MODY Flashcards

1
Q

What does MODY stand for?

A

Maturity Onset Diabetes of the Young

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2
Q

What are the most common types of MODY?

A
  1. Glucokinase mutation MODY
  2. Transcription factor MODY
  3. MODY X
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3
Q

What is glucokinase and what does it do?

A

Enzyme

Phosphorylates glucose to glucose-1-phosphate

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4
Q

Why is a mutation in the glucokinase gene an issue for people with MODY?

A

Abnormal GLUT2 function and glucokinase is less responsive to glucose

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5
Q

GCK-MODY is a progressive condition

True or false?

A

False

It is non-progressive

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6
Q

Transcription factor MODY most commonly affects which genes?

A
  1. HNF1A
  2. HNF4A
  3. HNF1B (rarer)
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7
Q

What is MODY X?

A

MODY with no proven/provable cause

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8
Q

Transcription factor MODY is progressive

True or False?

A

True

It is a progressive condition

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9
Q

Generally patients with MODY require insulin

True or false?

A

False

Although they may require it later on in life

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10
Q

How do patients with MODY generally present?

A
  1. Strong family history of diabetes
  2. Onset of diabetes in the 2nd to 5th decade
  3. Insulin independence
  4. Absence of B cell autoimmunity
  5. Absence of insulin resistance features
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11
Q

What are the key signs of insulin resistance?

A
  1. Acanthosis nigricans
  2. Abnormal fat distribution
  3. Central obesity
  4. Dyslipidaemia (abnormal fat (triglycerides or LDL) in the blood)
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12
Q

Patients with GCK-MODY have a _________ threshold for the initiation of glucose stimulated insulin secretion

A

Patients with GCK-MODY have a raised threshold for the initiation of glucose stimulated insulin secretion

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13
Q

Due to having a raised threshold for insulin secretion, patients with GCK-MODY have a lifelong what?

A

Mild, stable hyperglycaemia

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14
Q

How will a patient’s blood sugar levels change if they have GCK-MODY?

A

Low rise

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15
Q

What are patients with HNF1A and HNF4A mutations at risk of?

A

Microvascular and macrovascular consequences of diabetes

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16
Q

What is MODY often diagnosed as?

A

Type 1 diabetes

17
Q

If a patient is misdiagnosed with type 1 diabetes, yet actually has MODY, how may this be shown after 3-5 years post-diagnosis?

A
  1. Continued endogenous insulin secretion
  2. Persistent C-peptide
  3. No tendency to ketoacidosis
18
Q

How can C-peptide be measured?

A

Urine or blood

Urine is easier as the C-peptide to creatinine ratio can be measured

19
Q

Usually patients with MODY do not have which characteristic thing of type 1 diabetes?

A

Pancreatic autoantibodies

20
Q

What is the first line treatment for HNF1A and HNF4A MODY?

A

Sulphonyureas

(low doses, these agents are very effective in this type of MODY)

21
Q

What is the first line treatment for GCK-MODY?

A

Nothing

22
Q

In children with severe hyperglycaemia what treatment is given?

A

Insulin

This is the safest thing to do, despite there being a chance the child has MODY

23
Q

If a pregnant women has asymptomatic hyperglycaemia secondary to GCK-MODY, what man she present with?

A

Gestational diabetes

24
Q

What is the treatment for a pregant woman with GCK-MODY?

A

Insulin

(if there are signs foetal development may be impacted)

25
Q

What is the first line treatment for a pregant woman with HNF1A/HNF4A MODY?

A

Glibenclamide (a sulphonyurea)