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Clinical Pathology (RIP) > T3 - L3 Diabetes > Flashcards

T3 - L3 Diabetes Flashcards

1
Q

What is diabetes?

A
  • high blood glucose levels
  • high BP and high cholesterol levels

HYPERGLYCAEMiA

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2
Q

What is the normal blood glucose level?

A

5mmol/l

[After a meal the glucose level will be around 6-6.5 - no more]

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3
Q

How is a steady blood glucose level maintained?

A

By balancing the release of glucose from the liver, diet and exercise

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4
Q

Which hormone controls the release of glucose from the liver?

A

Insulin

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5
Q

Where is insulin produced?

A

The pancreas (beta cells)

[Pancreas is across the body around L2 behind the stomach]

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6
Q

What does insulin do?

A
  • controls the release of glucose from the liver
  • promotes glucose uptake in tissues
  • regulator of glycogen breakdown in the liver
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7
Q

What promotes insulin release?

A

High blood sugar

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8
Q

Where does glucose get turned into glycogen?

A

Liver

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9
Q

What does low blood sugar promote the release of?

A

Glucagon (from the pancreas)

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10
Q

What does glucagon do?

A

Stimulates breakdown of glycogen in the liver to produce glucose and raise blood sugar

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11
Q

What is hypoglycaemia?

A

Low blood glucose (less than 4mmol/l)

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12
Q

What is hyperglycaemia?

A

High blood glucose (greater than 11mmol/l)

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13
Q

What are the symptoms of diabetes?

A
  • thirst
  • polyuria
  • Nocturia
  • weight loss
  • tiredness
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14
Q

What are the signs of diabetes?

A
  • dry mouth
  • weight loss
  • glycosuria
  • hyperglycaemia
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15
Q

Rise in incidence of diabetes is associated with what?

A

Rise in obesity and reduction in physical activity

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16
Q

There is a high prevalence of diabetes in which ethnic groups?

A
  • Asians

- Afro-Caribbeans

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17
Q

What is GTT?

A

Glucose tolerance test

can be oral (OGTT) [Oral Glucose Tolerance Test]
or can be IV (IVGTT)

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18
Q

What is the process of the oral glucose tolerance test (OGTT)?

A

o First measure the person’s fasting glucose level
o Patient is given a drink (usually a small portion of lucozade) which gives
them 75g of glucose
o After 2 hours, glucose level is measured
o There’s a criteria which shows if its diabetes or not]

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19
Q

What is the normal vs. diabetic fasting glucose levels?

A

Normal = less than 6mmol/l

Diabetic = more than 7mmol/l

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20
Q

What investigations are done into diabetes?

A
  • HbA1c
  • renal function
  • liver function
  • lipids
  • thyroid function
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21
Q

What is HbA1c?

A

Hemoglobin A1C

Glycated hemoglobin is a form of hemoglobin that is covalently bound to glucose

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22
Q

What is HbA1c measured for?

A

To identify the three month average plasma glucose concentration

  • a test for diabetes diagnosis and assessing the degree of glycaemic control
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23
Q

What is the lifespan of a red blood cell?

A

3 months

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24
Q

features of type 1 diabetes?

A
  • Autoimmune destruction of the insulin producing islet beta cells
  • insulin deficient: insulin dependent
  • Usually young, can be any age
  • Often other endocrine disorders in patient or family
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25
What is type 1 diabetes also referred to as?
Insulin dependent | since they are insulin deficient
26
What autoantibody tests are done in type 1 diabetes?
- ICA - IA2 - GAD
27
What do you see on histology in type 1 diabetes?
Lymphocytic infiltration of the islets of Langerhans (insulitis)
28
What is LADA?
Latent autoimmune diabetes in adults
29
Who does LADA affect?
Older patients, often female
30
Patients with LADA often have a medical or family history of which conditions?
- type 1 diabetes - thyroid - pernicious anaemia - Addison's - coeliac - vitiligo
31
Which autoantibodies are tested for in LADA?
● [GAD = glutamic acid decarboxylase] ● [ICA = Islet Cell antibodies] ● [tTG = test for coeliac disease] ● [TPO = thyroid peroxidase]
32
Describe the main feature s of type 2 diabetes
- insulin resistant/deficient - not absolutely insulin dependent - strong family history - often obese or overweight - usually hypertensive and hyperlipidaemia - Genetic abnormality of the insulin or the insulin receptor
33
Name a type 2 diabetes variant
Ketosis-prone type 2
34
Describe the main features of ketosis-prone type 2 diabetes
- often obese, ethnic minority - ketosis when physically stressed with intercurrent illness - temporarily requires insulin - not insulin dependent
35
What is ketosis?
raised levels of ketone bodies typically pathological in conditions such as diabetes, or may be the consequence of a diet that is very low in carbohydrates.
36
Describe the relationship between BMI and risk of diabetes
As BMI increases, risk of diabetes increases higher risk in women than men
37
Diabetets may be secondary to pancreatic disorders such as...
- chronic/acute pancreatitis - calcific, tropical pancreatitis - pancreatectomy - pancreatic cancer - cystic fibrosis - haemochromatosis
38
What is haemochromatosis?
Inherited disorder in which iron levels in the body slowly build up over many years (iron overload storage disorder)
39
Which drugs can induce diabetes?
- diuretics - steroids - antipsychotics eg. olanzapine - psychiatric drugs (weight gain)
40
Which endocrine disorders can lead to diabetes?
- acromegaly - Cushing's syndrome - phaeochromocytoma
41
What is acromegaly?
High growth hormone levels - can cause diabetes
42
What is Cushing's syndrome?
High cortisol levels - can cause diabetes
43
What is phaeochromocytoma?
A neuroendocrine tumor of the medulla of the adrenal glands that secretes high amounts of catecholamines, mostly norepinephrine, plus epinephrine to a lesser extent
44
Name some ethnic variants of diabetes
- J type diabetes (Jamaican diabetes, Afro-Caribbeans) - flatbush diabetes (US Afro-Americans) - MRDM (malnutrition-related diabetes, tropical diabetes) - Z type diabetes - chronic calcific pancreatitis (secondary diabetes) - Z type diabetes (tropical pancreatic diabetes) in the South Africa
45
Describe the main features of J type Jamaican diabetes
- ketosis prone - not particularly obese - on and off insulin therapy - variable insulin requirements - also called flatbush diabetes
46
Name 2 genetic diabetes sydnromes
- Friedreich's ataxia | - dystrophia myotonica
47
What are the features of MODY (maturity onset diabetes in the young)?
- autosomal dominant pattern - 1-2% of diabetic cases - onset under 25 - insulin not required initially - glucokinase, HNF 1A, HNF 4A
48
what do α cells produce?
glucagon
49
what do β cells produce?
insulin
50
what do δ (Delta cells) cells produce?
somatostatin
51
what do PP cells produce?
pancreatic polypeptide
52
what is insulitis?
disease of the pancreas caused by lymphocytic infiltration of the islets of Langerhans
53
what are signs and symptoms of Diabetic ketoacidosis?
- inc frequent urintation - thirst - vomitting - tummy pain - fruity breath (like pear drop sweets or nail varnish) - deep or fast breathing - fatigue - confusion - passing out
54
what are the features of gestational diabetes?
- Diabetes appears during pregnancy - resolves after pregnancy - At risk of diabetes in later pregnancy and in future
55
what are the 4 most common types of MODY?
- HNF1-alpha - HNF4-alpha - HNF1-beta - Glucokinase
56
what is MODY?
‘Maturity onset diabetes in the young' - rare form of diabetes which is different from both Type 1 and Type 2 diabetes. - hereditary; caused by a mutation in a single gene. If a parent has this gene mutation, any child they have, has a 50 per cent chance of inheriting it from them.
57
features of HNF1-alpha MODY?
- most common cause of MODY - lowers the amount of insulin made by the pancreas - generally don't need insulin, treated with sulphonylureas.
58
features of HNF4-alpha MODY?
- least common form of MODY - big birth weight (9lb, 4kg and above) - low blood sugar at, or soon after birth - generally treated with sulphonylurea but may need to progress onto insulin
59
features of HNF1-beta MODY?
People with this type of MODY can have a variety of problems including; - renal cyst - uterine abnormalities - gout - diabetes
60
features of glucokinase MODY?
- glucokinsase enzyme doesn't phophorylate glucose into glucose-6 phosphate - blood glucose levels rise but only slightly higher than normal - generally no symptoms and found during routine testing (e.g. diabetes)
61
what is the most common form of MODY?
HNF1-alpha
62
what is the least common form of MODY?
HNF4-alpha
63
what is Friedreich’s ataxia?
- autosomal recessive genetic disease - causes difficulty walking - loss of sensation in limbs - impaired speech that progressively gets worse - symptoms typically appear between 5-15 - loss of sight and hearing - complications include; diabetes, scoliosis, heart disease.
64
what is Dystrophia myotonica?
- autosomal dominant genetic disease - muscle loss and weakness - muscles often contract and are unable to relax - cataracts - intellectual disability - heart conduction problems - early balding - inability to have children
65
which drugs can induce diabetes?
- diuretics - steroids - antipsychotics - psychiatric drugs
66
what is Haemochromatosis?
Haemochromatosis is an inherited condition in which iron levels in the body slowly build up over many years.
67
list some symptoms and signs of Haemochromatosis?
- fatigue - weight loss - weakness - joint pain - men: erectile dysfunction - women: irregular/absent periods
68
diabetes can occur secondary to what pancreatic disorders?
- chronic/acute pancreatitis - Calcific, tropical pancreatitis - Pancreatectomy - Cystic fibrosis - Haemochromatosis
69
which type of diabetes are not insulin dependent?
type 2 diabetes and variants e.g. ketosis prone type 2
70
what is LADA?
(Latent Autoimmune Diabetes in Adults)

Clinical Pathology (RIP) (49 decks)

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