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Endocrine System > Lecture 8 What is Diabetes Mellitus > Flashcards

Lecture 8 What is Diabetes Mellitus Flashcards

1
Q

Define diabetes

A

A group of metabolic diseases of multiple causes characterised by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both

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2
Q

What are the symptoms of hyperglycaemia

A

polydipsia, polyuria, blurred vision, weight loss, infections

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3
Q

What molecular decompensation are involved in hyperglycaemia

A

DKA HHS

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4
Q

What are the long term complications of hyperglycaemia

A 
Retinopathy
Neuropathy
Nephropathy
Stroke
MI
PVD
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5
Q

Normal fasting plasma glucose

A

=/<6

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6
Q

Intermediate fasting plasma glucose

A

6.1-6.9

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7
Q

DM fasting plasma glucose

A

=/>7

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8
Q

Random plasma glucose that would suggest DM

A

> /=11.1

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9
Q

Normal 2 hour OGTT value

A

=7.7

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10
Q

Intermediate 2 hours OGTT value

A

7.8-11

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11
Q

DM 2 hour OGTT value

A

> /=11.1

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12
Q

Intermediate hyperglycaemia in HbA1c

A

HbA1c 42-47mmol/mol

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13
Q

Advantages of testing glucose

A

Established method
Smaller variation between laboratories
More feasible in developing countries
Directly measures molecule thought to cause diabetic complications

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14
Q

Disadvantages of testing glucose

A

Requires a fasting
May require OGTT
Higher variability within individuals

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15
Q

Advantages of testing HbA1c

A

No need for fasting sample
More stable after collection
Marker of glyceamic control
Lower variability within individuals

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16
Q

Disadvantages of testing HbA1c

A

Measurement can be misleading due to haemoglobinopathies, anaemia or renal failure
May differ with age and ethnicity
More costly
Surrogate marker of hyperglycaemia

17
Q

When HbA1c cannot be used for diagnosis

A
  • All children and young people
  • Pregnant or recently pregnant
  • Short duration of diabetes symptoms
  • Acutely ill patients
  • HbA1c >48mmol/mol = pre-existing diabetes, nut value below this does not exclude it- patient must be retested once acute episode has resolved
  • Taking medication that causes rapid rise in glucose- corticosteroids, antipsychotic drugs
  • Acute pancreatic damage or pancreatic surgery
  • Renal failure
  • HIV
18
Q

What is the risk of an individual if their father has type 1 DM

A

6%

19
Q

What is the risk of an individual of their mother has type 1 DM

A

1%

20
Q

What is the risk of an individual if both parents have type 1 DM

A

30%

21
Q

What is the risk of an individual if their non-identical twin has type 1 DM

A

30%

22
Q

Aetiology of type 1 diabetes

A
  • Genetic predisposition
  • Trigger e.g. viral infection
  • Auto immunity
23
Q

Clinical presentation of type 1 diabetes on short duration

A
  • Thirst
  • Tiredness
  • Polyuria/nocturia
  • Weight loss
  • Blurred vision
  • Abdominal pain
24
Q

Clinical presentation of type 1 diabetes on exmination

A
  • Ketones on breath
  • Dehydration
  • May have increased respiratory rate, tachycardia, hypotension
  • Low grade infections, thrush, balanitis (diaper rash)
25
Q

What is insulin

A
  • Protein consisting of alpha(21) and beta(30) chains

* Linked together with disulphide bonds

26
Q

What is the risk of an individual for type 2 diabetes if their twin has it

A

90-100%

27
Q

What is the risk of an individual for type 2 diabetes if one parent has it

A

15%

28
Q

What is the risk of an individual for type 2 diabetes if both parents have type 2 diabetes

A

75%

29
Q

What is the risk of an individual for type 2 diabetes if their sibling has type 2 diabetes

A

10%

30
Q

What is the risk of an individual for type 2 diabetes if their non-identical twin has type 2 diabetes

A

10%

31
Q

Symptoms of type 2 diabetes

A
  • May have no symptoms
  • Thirst
  • Tiredness
  • Polyuria/nocturia
  • Sometimes weight loss
  • Blurred vision
  • Symptoms of complications e.g., CVD
32
Q

Signs of type 2 diabetes

A
  • No ketotic
  • Usually overweight but not always
  • Low grade infection, thrush/balanitis
  • May have microvascular complications and Dx
33
Q

Screening for Diabetes in asymptomatic patients

A

• All eligible adults aged 40 and over, except pregnant women
• People aged 25-39 of south Asian, Chinese, African-Caribbean, Black African and other high risk black and minority ethnic groups except pregnant women
• Adults with conditions that increase risk of type 2 diabetes
 CV disease
 Hypertension
 Obesity
 Stroke
 PCOS
 History of gestational diabetes
 Mental health problems

34
Q

Name other types of DM

A
  • MODY: Maturity Onset Diabetes in the Young
  • Gestational diabetes
  • Secondary diabetes
35
Q

What is the cause of MODY

A

 Autosomal dominant
 5% of people with diabetes
 Impaired beta-cell function
 Single gene defect
 Glucokinase mutations- onset at birth, stable hyperglycaemia, diet treatment, complications rare
 Transcription factor mutations (HNF-1a, HNF=1b, HNF-4a). Adolescence/youg adult onset, progressive hyperglycaemia, 1/3 diet, 1/3 OHA, 1/3 insulin. Complications frequent

36
Q

What is gestational diabetes associated with

A

 Increasing insulin resistance in pregnancy
 Associated with FH of type 2 diabetes
 Increased risk of type 2 diabetes later in life
 Develops 2nd/3rd trimester
 More common if overweight and inactive

37
Q

What are neonatal problems in gestational diabetes

A

macrosomia (newborn who’s significantly larger than average), respiratory distress, neonatal hypoglycaemia

38
Q

Name causes of secondary diabetes

A 
	Any major disease of the exocrine pancreas 
–	Chronic pancreatitis
–	Haemochromatosis
–	Cystic fibrosis
	Endocrinopathies
–	Acromegaly
–	Cushing’s syndrome
–	Glucagonoma
–	Pheochromocytoma
	Drug or chemical induced diabetes
–	Steroids

Endocrine System (26 decks)

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