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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
Q

What is type 1 diabetes also referred to as?

A

Insulin dependent

since they are insulin deficient

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26
Q

What autoantibody tests are done in type 1 diabetes?

A
  • ICA
  • IA2
  • GAD
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27
Q

What do you see on histology in type 1 diabetes?

A

Lymphocytic infiltration of the islets of Langerhans (insulitis)

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28
Q

What is LADA?

A

Latent autoimmune diabetes in adults

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29
Q

Who does LADA affect?

A

Older patients, often female

30
Q

Patients with LADA often have a medical or family history of which conditions?

A
  • type 1 diabetes
  • thyroid
  • pernicious anaemia
  • Addison’s
  • coeliac
  • vitiligo
31
Q

Which autoantibodies are tested for in LADA?

A

● [GAD = glutamic acid decarboxylase]
● [ICA = Islet Cell antibodies]
● [tTG = test for coeliac disease]
● [TPO = thyroid peroxidase]

32
Q

Describe the main feature s of type 2 diabetes

A
  • 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
Q

Name a type 2 diabetes variant

A

Ketosis-prone type 2

34
Q

Describe the main features of ketosis-prone type 2 diabetes

A
  • often obese, ethnic minority
  • ketosis when physically stressed with intercurrent illness
  • temporarily requires insulin
  • not insulin dependent
35
Q

What is ketosis?

A

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
Q

Describe the relationship between BMI and risk of diabetes

A

As BMI increases, risk of diabetes increases

higher risk in women than men

37
Q

Diabetets may be secondary to pancreatic disorders such as…

A
  • chronic/acute pancreatitis
  • calcific, tropical pancreatitis
  • pancreatectomy
  • pancreatic cancer
  • cystic fibrosis
  • haemochromatosis
38
Q

What is haemochromatosis?

A

Inherited disorder in which iron levels in the body slowly build up over many years (iron overload storage disorder)

39
Q

Which drugs can induce diabetes?

A
  • diuretics
  • steroids
  • antipsychotics eg. olanzapine
  • psychiatric drugs (weight gain)
40
Q

Which endocrine disorders can lead to diabetes?

A
  • acromegaly
  • Cushing’s syndrome
  • phaeochromocytoma
41
Q

What is acromegaly?

A

High growth hormone levels - can cause diabetes

42
Q

What is Cushing’s syndrome?

A

High cortisol levels - can cause diabetes

43
Q

What is phaeochromocytoma?

A

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
Q

Name some ethnic variants of diabetes

A
  • 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
Q

Describe the main features of J type Jamaican diabetes

A
  • ketosis prone
  • not particularly obese
  • on and off insulin therapy
  • variable insulin requirements
  • also called flatbush diabetes
46
Q

Name 2 genetic diabetes sydnromes

A
  • Friedreich’s ataxia

- dystrophia myotonica

47
Q

What are the features of MODY (maturity onset diabetes in the young)?

A
  • autosomal dominant pattern
  • 1-2% of diabetic cases
  • onset under 25
  • insulin not required initially
  • glucokinase, HNF 1A, HNF 4A
48
Q

what do α cells produce?

A

glucagon

49
Q

what do β cells produce?

A

insulin

50
Q

what do δ (Delta cells) cells produce?

A

somatostatin

51
Q

what do PP cells produce?

A

pancreatic polypeptide

52
Q

what is insulitis?

A

disease of the pancreas caused by lymphocytic infiltration of the islets of Langerhans

53
Q

what are signs and symptoms of Diabetic ketoacidosis?

A
  • 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
Q

what are the features of gestational diabetes?

A
  • Diabetes appears during pregnancy
  • resolves after pregnancy
  • At risk of diabetes in later pregnancy and in future
55
Q

what are the 4 most common types of MODY?

A
  • HNF1-alpha
  • HNF4-alpha
  • HNF1-beta
  • Glucokinase
56
Q

what is MODY?

A

‘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
Q

features of HNF1-alpha MODY?

A
  • most common cause of MODY
  • lowers the amount of insulin made by the pancreas
  • generally don’t need insulin, treated with sulphonylureas.
58
Q

features of HNF4-alpha MODY?

A
  • 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
Q

features of HNF1-beta MODY?

A

People with this type of MODY can have a variety of problems including;

  • renal cyst
  • uterine abnormalities
  • gout
  • diabetes
60
Q

features of glucokinase MODY?

A
  • 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
Q

what is the most common form of MODY?

A

HNF1-alpha

62
Q

what is the least common form of MODY?

A

HNF4-alpha

63
Q

what is Friedreich’s ataxia?

A
  • 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
Q

what is Dystrophia myotonica?

A
  • 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
Q

which drugs can induce diabetes?

A
  • diuretics
  • steroids
  • antipsychotics
  • psychiatric drugs
66
Q

what is Haemochromatosis?

A

Haemochromatosis is an inherited condition in which iron levels in the body slowly build up over many years.

67
Q

list some symptoms and signs of Haemochromatosis?

A
  • fatigue
  • weight loss
  • weakness
  • joint pain
  • men: erectile dysfunction
  • women: irregular/absent periods
68
Q

diabetes can occur secondary to what pancreatic disorders?

A
  • chronic/acute pancreatitis
  • Calcific, tropical pancreatitis
  • Pancreatectomy
  • Cystic fibrosis
  • Haemochromatosis
69
Q

which type of diabetes are not insulin dependent?

A

type 2 diabetes and variants e.g. ketosis prone type 2

70
Q

what is LADA?

A

(Latent Autoimmune Diabetes in Adults)

Clinical Pathology (RIP) (49 decks)

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