Other types of diabetes Flashcards
What is MODY?
Monogenic diabetes of the young
What is the pathogenesis of MODY?
autosomal dominant inheritance
Glucokinase mutation or SUR1 mutation
What age does glucokinase mutation MODY present?
presents at birth
What is the glycaemic profile of a glucokinase mutation MODY?
stable hyperglycaemia
How is glucokinase MODY treated?
dietry controlled
What transcription factors are affected in TF MODY mutations?
HNF1 alpha
HNF1 beta
HNF4 alpha
What age to transcription factor MODY present?
adolescence
What is the glycaemic profile of a transcription factor MODY?
preogressive hyperglycaemia
How are transcription factor MODYs treated?
diet
Oral hypoglycaemic agents
insulin
what transcription factor MODY can be managed with sulphonylureas?
HNF1 alpha
What is the aetiology of MODY?
Young onset strong FHx associated renal cysts GAD negative C peptide positive
What is the cause of neonatal diabetes?
Mutation in K+ channel gene ATP does not close Katp channel Hyperpolarisation no Ca2+ influx no insulin released
When is transient neonatal diabetes a) diagnosed b) resolved?
a) less than 1 week
b) median 12 weeks
When is permanent neonatal diabetes diagnosed?
0-6 weeks
What is the treatment for neonatal diabetes?
insulin in first 3 months
may need lifelong treatment
What are the genetic causes of Type 3 diabetes?
Cystic fibrosis
Myotonic dystrophy
Turner’s syndrome
What are the endocrine causes of Type 3 diabetes?
Cushing’s
Acromegaly
Phaeochromocytoma
Glucagonoma
What are the drug induced causes of Type 3 diabetes?
Glucocorticoids
Diuretics
Beta blockers
What are the oancreatic causes of type 3 diabetes?
chronic/recurrant pancreatitis
Haemochromatosis
Cystic fibrosis
What is type 4 diabetes and how is it characterised?
Gestational diabetes
Any degree of glucose intolerance in pregnancy
What happens in diabetes insipidus?
ADH disturbances
Not registered in kidney
Higher volume, less concentrated urine
Symptoms of thirst
What happens in diabetes insipidus?
ADH disturbances in ant pit
Not registered in kidney
Higher volume, less concentrated urine
Symptoms of thirst
How does gestational diabetes occur?
Progesterones and hPL cause insulin resistance
if already predisposed rise in blood glucose
What are the foetal complications of gestatoinal diabetes?
congenital malformation prematurity intrauterine growth retardation macrosomia (>90th centile size) polyhydramnios stillbirth
What are the complications of gestational diabetes in neonates?
respiratory distress
hypo/hyperglycaemia
How is gestational diabetes managed?
pre pregnancy counselling folic acid 5mg change from tablets to insulin regular eye checks Avoid ACEI (use labetalol, nifedipine, methy dopa)
how do you ensure resolution of gestational diabetes?
6 weeks post natal GTT
What %age of gestational diabetics go on to have in next 10 years
a) type 1
b) type 2?
a)
How do you prevent post gestational diabetes from becoming permenant?
low weight
healthy diet
aerobic exercise
annual fasting glucose
When does gestational diabetes present?
3rd trimester
