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TMS > Trigger 1: Diabetes > Flashcards

Trigger 1: Diabetes Flashcards

1
Q

diabetes mellitus

A

hyperglycaemia due to insufficient insulin secretion

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2
Q

Clinical def:

A

fasting blood glucose over 7mmol/L

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3
Q

type 1 incidence vs T2

A

10% vs 90%

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4
Q

Consequences of diabtes

A
  • Reduces life expectancy between:
    o 5 to 14 years in people with T1
    o 6 years for Y2
  • Contributes to kidney failure and CVD
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5
Q

Monogenic forms

A

Single gene defects causes diabetes (due to B-cell defect)

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6
Q

types of monogenic diabetes

A
  • Neonatal

- Maturity onset diabetes of the young

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7
Q

Neonatal gene defects

A
  • Most common mutations in KCNJ11 and ABCC8 (form subunits of kATP channel)
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8
Q

(2) Maturity onset diabetes of the young (MODY) gene defect

A
  • 6 genes have been identified that account for 87% of UK MODY:
    i. HNF1A
    ii. HNF1B
    iii. Hnf4A
    iv. Glucokinase
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9
Q

Type 2 diabetes

A

Hyperglycaemia due to insufficient secretion. Combination of increased insulin resistance and beta-cell defects. Can have very high levels of insulin secretion, but due to insulin resistance glucose levels remain high.

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10
Q

presentation of T2DM

A 
Presentation of type 2 diabetes
	Long duration
	Older at diagnosis: 50s and 60s
	Overweight
	Strong family history
	Thirst, hunger, polyuria 
	Oral and vaginal thrush
	Tiredness, sleepiness , change of behaviour
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11
Q

Treatment of type 2 diabetes

A 
	Diet
	Exercise
	Drugs to improve insulin sensitivity
	Drugs to stimulate insulin secretion
	Drugs to promote glucose excretion via the kidneys
	Insulin injections
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12
Q

Drugs to stimulate insulin secretion

A
  • GLP-1 agonists

- Sulphonylureas

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13
Q

Drugs to promote glucose excretion via the kidneys

A
  • Gliflozins
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14
Q

Drugs to improve insulin sensitivity

A
  • Metformin

- Pioglitazone

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15
Q

Type 1 diabetes

A

Autoimmune destruction of insulin-producing beta cells of the pancreas. Due to a presence of autoantibodies and autoreactive T-cells directed against islet cells or their antigenic constituents e.g. Insulin, GAD65, IA-2.
 People with type 1 diabetes selectively lose the insulin-secreting B-cells from their islets

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16
Q

Possible reasons for destruction of B cells in T1DM

A
  • Vit D def
  • Virus?
  • environmental toxins
  • hygiene hypothesis
  • overt diabtes
17
Q

precipitating events

A

Cause (an event or situation, typically one that is undesirable) to happen suddenly, unexpectedly, or prematurely- in T1D occurs in older people

18
Q

Symptoms of T1DM

A
  • thirst
  • thinner
  • tired
  • toilet
19
Q

Characteristics of T1DM

A
  • Young age onset
  • Sudden onset
  • Thin
  • Immune-auto antibodies, T cells
  • Genetic- MHC class II and I, CTLA4
  • Family history
  • Insulin deficient
  • Ketoacidosis
20
Q

treatment of T1DM

A
  • Insulin replacement therapy- injections or pump
  • Regular blood glucose monitoring
  • Carbohydrate counting/exercise
  • Transplantation- islet or pancreas
21
Q

Testing for diabtes

A
  • HbA1c
  • FPG
  • OGTT
  • Random venous blood glucose
22
Q

HbA1c

A

 Measures % of glycated H in the blood
 Increased in more hyperglycaemic periods
 >6.5% for clinical diagnosis
 Advantage: doesn’t require fasting and representative of glycaemic control form the past 3 months

23
Q

Fasting blood glucose

A

> 7mmol/L

24
Q

Random venous blood glucose

A

> 11.1mmol/l

25
Q

testing for type 1

A

(1) Anti-GAD autoantibodies
 Presence observed in 75% of T1 diabetes
(2) Serum C-peptide
 Marker for insulin production levels
(3) Insulin autoantibodies
 In around 50% T1 diabetes children, not commonly detected in adults

26
Q

(1) Anti-GAD autoantibodies

A

 Presence observed in 75% of T1 diabetes

27
Q

(2) Serum C-peptide

A

 Marker for insulin production levels

28
Q

(3) Insulin autoantibodies

A

 In around 50% T1 diabetes children, not commonly detected in adults

29
Q

Gliflozins

A

stimulate glucose excretion via the kidneys (SGLT2 inhibitors help the kidneys lower blood glucose levels.)

30
Q

Metformin and Pioglitazone

A

enhances sensitivity to insulin

31
Q

GLP-1 agonists and Sulphonylureas

A

stimulate insulin secretion

TMS (2 decks)

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