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MET3B > Type 1 and Type 2 diabetes > Flashcards

Type 1 and Type 2 diabetes Flashcards

1
Q

What is type 1 diabetes?

A

inability to produce/secrete insulin due to autoimmune destruction of the beta-cells in the pancreatic islets of Langerhan.

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2
Q

What is type 2 diabetes?

A

a combination of peripheral insulin resistance and inadequate secretion of insulin. It is strongly associated with obesity and the metabolic syndrome.

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3
Q

At what age does type 1 diabetes develop?

A

typically develops in children and adolescents

But condition can develop at any age

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4
Q

Which genes are associated with diabetes development?

A

HLA-DR3- DQ2

HLA-DR4-DQ8

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5
Q

Which other autoimmune conditions is type 1 diabetes associated with?

A

Autoimmune thyroiditis

Graves disease

Coeliac disease

Addison’s disease

Pernicious anaemia

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6
Q

Describe the hypotheses behind diabetes development - combination of genetic and environmental factors

A

genetically susceptible individuals may develop autoantibodies that target the beta-cells in response to an external trigger (e.g. viral infection).

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7
Q

Which autoantibody is most commonly found in those with type 1 diabetes?

A

anti-glutamic acid decarboxylase (anti-GAD) antibody

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8
Q

Where is anti-glutamic acid decarboxylase (anti-GAD) antibody found?

A

enzyme found within beta cells of the pancreas

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9
Q

What is the normal range for blood glucose?

A

3.5-8.0 mmol/L.

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10
Q

What are the consequences of decreased insulin concentration in the body?

A

More glucose is produced by the liver -
Increases glycogenolysis and gluconeogenesis

Decreased glucose uptake
Increased lipolysis

Decreased glucose uptake in adipose tissue and muscle

Decreased protein synthesis and increases protein degradation (increased fat and muscle break down)

Reduced peripheral uptake of glucose to use for energy. Weight loss occurs

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11
Q

What happens to the blood sugar when enough insulin is not being produced?

A

hyperglycaemia - high blood sugar

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12
Q

Which acid base disorder is associated with type 1 diabetes and how does it develop?

A

metabolic acidosis
Body is not obtaning enough enegery as glucose is not being taken up peripheraly and being used for energy

Fatty acids are taken up into hepatocytes and converted into ketone bodies.

Ketone bodies are released back into the circulation and utilised for energy in the form of ATP.

The development of ketosis leads to metabolic acidosis

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13
Q

What are the features of Latent-onset autoimmune diabetes in adults?

A

Type 1 diabetes later in life
autoimmune destruction of beta cells
tends to have a gradual onset.

patients who develop diabetes in adult life with associated ketosis, weight loss, low BMI and family history of autoimmune disease.

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14
Q

What are the signs and symptoms of type 1 diabetes?

A

Symptoms

  • lethargy
  • polyuria
  • polydipsia
  • weight loss
  • Vomiting

Signs

  • Mild-moderate dehydration (dry skin, dry mucous membranes, reduced skin turgor)
  • BMI < 25
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15
Q

How is type 2 diabetes diagnosed?

A

classical clinical features are found in the presence of a raised random blood glucose level.

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16
Q

Which further tests are conducted on patients suspected with Latent-onset autoimmune diabetes in adults?

A

c-peptide, genetic testing

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17
Q

There are 5 main aspects to the management of type 1 diabetes - name them

A

Insulin use and regimes

Blood glucose monitoring

Treatment targets

Monitoring for
complications

Education

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18
Q

List the different types of insulin used in the treatment of type 1 diabetes

A

Rapid acting - Novorapid, Lispro

Short acting - Humulin R

Intermediate acting - Humulin I or N

Mixed - Humulin M3
or Humulin 70/30: Mix of short and intermediate-acting insulin

Long acting - Lantus, Levmir

Biphasic - mixture of rapid and intermediate eg Novomix 30

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19
Q

What are the 3 main insulin regimes used in patients with type 1 Diabetes?

A

Basal-bolus regime - rapid- or short-acting insulin before meals and a long-acting preparation for basal requirements.

One, two, or three injections per day regime: - traditionally a biphasic regime with the use of both short-acting and intermediate-acting insulin as separate injections or a mixed product.

Continuous insulin infusion via a pump - supplies rapid- or short-acting insulin. It may be used in patients who are experiencing troubling hypoglycaemic episodes with multiple daily injections regimes.

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20
Q

Which of the insulin regimes is used for newly diagnosed patients?

A

Basal-bolus regime

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21
Q

Which of the insulin regimes is used for patients having troubling hypoglycaemia episodes?

A

Continuous insulin infusion via a pump

22
Q

How often are people with hypoglycaemia required to monitor there blood glucose in a day? When during the day can it be monitored? What is the target blood glucose at monitoring period?

A

At least four times a day

On waking: fasting blood glucose 5–7 mmol/L

Before meals: blood glucose 4–7 mmol/L

Post meals: test after 90 minutes, blood glucose 5–9 mmol/L

Can also measure it before bed instead of in the morning

23
Q

Under which conditions may a patient be required to monitor there blood glucose more than 4 times daily

A

porting activities, pregnancy and in those with hypoglycaemic episodes.

24
Q

What is used to monitor the long term control of blood glucose? How often should the test be conducted?

A

HbA1c - glycated haemoglobin, indicative of the average blood glucose over 3 months

It should be repeated every 3-6 months to assess glycaemic control.

25
Q

What should the target HbA1c be? When may a higher target be required?

A

HbA1c < 48 mmol/L (6.5%).

Higher threshold?
hypoglycaemic episodes, occupation and co-morbidities.

26
Q

How often should patients obtain a diabetic complications review. What is assessed during these reviews?

A

At least once a year- more often if required

Assessment of injection site - fat accumilation

Retinopathy review - screening

Nephropathy review - renal function (eGFR) and albumin:creatinine ratio (ACR)

Diabetic foot review (neuropathy) - full examination including footwear, monofilament assessment of neuropathy, vascular assessment +/- dopplers.

Cardiovascular risks - optimisation of blood pressure, lipids, weight, smoking and others

Thyroid disease - Blood tests

27
Q

Which Retinopathy complications are associated with diabetes?

A

Non prolifertaive - Dilation of the retina veins and microaneurysms which can cause internal hemorrhaging and oedema in the retina. Oedema in the central retina is the main cause of vision loss in this case

  • Dot and blot haemorrhages
  • Hard exudates
  • Cotton wool spots
  • Venous beading (pre- proliferative)

Proliferative
Fragile, new blood vessels form near the optic disk and grow on the vitreous chamber and elsewhere in the retina. They can bleed, reduce vision and lead to separation and detachment of areas of the retina

  • new vessels at the disc and elsewhere
  • fibrosis
  • traction retinal detachment

Maculopathy
- Exudates

  • Oedema
28
Q

Which Nephropathy complications are associated with diabetes?

A

Disease of the kidney involving damage to the blood vessels
in the glomerulus

is characterised by proteinuria, glomerular hypertrophy,
decreased glomerular filtration and renal fibrosis

First sign = microalbuminuria, which can be assessed with an albumin:creatinine ratio (ACR). An ACR 3 - 30 mg/mmol is suggestive of microalbuminuria

29
Q

Which neuropathy complications are associated with diabetes?

A

Damage to the nerve fibres and blood vessels supplying nerves

  • Peripheral
    It causes pain or loss of feeling in the hands, arms, feet, and legs

It causes pain in thighs and hips and weakness in legs

  • It can cause changes in digestion, bowel (gastric paresis) and bladder control problems, and erectile dysfunction

It can affect any nerve in the body and it causes pain or weakness

Symmetrical polyneuropathy: typically a peripheral neuropathy that occurs in the leg secondary to loss of vibration, pain and temperature sensation.

Mononeuropathy: damage to a single cranial or peripheral nerve (e.g. third nerve palsy).

Diabetic amyotrophy: a spectrum of disease affecting the lumbosacral plexus leading to symmetrical pain, weakness and wasting in the proximal muscles of the leg.

Autonomic neuropathy: a spectrum of conditions related to damage of the autonomic nervous system, which can effect multiple systems.

30
Q

Which Cardiovascular complications are associated with diabetes?

A
  • Increases risk of atherosclerosis plaque formation
  • Tissue nutrient and oxygen supply to heart and brain and extremities is compromised
  • Cerebrovascular disease (stroke)
  • Heart Disease (Myocardial infarction, congestive heart failure)
  • Peripheral vascular disease (ulceration, gangrene and amputation
31
Q

In the context of type 1 diabetes what does the term sick day rules mean?

A

Understanding what to do during intercurrent illnesses is essential in patients with T1DM to prevent poor glycemic control and potential ketoacidosis.

32
Q

List 5 sick day rules

A

Continue insulin therapy, alterations may be required, advice from a specialist may be sought

Increase frequency of blood glucose monitoring

Consider ketone monitoring

Maintain good hydration and when possible a normal meal pattern, meals may be replaced by carbohydrate based drinks

Seek urgent medical attention if unable to tolerate oral intake, drowsy or sustained vomiting

33
Q

Which Diabetic foot problems /complications are associated with diabetes?

A

Due to loss of sensation and poor blood supply, patients are at risk of a number of complications including diabetic ulcers, secondary infection (e.g. cellulitis, osteomyelitis), skin necrosis and eventually amputation.

Charcot’s joint - results from loss of sensation and subsequent repeated micro-trauma to the foot. Typically mid foot. Microtrauma in the presence of poor peripheral blood flow leads to remodelling, swelling and distortion of the whole joint.

34
Q

Which skin infections are those with diabetes prone to?

A

staphylococcal skin abcesses, oral or genital candidiasis

35
Q

Which symptoms are associated with typ2 2 diabetes?

A
  • polyuria
  • polydipsia
  • nocturia
  • weight loss
  • fatigue
  • blurred vision
  • pruritis
  • recurrent urinary or genitourinary infections
36
Q

Name the 4 tests used in the diagnosis of diabetes

A

Fasting plasma glucose (FPG)

Random plasma glucose (RPG)

75 gram oral glucose tolerance test (OGTT)

Haemoglobin A1c (HbA1c, glycated haemoglobin)

37
Q

What is the difference in diagnosiing diabetes in someone with symptoms and in someone without?

A

for an individual who has no symptoms, two diagnostic tests are required (eg 2x
FPG, or HbA1c, but only one abnormal OGTT is required)

One diagnostic test is enough to diagnose diabetes for someone with symptoms

38
Q

What is the difference in diagnosing diabetes in someone with symptoms and in someone without?

A

For an individual who has no symptoms, two diagnostic tests are required (e.g. 2x
FPG, or HbA1c, but only one abnormal OGTT is required)

One diagnostic test is enough to diagnose diabetes for someone with symptoms

39
Q

For each test used in diagnosing diabetes, state which values are normal, abnormal, and indicative of impaired glucose tolerance (IGT)

A

Fasting plasma glucose
N = <6.0 DM = >7.0 IGT = <7.0
Impaired fasting glucose = 6.1-6.9

Random blood glucose
N = <7.8 DM = >11.1

HbA1c
N = <42 (5.9%) DM = > 48 (6.5) IGT = 42-47 (6.0-6.4)

2H plasma glucose
N = <7.8 DM = >11.1
IGT = 7.8-11.0
IFG = <7.8

40
Q

For each test used in diagnosing diabetes, state which values are normal, abnormal, and indicative of impaired glucose tolerance (IGT)

A

Fasting plasma glucose
N = <6.0 DM = >7.0 IGT = <7.0
Impaired fasting glucose = 6.1-6.9

Random blood glucose
N = <7.8 DM = >11.1

HbA1c
N = <42 (5.9%) DM = > 48 (6.5) IGT = 42-47 (6.0-6.4)

2H plasma glucose (OGTT)
N = <7.8 DM = >11.1
IGT = 7.8-11.0
IFG = <7.8

41
Q

Which endocrine disease can cause diabetes?

A

Acromegaly - excess growth hormone

Cushing’s syndrome - excess cortisol

Glucagonoma - excess glucagon

Phaechromocytoma - excess catecholamines

Hyperthyroidism - excess thyroid hormone

Conn’s syndrome- excess aldosterone

42
Q

Which drugs can cause diabetes?

A

Glucocorticoids

b-blockers

Thiazide diuretics

Tacrolimus (used in transplantation – may cause “New Onset Diabetes
after Transplantation” [NODAT])

Atypical anti-psychotics – eg. olanzapine, risperidone, clozapine

43
Q

Which infections can cause type 2 diabetes?

A

Congenital rubella
Cytomegalovirus

others

44
Q

What does the term glucose toxicity mean with regards to type 2 diabetes?

A

When hyperglycaemia enhances insulin resistance and b- cell failure (unable to produce as much insulin) in type 2 diabetes

High glucose = poorer B cell function so less insulin secretion

45
Q

What are thrifty genes?

A

Genes,which favour that favour fat storage and / or insulin resistance help us in times of famine

May be overly activated in diabetes

46
Q

How do fat cells contribute to insulin resistance?

A

pro-inflammatory cytokines from adipocytes contribute to insulin resistance

47
Q

In type 2 diabetes, what happens to the mass of beta cells and alpha cells?

A

b-cell mass is relatively preserved

a-cell population increased – leads to excess glucagon relative to insulin

48
Q

Later on with type 2 diabetes, which protein is deposited in the pancreas which lings diabetes to dementia?

A

Amyloid peptide deposition in the pancreatic islets occurs late in the disease

49
Q

List the 5 main factors associated with metabolic syndrome?

A
  • Central Obesity
  • Low HDL Concentration
  • High Triglyceride
  • High Blood pressure
  • increased Fasting glucose
50
Q

Which individuals should be screened for type 2 diabetes?

A
  • Over weight people
  • Strong family history of diabetes
  • History of gestational diabetes
  • Ethnic minorities
    ▪ South Asian – 6x increased risk
    ▪Afro-Caribbean – 2x increased risk
    Individuals with known

vascular disease

  • Coronary Heart Disease,
  • Peripheral Vascular Disease,
  • Cerebrovascular disease
  • Patients on steroids / atypical anti-psychotic therapy / transplants

Unexplained foot ulcers / recurrent candida / skin abscesses

51
Q

When can using HbA1cot diagnose diabetes be problematic?

A

conditions interrupting erythropoiesis (e.g. EPO use, iron-deficiency),

haemoglobin structure issues (e.g. haemoglobinopathies),

glycation issues (e.g. CKD, alcoholism),

red cell survival (e.g. haemolysis, splenectomy)

52
Q

What are the 3 main injection sites for insulin? List in order of fastest absorption site to slowest

A

Abdomen
Thighs
Buttocks

MET3B (17 decks)

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