T1DM Flashcards
T1DM is associated with what other autoimmune diseases?
thyroid coeliac addison's pernicious anaemia vitiligo
1 in 20 people with what have TIDM?
coeliac
20% of all T2DM
Slowly-progressive disease onset
Non-obese
No FHx T2DM
Age >35 y at onset
Mild IR
Low c-peptide
HLA gene positive (GAD)
80% GAD+ -> insulin-dependence in 6 years
diagnosis?
LADA
what does LADA stand for?
latent autoimmune diabetes of adulthood
Addison’s disease Hypothyroidism Hypogonadism Vitiligo Coeliac disease
T1DM may be associated with all of the above in what?
polyglandular endocrinopathy type 2
type 1 endocrinopaty is autosomal what?
autosomal recessive
mild immune deficiency
mucocutaneous candidiasis and additionally alopecia, pernicious anaemia, hypoparathyroidism is seen in what?
type 1 endocrinopathy
lymphocytes attacking islets is seen in what?
T1DM
amyloid deposition is seen in what?
T2DM
name the important islet autoantibodies
GAD
IA-2
IA-2beta
ZN-T8
GAD is more associated with T_DM than T_DM
GAD is more associated with T1DM than T2DM
what chromosome is important in T1DM?
chromosome 6
what antigen is important in T1DM?
HLA
insulin deficiency results in:
- decreased _______ uptake
- increased _______ catabolism
- increased _________
- decreased GLUCOSE uptake
- increased PROTEIN catabolism
- increased LIPOLYSIS
state the classical symptoms fo T1DM
polyuria
polydipsia
weight loss
general malaise
vomiting
abdominal pain
altered consciousness
acidotic breathing
diagnosis?
DKA
Acute Onset Presents with DKA or severe symptoms Peak incidence pre-school and peri-puberty Non-obese Insulin dependent Family history uncommon
diagnosis?
T1DM
Slow onset – typically present for 6 to 10 years before presentation Middle-aged /elderly Obese & Sedentary Non-insulin dependent Family history common
diagnosis?
T2DM
diagnosis of T1DM is based on history and presentation (eg DKA) but ___________ and _-_______ may help
diagnosis of T1DM is based on history and presentation (eg DKA) but ANTIBODIES and C-PEPTIDE may help
name the diet of dose adjustment for normal eating
DAFNE
the benefits of good glucose control in diabetics are reduced ____________ and _____________ complications
the benefits of good glucose control in diabetics are reduced MICROVASCULAR and MACROVASCULAR complications
HbA1c (mmol/mol):
normal -
prediabetes -
diabetes -
normal - <42
prediabetes - 42-47
diabetes - 48 or over
HbA1c (%):
normal -
prediabetes -
diabetes -
normal - <6%
prediabetes - 6-6.4%
diabetes - 6.5% or over
name the 3 microvascular risks of diabetes
retinopathy
nephropathy
neuropathy
name 4 things that relate to glucose variability
injection
tissue
external factors
carbohydrate delivery
insulin secretion in response to a meal is __phasic
insulin secretion in response to a meal is BIphasic
what is usually seen in the urine of a T1DM patient?
ketone bodies
c-peptide in a T1DM patient is usually high or low?
low
children diagnosed under the age of six months are much more likely to have _________ rather than T1DM
children diagnosed under the age of six months are much more likely to have MONOGENIC rather than T1DM
a diagnosis of what is established by the presence of
elevated levels of pancreatic auto-antibodies in patients
with ‘recently diagnosed’ diabetes who do not initially
require insulin?
LADA
what does LADA stand for?
LAtent onset Diabetes of Adulthood
a.k.a slowly progressive T1DM
occurs in young adults 25 to 40
male preponderance
usually non-obese
auto-antibody positive
associated auto-immune conditions
non-insulin requiring at diagnosis
sub-optimal control on oral agents
diagnosis?
LADA
people with what lung disease is diabetes common in?
cystic fibrosis
Diabetes Insipidus
Diabetes Mellitus
Optic Atrophy
Deafness
Neurological anomalies
diagnosis?
DIDMOAD or Wolfram syndrome
autosomal recessive
Often very obese Polydactyly Hypogonadal Visual impairment Hearing impairment Mental retardation Diabetes
diagnosis?
bardet-biedl syndrome
short/severe
ketones in urine
antibodies positive
diagnosis?
T1DM
longer/variable
ketones 0/++
antibodies positive
insulin delayed
diagnosis?
LADA
variable
ketones 0/+
antibodies negative
inheritance
diagnosis?
MODY
long/mild
ketones 0
antibodies negative
overweight
diagnosis?
T2DM
name some diseases associated with diabetes
thyroid coeliac pernicious anaemia Addison's disease IgA deficiency
rare:
autoimmune polyglandular syndromes (T1 and T2)
AIRE mutations
IPEX syndrome
often asymptomatic bloating/diarrhoea malabsorption anaemia low albumin and calcium anti TTG antibodies IgA deficiency duodenal biopsy
diagnosis?
coeliac disease
Addisons disease vitiligo primary hypogonadism primary hypothyroidism coeliac disease
the above are all type _ polyglandular endocrinopathies
Addisons disease vitiligo primary hypogonadism primary hypothyroidism coeliac disease
the above are all type 2 polyglandular endocrinopathies
muck-cutaneous candidiasis
primary hypoparathyroidism
pernicious anaemia
alopecia
the above are all type _ polyglandular endocrinopathies
muck-cutaneous candidiasis
primary hypoparathyroidism
pernicious anaemia
alopecia
the above are all type 1 polyglandular endocrinopathies
1 in __ with thyroid disease have T1DM
1 in 20 with thyroid disease have T1DM
bardet-biedl syndrome is seen in _______________ parents
bardet-biedl syndrome is seen in CONSANGUINEOUS parents
what are lumps under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action
lipohypertrophy
too much insulin can result in what?
hypoglycaemia
who should receive IV insulin?
those with DKA or HHS or acute illness or fasting patients
the following are indications for what:
Severe hypoglycemia/ metabolic complications
Incapacitating clinical or emotional problems
pancreas transplant
replacing only the endocrine component of the pancreas is called what?
pancreatic islet transplantation
what should you be careful about in DKA treatment for under 18s?
fluid resuscitation
what is there the risk of in fluid resuscitation in DKA in under 18s?
cerebral oedema
what are you at risk of if your insulin pump breaks?
DKA
name the screening test performed in congenital thyroid disease
Guthrie test
hyperpigmentation of the scrotum and virtualised newborns are due to what condition?
congenital adrenal hyperplasia
