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Endocrine > T1DM > Flashcards

T1DM Flashcards

1
Q

T1DM is a condition of relative/absolute insulin deficiency?

A

Absolute (T2DM is relative deficiency)

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2
Q

What’s the normal fasting glucose result? (mmol/L)

A

6.0mmol/L and below

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3
Q

What’s the normal 2-hour post OGTT glucose result?

A

7.7mmol/L and below

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4
Q

Diabetes is indicated if a random glucose tested is above what (mmol/L)

A

11.1mmol/L

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5
Q

Patients who are <1 year old are unlikely to develop T1DM. Why?

A

T1DM is an autoimmune condition - it usually takes years for the full beta-islet destruction to occur.

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6
Q

T1DM can be detected through antibody screening prior to clinical symptom onset. True/false?

A

True, this is “latent autoimmune T1DM”

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7
Q

T1DM tends to present in pre-school/school/high-school?

A

Pre-school and around puberty

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8
Q

Microvascular complications of T1DM are usually present upon diagnosis. True/false?

A

False

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9
Q

Typical presenting symptoms of T1DM (6)

A

1) Thirst
2) Polyuria
3) Weakness fatigue
4) Blurry vision
5) Thrush
6) UTI infections

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10
Q

Which tests can differentiate T1DM from T2DM?

A

Type 1: GAD / anti-Islet antibodies present, ketonuria, C-peptide will be low in T1DM (high in T2DM)

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11
Q

“Type 3 diabetes” commonly refers to that which is…

A

Secondary to other disease (e.g. pancreatic disease), drug induced, caused by genetic abnormalities

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12
Q

HbA1C provides a snapshot of insulin control over which time-frame?

A

Previous 2-3 months

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13
Q

The macrovascular complications of diabetes include (3)

A

1) Heart disease and stroke
2) Foot ulcer
3) Peripheral vascular disease

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14
Q

The microvascular complications of diabetes include (3)

A

1) Retinopathy
2) Neuropathy
3) Nephropathy

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15
Q

What’s the strongest established risk factor for development of T1DM?

A

Monozygotic twin has T1DM (30-50% risk)

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16
Q

What’s the general population risk for developing T1DM?

A

1:250 to 1:300

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17
Q

If both parents have T1DM, how likely is a child to develop it?

A

30%

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18
Q

What carries greater risk; a mother or father with T1DM?

A

Father

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19
Q

HLA genes represent what % of familial risk for T1DM?

A

50%

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20
Q

Which two HLA-types are the highest risk for development of T1DM? What’s the increased fold in risk?

A

DR3-DQ2
DR4-DQ8

19-fold risk

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21
Q

The diagnoses of T1DM has a seasonal variation. True/false?

A

True (more made in winter months)

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22
Q

Can viral infection trigger T1DM?

A

Yes

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23
Q

C-peptide loss is one of the first signs of T1DM. True/false?

A

False - C-peptide is the LAST factor to be lost.

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24
Q

Classical triad of symptoms for T1DM?/

A

Polyuria (may present with enuresis in children), polydipsia, weight loss

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25
Q

Describe the difference between basal and bolus insulins?

A

Basal insulin = a long acting insulin (usually given OD)

Bolus = a “with-meals” regimen

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26
Q

What’s the target HbA1c for T1DM?

A

48-58mmol/L

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27
Q

T1DM accounts for which % of diabetes diagnoses in those <25 years old?

A

90%

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28
Q

How many T1DM will have CF?

A

20%

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29
Q

Insulin is secreted into which structure?

A

Hepatic portal vein

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30
Q

Do T1DM tend to present with HHS or DKA?

A

DKA

31
Q

LADA is defined as

A

Presence of pancreatic auto-antibodies in patients with recently diagnosed diabetes in patients who do NOT require insulin

32
Q

LADA is AKA

A

“slowly progressive T1DM”

33
Q

When should LADA be considered? (4)

A

1) Autoantibody positive
2) Non-insulin requiring at positive
3) Associated with other autoimmune conditions
4) Non-obese

34
Q

Around what % of CF patients develop T1DM?

A

25%

35
Q

Wolfram Syndrome encompasses (4)

A

1) Diabetes Insipidus
2) DM
3) Optic atrophy
4) Deafness

36
Q

Bardet-Biedl Syndrome signs (3), what’s it associated with?

A

Signs: obese, polydactyly, visual impairment. Associated with consanguineous marriage (2nd cousins or closer)

37
Q

What’s the prevalence of coeliac disease in T1DM patients?

A

1:20

38
Q

Coeliac disease antibody test

A

anti-TTG positive

39
Q

Thyroid disease is how common in T1DM?

A

1:20

40
Q

Can T1DM be diagnosed on a single fasting glucose >7.0mmol/L?

A

No, requires symptoms OR a repeat testing

41
Q

T1DM often needs antibodies to confirm?

A

No, often on history (e.g. DKA)

42
Q

Signs of hypoglycaemia include (3)

A

1) Pallor
2) Tremor
3) Hunger

43
Q

Basal insulin normally accounts for around what % of insulin produced?

A

50% (rest is post-prandial)

44
Q

Target blood glucose for T1DM patients pre-meals?

A

3.9-7.2mmol/L

45
Q

Target blood glucose for T1DM post-meal?

A

<10mmol/L

46
Q

NovoRapid is a rapid/long acting insulin.

A

Rapid

47
Q

Rapid insulin analogues tend to have peak action after how long?

A

60-90 minutes

48
Q

How long do rapid-

insulin analogues typically last?

A

4-5 hours

49
Q

ActRapid and Humulin S are examples of what insulin type?

A

Soluble insulin analogues

50
Q

Soluble insulin tends to peak after how ong?

A

2-4 hours

51
Q

Humulin I is a basal / bolus insulin?

A

Basal

52
Q

Lantus (Glargine) is basal / bolus insulin?

A

Basal

53
Q

DAFNE is used in T1DM. True/false?

A

True - Dose Adjustment for Normal Eating

54
Q

Insulin pumps continuously inject short / long acting insulin?

A

Short-acting

55
Q

Insulin pumps are only designed to adminster basal doses of insulin. True/false?

A

False - can give boluses

56
Q

Metabolic control in T1DM can be measured through which laboratory investigations? (3)

A

1) BG monitoring
2) Urinalysis
3) HbA1c

57
Q

The formation of HbA1c is enzymatic. True/false?

A

False - occurs naturally in response to a high glucose

58
Q

What’s the injection site complication of multiple insulin injections?

A

Lipohypertrophy

59
Q

What are the top 3 errors in prescribing insulin?

A

1) Wrong dose
2) Omitted medicine (i.e. someone has given a dose before & not recorded)
3) Wrong type of insulin

60
Q

Should insulin be omitted if patient is hypoglycaemic?

A

No - treat hypoglycaemia but continue insulin (prevents reactive hyperglycaemia)

61
Q

What’s the general aim of diet in management of T1DM/

A

Consistent quantities of CHO

62
Q

Name an advanced carbohydrate counting programme.

A

DAFNE

63
Q

Does advanced calorie counting lead to long-term benefit?

A

Not really (no evidence for change in weight loss or lipid profile)

64
Q

What are the short-term (6 month) effects of advanced calorie counting? (3)

A

Better HbA1c, more freedom of diet, increased QoL

65
Q

What is the standard treatment in early-stages of hypoglycaemia?

A

15-20g simple carbohydrate

66
Q

List the most common causes of hypos (3)

A

1) Missed/delayed meal
2) Not enough CHO in last meal
3) Increased exercise

67
Q

Patients are safe from hypos 6 hours after exercise. True/false?

A

False - can occur 12-24 hours after exercise. (esp if exercise is >60 minutes moderate)

68
Q

Why should exercise be avoided in low insulin states?

A

Leads to low glucose absoprtion into muscles and muscles will secrete glucagon which can cause hyperglycaemia

69
Q

True/false: sucrose has a different profile than other CHOs?

A

False

70
Q

Sweetners are always non-nutritive (i.e. cannot be reduced to CHOs)?

A

False

71
Q

Diabetic foods should be recommended to diabetic patients, true/false?

A

False

72
Q

Low GI foods raise BG slowly. True/false?

A

True

73
Q

In practice, low GI foods should be recommended. True/false?

A

False - no evidence to suggest benefit, more important is total CHO content

74
Q

Is there evidence to suggest all DM patients should be given vitamin supplements?

A

No, only benefit if there is a deficiency

Endocrine (17 decks)

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