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Endocrinology > Pathophysiology and Treatment of Type I Diabetes Mellitus > Flashcards

Pathophysiology and Treatment of Type I Diabetes Mellitus Flashcards

1
Q

Name a form of type I diabetes that presents late.

A

Latent Autoimmune Diabetes in Adults (LADA)

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2
Q

State two monogenic causes of diabetes.

A

Mitochondrial Diabetes

Maturity Onset Diabetes of the Young

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3
Q

Diabetes can also present with endocrine diseases. Name three endocrine diseases that are associated with diabetes.

A

Phaeochromocytoma
Cushing’s Syndrome
Acromegaly

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4
Q

What conditions and triggers are required for the onset of type 1 diabetes mellitus?

A

Environmental trigger in the presence of a genetic predisposition –> autoimmune attack of islet cells

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5
Q

Which type of diabetes has a bigger genetic component?

A

Type 2 Diabetes Mellitus

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6
Q

What can be measured in the blood to give an indication of insulin function?

A

C-peptide

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7
Q

Describe the pathogenesis of T1DM.

A

You get gradual autoimmune destruction of beta cells resulting in gradually reducing levels of insulin (and C-peptide)
One of the first signs will be the loss of first phase insulin
There will be eventual destruction of all beta cells

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8
Q

Why is T1DM described as a ‘relapsing-remitting’ disease?

A

Over time the beta cell mass appears to reduce, then stabilise, then reduce again
There is a theory that this is due to the imbalance in effector T-cells and regulatory T-cells

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9
Q

What is the importance of the autoimmune basis of T1DM?

A

Increased prevalence of other autoimmune diseases (e.g. rheumatoid arthritis, thyroid disease)

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10
Q

What are the histological features of T1DM?

A

Lymphocyte infiltration of beta cells (which destroys the beta cells)

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11
Q

On which chromosome is the HLA found?

A

Chromosome 6

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12
Q

Which alleles convey a risk of diabetes? Which of these alleles is associated with the most significant risk?

A

DR alleles

DR3 and DR4 = significant risk

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13
Q

What are the two most significant markers of diabetes?

A

Islet Cell Antibodies (ICA)

Glutamic Acid Decarboxylase Antibodies (GADA)

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14
Q

State two other antibody markers of diabetes that are not used in clinical practice?

A

Insulin Autoantibodies (IAA) Insulinoma-associated-2 autoantibodies (IA-2A)- receptor like family

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15
Q

State some symptoms of T1DM.

A 
Polyuria 
Nocturia 
Polydipsia 
Blurring of vision  
Thrush (due to increased risk of infection) 
Weight loss 
Fatigue
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16
Q

What are the signs of T1DM?

A 
Dehydration 
Cachexia 
Hyperventilation (kussmaul breathing) 
Smell of ketones  
Glycosuria 
Ketonuria
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17
Q

What are the triglycerides in adipocytes broken down to?

A

Glycerol

Fatty Acids

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18
Q

What does insulin have a negative effect on?

A

Hepatic glucose output (HGO)
Protein breakdown in muscle
Ketone body generation by the liver
Glycerol release from the fat cells

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19
Q

What does insulin have a positive effect on?

A

Glucose uptake by tissues

20
Q

State 4 other hormones that increase hepatic glucose output.

A

Catecholamines
Cortisol
Growth Hormone
Glucagon

21
Q

Describe how insulin deficiency leads to diabetic ketoacidosis (DKA).

A

Insulin has a suppressive effect on hepatic ketone body generation.
In insulin deficiency, fatty acids from the breakdown of triglycerides, travel to the liver where they are used to produce ketone bodies.

22
Q

What is a defining feature of insulin deficiency?

A

Ketone Bodies

NOTE: some cases of T2DM can also get DKA but this is mainly a complication of T1DM

23
Q

State some long-term complications of T1DM.

A

Neuropathy
Nephropathy
Retinopathy
Vascular Disease

24
Q

What is the main treatment for T1DM?

A

Exogenous insulin

25
Q

Describe the dietary changes that are recommended in T1DM.

A

Decreased fat
Decreased refined carbohydrates
Increased complex carbohydrates
Increased soluble fibre

26
Q

Describe the features of the insulin that is given with meals.

A

Short-acting
Human Insulin
Insulin analogues are genetically engineered to mimic normal physiology

27
Q

State three forms of insulin that are given with meals.

A

Lipsro
Aspart
Glulisine

28
Q

Describe the features of background insulin.

A

Long-acting

Non-C bound to zinc or protamine

29
Q

State three forms of insulin that is given as background insulin.

A

Glargine
Detemir
Degludec

30
Q

What do insulin pumps do?

A

Continuous insulin delivery
There are pre-programmed basal rates and boluses for meals
But these DO NOT measure blood glucose so the feedback loop isn’t complete

31
Q

Describe the use of islet cell transplants.

A

Islet cells can be harvested from donors and injected into the liver of a patient with diabetes
They must be on immunosuppressants for life

32
Q

How is capillary monitoring done and what does it give a measure of?

A

Prick the finger and test the blood drawn
It is a measure of venous blood glucose
NOTE: you can also get continuous monitors, which aren’t as accurate (need to be calibrated with capillary glucose)

33
Q

What is HbA1c level used to gage?

A

Glycaemic control over the past 3 months (red cell life span = 120 days)

34
Q

What HbA1c level are T1DM patients aiming for?

A

< 7%

35
Q

When might the HbA1c level not be accurate?

A

In any case of increased haemoglobin turnover e.g. haemolytic anaemia and haemoglobinopathies

36
Q

What are the main acute complications of T1DM?

A

Hypoglycaemia

Metabolic acidosis

37
Q

What are the two main ketones that circulate in metabolic acidosiscaused by T1DM?

A

Acetoacetone

Hydroxybutyrate

38
Q

DKA tends to be in patients with T1DM, however, some subsets of T2DM also get ketoacidosis. What are these subsets?

A

Black and Asian patients with T2DM

May be due to pancreatic insufficiency at a time of stress

39
Q

Define hypoglycaemia.

A

Blood glucose < 3.6 mmol/L

40
Q

Define severe hypoglycaemia.

A

Any level of hypoglycaemia that requires another person to treat it

41
Q

What can recurrent hypos result in?

A

Loss of warning (hypoglycaemia unawareness)

This can lead to poor glycaemic control

42
Q

At what times during the day do hypos tend to happen?

A

Pre-lunch

Nocturna

43
Q

What can trigger a hypo?

A 
Unaccustomed exercise  
Missed meals  
Inadequate snacks 
Alcohol (may make you unaware of hypo symptoms) 
Inappropriate insulin regime
44
Q

State some signs and symptoms of hypoglycaemia.

A 
Signs and symptoms are due to increased sympathetic activity and due to impaired CNS function  
Palpitations  
Tremor  
Sweating  
Pallor/cold extremities 
Anxiety  
Drowsiness 
Confusion
Altered behaviour  
Focal neurology  
Coma
45
Q

How is hypoglycaemia treated?

A

Oral glucose
Complex carbohydrate (to maintain blood glucose after initial treatment)
Parenteral – if consciousness impaired
 IV dextrose (e.g. 10% glucose infusion)
 1 mg glucagon IM

Endocrinology (18 decks)

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