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Endocrine > Poster- diabetes 1 > Flashcards

Poster- diabetes 1 Flashcards

1
Q

Normal range for HbA1c

A

Less than 42

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2
Q

Diabetes range for HbA1c

A

Greater than or equal to 48

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3
Q

Normal range for fasting glucose

A

Less than 7mmol

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4
Q

Diabetes range for fasting glucose

A

Above 7 mmol

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5
Q

Normal range for 2 hour oral glucose tolerance test

A

Less than 11mmol

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6
Q

Diabetes range for 2 hour OGTT

A

Above 11.0mmol

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7
Q

Quick pathology of type 1 diabetes

A

Pancreatic beta cells are destroyed by T cells. This means they fail to produce insulin which causes glucose to remain in the blood and hyperglycaemia occurs.

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8
Q

What is type 1 diabetes associated with?

A

HLA DR3

HLA DR4

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9
Q

Characteristically these autoantibodies will be present in type 1 diabetes

A

Anti-islet cell antibodies

Anti- GAD

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10
Q

Type 1 diabetes is more common than type 2. T or F.

A

F- type two is more common.

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11
Q

It is likely that patients with diabetes will have a first degree relative also with diabetes. T or F

A

Partially true. 15% of people younger than 15 diagnosed have a first degree relative with type 1.

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12
Q

What other diseases is diabetes associated with?

A 
Around 25% of CF sufferers also have DM. 
Coeliac disease
Thyroid diseases
Addisons disease
Pernicious anaemia
IgA deficiency.
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13
Q

Classic triad of symptoms of adults with type 1 diabetes

A

Polyuria- excessive urination
Polydipsia- excessive (often unquenchable) thirst
Weight loss

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14
Q

What other symptoms may accompany the triad for adults with type 1 diabetes?

A

Candida infection (thrush)
DKA
Fatigue
Blurred vision

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15
Q

Symptoms of children with type 1 diabetes

A

Often similar to adults with the polyuria, polydipsia and weight loss.
However also tend to have low muscle mass (due to lipolysis, gluconeogenesis and glycogenesis)
Also could have secondary nocturnal enuresis- child previously trained not to wet the bed, now has started doing it again.

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16
Q

How does DKA occur?

A

When there is prolonged insulin insufficiency, the body starts to do lipolysis (along with gluconeogenesis and glycogenolysis). The lipolysis provides energy however a breakdown product is free fatty acids.
These FFA are then converted to ketone bodies by the liver.

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17
Q

Symptoms of DKA

A 
Kussmaul breathing- deep laboured breathing associated with kidney failure and DKA
Dehydration
Nausea
Vomiting
Change of mental state
Fruit/pear drop smell of breath
Polyuria
Tachycardic and hypertensive
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18
Q

Treatment of DKA

A

Use fluids to stop dehydration.
Replace lost electrolytes
Insulin

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19
Q

What do you have to be wary of when treating children with DKA

A

Fluid resus should be done based on weight because they are at risk of cerebral oedema.

20
Q

Blood glucose target level before meals in a normal patient

A

4-5.9mmol

21
Q

Blood glucose target levels 2 hours after a meal in a normal individual

A

Less than 8

22
Q

Blood glucose target levels before a meal in an adult type 1 diabetic

A

4-7

23
Q

Blood glucose target levels 2 hours after a meal in an adult type 1 diabetic

A

Less than 9

24
Q

Blood glucose target levels before a meal in a type 2 diabetic

A

4-7

25
Q

Blood glucose target levels 2 hours after a meal in a type 2 diabetic

A

Less than 8.5

26
Q

Blood glucose target levels before a meal in a child with type 1 diabetes

A

4-8

27
Q

Blood glucose target levels 2 hours after a meal in a child with type 1 diabetes

A

Less than 10.

28
Q

At what stage is it hypoglycaemia

A

4mmol and less

4 is the FLOOR

29
Q

Symptoms of hypoglycaemia

A 
Patient becomes pale and sweaty
They have tremors and palpitations
They are confused, nauseous, hungry
Weak and fatigued
Tachycardic
30
Q

Cognitive symptoms of hypoglycaemia

A

Slow at processing information
Tense
Effects memory

31
Q

Severe hypoglycaemia can present as

A

Seizures
Coma
Unconciousness

32
Q

What is impaired hypoglycaemia awareness and why is it more dangerous than hypoglycaemia?

A

This is when the patient feels no symptoms during hypoglycaemia or no change in symptoms. This is dangerous as it doesn’t allow them to recognise it and then rectify the situation.

33
Q

Who is most likely to get impaired hypoglycaemia?

A

Those who have frequent low blood glucose levels or patients being intensively treated.

34
Q

Describe type 2 diabetes briefly

A

Insulin resistance leading to hyperglycaemia

35
Q

How does obesity contribute to type 2 diabetes

A

Obesity leads to a decreased number of insulin receptors.

36
Q

What are the risk factors for developing type 2 diabetes

A 
genetic predisposition (family history)
Obesity
Gestational diabetes
MI/stroke
Age
Ethnicity- Asian, African, afro-caribbean 
PCOS
Metabolic disorders
37
Q

Short pathophysiology of type 2 diabetes

A

Insulin resistance means that blood sugar levels are still high. Initially beta cells compensate for this by making more insulin however after a while they become exhausted and therefore people become insulin deficient.

38
Q

Clinical features of type 2 diabetes

A

Polyuria, polydipsia and hyperglycaemia- however can be clinically silent for up to 12 years.
Also patients with type 2 diabetes tend to present with complications such as neuropathy, retinopathy, blurred vision, fatigue, weakness, infections and thrush.

39
Q

Likely history from a patient with type 2 diabetes (include presentation, diet, PMH and FH)

A

Rapid onset of symptoms
Diet- contains lots of sugar
PMH- heavy alcohol consumption, previous pancreatitis
FH- diabetes, autoimmune conditions, insulin resistance, CV disease, high bp, high lipids,

40
Q

How would you diagnose someone with type 2 diabetes

A

Blood glucose levels

41
Q

Treatment of type 2 diabetes

A

Diet and exercise to lose weight. Prognosis greatly increases with weight loss.
Patient may need drug therapy e.g. metformin, sulphonylureas and possibly exogenous insulin.

42
Q

Why would a patient with type 2 diabetes not have ketones in their urine?

A

The low circulating volume insulin means that ketone bodies are not produced.

43
Q

Histological appearance of type 2 diabetes

A

Amyloid deposits in islet cells.

44
Q

Gestational diabetes

A

Diabetes that comes on during pregnancy and resolves post natally. Increased future risk of type 2.

45
Q

Secondary diabetes

A

Diabetes that comes secondary to other diseases e.g. endocrinopathies (Cushings, acromegaly), haemochromatosis, post pancreatitis, CF

46
Q

Monogenic diabetes

A

Diabetes that develops due to a mutation in a gene regulating insulin action or secretion. MODY, mitochondrial diabetes.

Endocrine (20 decks)

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