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Endocrinology > Type 1 Diabetes Mellitus > Flashcards

Type 1 Diabetes Mellitus Flashcards

To learn about T1DM

1
Q

What is the typical presentation of T1DM?

A
  1. Typically a young person presents with a short history of polydipsia, polyuria, weight loss and malaise
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2
Q

What is the polyuria due to?

A

Due to the osmotic diuretic effect of glucose and ketone bodies in the urine

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3
Q

What is the weight loss due to in T1DM

A

Combined effects of dehydration and catabolism

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4
Q

What does NICE say in respect to the diagnosis of T1DM?

A

People with T1DM have one or more of:

  1. ketosis
  2. rapid weight loss
  3. Age of onset below 50
  4. BMI below 25kg/m2
  5. History of autoimmune disease in family
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5
Q

What is the pathogenesis of T1DM

A

Slow progressive immunological destruction of beta cells by antigen specific cytotoxic T lymphocytes

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6
Q

How is DM diagnosed?

A
  1. History
  2. Random venous plasma glucose conc >= 11.1 mmol/L
  3. fasting glucose >= 7.0mmol/L
  4. 2 hour plasma glucose conc >= 11.1 after 75g oral glucose tolerance test 2 hours
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7
Q

How is HbA1c used in the diagnosis of DM?

A

HbA1c >= 6.5%, but test should not be used alone

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8
Q

Where should HbA1c should not be used ?

A
  1. All children and young people
  2. Patients of any age suspected with T1DM
  3. Patents with symptoms of less than 2 months
  4. Patients on drugs that cause rapid glucose rise
  5. Pregnancy
  6. Factors that influence HbA1c and its measurement
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9
Q

What is the typical presentation of IDDM (subacute)

A
  1. Polydipsia, polyuria, weight loss, malaise
  2. Bacterial/fungal infections
  3. Cramps, blurred vision, abdominal pains
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10
Q

What are other acute complications of IDDM?

A

Acute diabetic ketoacidosis:

  1. Precipitating event
  2. ketotic breath
  3. acidotic respiration
  4. Nausea and vomitting
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11
Q

What are the aims diabetes management?

A
  1. To prevent Hypo/Hyperglycemia and to maintain a level of glycemic control
  2. To prevent longterm micro/macro vascular complications.
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12
Q

What does the treatment of DM involve?

A
  1. Dietary measures
  2. Therapy with oral hypoglycaemic agents
  3. Insulin therapy
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13
Q

What are the management options in T2DM?

A
  1. Diet
  2. Monitoring
  3. Metformin
  4. Insulin secretagogues
  5. PPAR gamma agonists
  6. Alpha glusidase inhibitors
  7. Insulins
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14
Q

What is diabetic eye disease?

A

Occurs in people aged 25-65:

  1. Diabetic retinopathy
  2. Diabetic cataract
  3. Glaucoma
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15
Q

Why is myopia present in diabetes?

A

Results in an increased refractive index of the lens, due to dehydration.

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16
Q

What is diabetic retinopathy?

A
  1. Microangiopathy affecting precapillary arterioles, capillaries and venules.
  2. Features micro vascular occlusion and leakage
17
Q

What are the early clinical signs?

A
  1. Micro aneurysms
  2. Dot intraretinal heamorrhages
  3. Flame shaped hemorrhages
  4. Reinal oedema
  5. Hard exudates
18
Q

What are the types of neuropathy that diabetics get?

A
  1. A sensory diffuse mononeuropathy
  2. Painful diabetic neuropathy
  3. Mononeuropathies
  4. Autonomic neuropathy
  5. Mononeuritis multiplex
19
Q

What is diabetic mononeuropathy?

A
  1. Diabetic mononeuropathy. can affect peripheral or cranial nerves
  2. 3rd and 6th cranial nerves affected
  3. Palsy usually resolves in time
20
Q

What is mononeuritis multiplex?

A

Involves more than one peripheral or cranial nerves

21
Q

What is Diabetic autonomic neuropathy?

A

Tends to affect the parasympathetic arm of the autonomic nervous system, in particular vagal stimulation

22
Q

What are the features of diabetic autonomic neuropathy?

A
  1. Postural hypotension
  2. Impotence
  3. Abnormal sweating
  4. Dependant oedema
23
Q

What are the factors that predispose to the development of diabetic foot issues?

A
  1. Microangioathy: Decreased awareness
  2. Restricted capillary perfusion
  3. Arteriovenous communication from beneath skin, divert nutrion away from skin - poor healing
  4. Bacterial growth favoured by glucose rich tissue environment
24
Q

Which patients are most at risk of diabetic foot complications?

A
  1. Older poorly controlled T2DM

2. Patients with long standing T1DM

25
Q

What are the complications of diabetic foot ulcers?

A
  1. May be neuropathic or arterial
  2. Often develop beneath the first metatarsal head or between toes
  3. If neuropathic the ulcer may be painless and deeply penetrating
  4. Infection with staphylococcus aureus
26
Q

What are the complications of necrosis of individual toes?

A
  1. Toes can become painful
  2. Toes become blue/black and mummyfie
  3. Toes may shed spontaneously
  4. Can occur I. non diabetic patients but risk greater in diabetic patients
27
Q

What is the management of diabetic neuropathy in particular chronic distal sensorimotor neuropathy?

A
  1. Annual foot exam: neuro, vascular, foot structure and skin integrity
  2. Regular chiropody
  3. Education
  4. Feet kept in good condition
28
Q

What is the mangement of painful diabetic neuropathy?

A
  1. Maintain good glycemic control
  2. Gabapentin for neuropathic pain
  3. Phenytoin, carbamazapine
    4 Capsaicin cream
  4. Pregabalin
  5. Opiod analgesics
  6. NICE suggest duloxetine as first line treatment

Endocrinology (13 decks)

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