenytoin)
What is the hyperthyroid condition that causes increase in TSH ?
TSH-secreting pituitary adenoma
What is Sick euthyroidism?
In any systemic illness, TFTS may become deranged. The typical pattern is for ‘everything to be low’. The test should be repeated after recovery.
In factitious hyperthyroidism ____ will be low ?
Serum thyroglobulin
What is the presentation of ovarian teratoma with thyroid tissue?
Hyperthyroidism
What is the cause of Primary atrophic hypothyroidism?
Diff use lymphocytic infiltration of the thyroid, leading to atrophy, hence no goitre.
what is the effect of pregnancy on TBG, T3 and T4?
- The hyperestrogenic state during pregnancy stimulates the synthesis of thyroid-binding globulin (TBG) and increases TBG’s glycosylation. This process slows the clearance of TBG, increasing its serum level.
- As more free T3 and T4 bind to TBG, the level of free thyroid hormones decreases.
- Consequently, the pituitary gland secretes more TSH, enhancing the production and secretion of thyroid hormones. This achieves a new equilibrium in which the total T3 and T4 levels (i.e., bound and unbound T3 and T4) are increased while the free T3 and T4 levels are normal.
In the kidney, PTH promotes Ca2+ reabsorption from the ____ convoluted tubule.
distal
In a thyroid specimen large pleomorphic and spindle-shaped cells, favouring the diagnosis of _______carcinoma.
Anaplastic
A unilateral adenoma is treated with surgical resection, while bilateral adenomas are treated with ________________ such as eplerenone and spironolactone.
aldosterone antagonists
