SG 3.3: Living with Diabetes Flashcards
A 25 y/o woman has a history of type 1 diabetes for 10 years and presents to you for pre-conception counselling. Her husband does not have diabetes. She asks you what is the risk that her child will develop DM1?
4%
if she has no family history at all it’s .4% but the offspring of an affected mother is 1-4%
offspring of an affected father is 3-5%
offspring with both parents is as high as 30%
A 29 y/o male has a first-degree relative with type 1 diabetes and wants to know the implications of having a positive GAD65 antibody.
Which of the following is true regarding autoimmune type 1 diabetes?
A. Positive antibodies and presence of HLA-DR2 tend to have more rapid progression to hyperglycemia.
B. Oral glucose tolerance tests become abnormal prior to the loss of first-phase insulin release in patients at risk for type 1 diabetes.
C. IA-2 and islet cell antibodies (ICA) are more commonly seen in latent autoimmune diabetes in adults (LADA) than in children with type 1 diabetes.
D. GAD antibody positivity is more predictive of future hyperglycemia development than the presence of multiple islet antibodies.
E. Presence of ICA at diagnosis predicts more rapid decline in β-cell function.
E. Presence of ICA at diagnosis predicts more rapid decline in β-cell function.
islet cell antibodies is a bad prognosis for β-cell function
which of the following is true regarding susceptibility genes related to autoimmune type I DM?
A. HLADR2 increases risk
B. HLADR4 decreases risk
C. DBQ1 confers increased risk
D. HLADR3 reduces risk
E. HLADR3, HLADR4 both confer increased risk
E. HLADR3, HLADR4 both confer increased risk
what is predictive of future DMI?
screening first-degree relatives of individuals with type 1 diabetes can be used to predict both likelihood of developing disease and timing of disease onset
multiple positive antibodies are highly predictive of future disease development, while positivity for only one autoantibody may not lead to diabetes development
which antibodies can be detect prior to manifestation of autoimmune hyperglycemia?
- islet-cell antibodies (ICA),
- insulin antibodies (IAA),
- glutamic acid decarboxylase antibodies (GAD), and
- antibodies to tyrosine phosphatase-like proteins (IA-2, ICA512)
ICA presence, titer, persistence, and association with other autoimmune markers (GAD and IAA) is associated with increasing risk of type 1 diabetes
in individuals with multiple autoimmune antibodies, testing of first-phase insulin release with an IV glucose tolerance test adds to the predictive value for the future development of hyperglycemia or an abnormal oral glucose tolerance test
which antibodies are common in LADA?
While ICA and GAD are common in LADA, IA-2 antibodies and IAA are much less commonly seen in LADA than in type 1 diabetes
what are the major susceptibility genes for type I diabetes?
HLADR3 and 4
HLADR2 is actually protective!
DQB10602 also has reduced risk
what is the pathophysiology of type I DM?
- interactions between genes imparting susceptibility and resistance
- variable insulinitis and B cell sensitivity to injury
- over time you have loss of first phase insulin response which means that when you give IV glucose you don’t have a good insulin response
- glucose intolerance indicates type I diabetes is official; before this it was prediabetes
- C-peptide is undetectable
A 44 y/o Asian American presents for an annual physical exam. He is physically active and strives to eat healthy. Denies any symptoms today except for c/o mild fatigue lately, and states that he has been under a lot of stress at work.
He is requesting for his vitamin D level to be checked, as wants to make sure it’s not low. His vitals are normal, BMI is 23, and he takes a daily multivitamin. His cholesterol was check at a health fair at work 6 months ago and was normal.
You order for fasting blood work and fasting glucose is 150. what is the next best step?
perform 75 g OGTT
blood glucose over 126 is one of the criteria for diagnosing DM so do the OGTT to confirm
if the OGTT comes back at 200 how do you interpret his results if a fasting glucose was 150?
new onset diabetes
criteria for diagnosis of DMII:
1. fasting glucose of over 126
- 2hr plasma glucose is over 200 during oGTT
- A1c over 6.5
- symptoms of hyperglycemia OR hyperglycemic crisis, a random plasma glucose over 200
in the absence of unequivocal hyperglycemia, diagnosis requires 2 abnormal test results from the same sample OR in 2 different test samples
A 50 y/o male with a history of diabetes returns to your office for review of his labs. His A1c is 9.0%, increased from 7.0% at his last visit. His current drug regimen includes glipizide and metformin. He reports that he takes his medications regularly, but his wife is concerned about his diabetes control.
Which of the following labs would best indicate a need for insulin to control this patient’s blood sugar?
A. Anti-GAD antibody
B. C-peptide
C. Fasting blood sugar
D. IGF-1
E. Random blood glucose
B. C-peptide
DM type 2 may result from insulin resistance but ultimately, overworked β-cells stop producing insulin and pts become insulin dependent
one way to determine when insulin therapy is indicated is to check a C-peptide
C-peptide is cleaved when pro-insulin is converted to insulin; normal ranges of C-peptide indicate endogenous production of insulin
what is the anti-GAD antibody used to diagnose?
type I DM or autoimmune diabetes
A 29 y/o Asian woman comes to your office because she has been feeling increasing hunger for the past week and she wants to be seen by an endocrinologist. Her job has been very stressful and she is worried about her pregnancy (currently at 24 weeks). This is her first pregnancy. Pre-pregnancy BMI is 24 kg/m2. She has gained 14 lbs.
She had a 50-g OGTT after an overnight fast by her ob-gyn. Her 1-hr glucose was 148 mg/dl. You tell her:
A. You meet criteria for gestational diabetes and should be started on insulin
B. You meet criteria for gestational diabetes and you can start metformin
C. You do not meet criteria for gestational diabetes and you should have a 100-g OGTT to determine if you have gestational diabetes
D. You can only be diagnosed with gestational diabetes by a 75-g OGTT
C. You do not meet criteria for gestational diabetes and you should have a 100-g OGTT to determine if you have gestational diabetes
Step 1: 50 g OGTT, non-fasting
If 1 hr ≥ 140 mg/dl, then proceed to:
Step 2: 100 g OGTT, fasting and then you can make a diagnosis with 2 or more:
- Fasting ≥ 95 mg/dl
- 1 hr ≥ 180 mg/dl
- 2 hr ≥ 155 mg/dl
- 3 hr ≥ 140 mg/dl
the other test you can do is a 1 step 75 g OGTT at 24-28 weeks after an over night fast and you can make a diagnosis with 1 or more of the following:
1. fasting ≥ 92 mg/dl
- 1 hr ≥ 180 mg/dl
- 2 hr ≥ 153 mg/dl
A 20 y/o woman presents for evaluation of polyuria and polydipsia. She has a history of cystic fibrosis, diagnosed at the age of two. She reports recent weight loss despite compliance with her treatment of exocrine pancreatic insufficiency. She does not have any acute pulmonary symptoms at this time.
On physical exam, she is thin, in no apparent distress; weight is 100 lbs (BMI 19). Her vitals are normal. Random plasma glucose is 147 mg/dl.
Which of the following is the best diagnostic test to diagnose cystic fibrosis related diabetes (CFRD)?
A. Fasting plasma glucose
B. Measurement of glutamic acid decarboxylase antibodies
C. A1c measurement
D. 75-g oral glucose tolerance test
E. Continuous glucose monitoring
D. 75-g oral glucose tolerance test
The OGTT result comes back with a 2 hour plasma glucose of 300. A diagnosis of cystic fibrosis related diabetes is confirmed. How would you management her medically? when would you screen a CF patient for DM complications?
A. Start patient on metformin
B. Start patient on glipizide
C. Start patient on insulin
D. Start patient on liraglutide
E.. 75-g oral glucose tolerance test
C. Start patient on insulin and begin annual monitoring 5 years after CFDM
