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Endocrinology Y2 > Type I Diabetes Mellitus > Flashcards

Type I Diabetes Mellitus Flashcards

1
Q

diabetic ketoacidosis is more common in what type of diabetes?

A

1 but can present in both

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2
Q

What 3 endocrine diseases can cause diabetes and how?

A

Pheochromocytoma, Cushing’s Syndrome and Acromegaly through inducing hyperglycaemia

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3
Q

Type 1 diabetes is fundamentally ..

A

autoimmune destruction of beta islet cells and so insulin deficiency

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4
Q

Type 2 diabetes is fundamentally …

A

Resistance to insulin developing which leads to beta islet exhaustion and then failure

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5
Q

What is measured as a marker of insulin function?

A

C peptide

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6
Q

Which diabetes type has a bigger genetic influence

A

T2

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7
Q

what is an indicator that a patient will develop diabetes

A

Loss of 1st phase insulin

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8
Q

which type of diabetes has been described as a relapsing/remitting disease?

A

T1

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9
Q

why is the immune basis of T1 diabetes important? (2)

A

Increased prevalence of other autoimmune disease is associated with people who have autoimmune T1DM

And having T1DM can mean you family are predisposed to other autoimmune diseases

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10
Q

How can detecting Auto‐antibody levels be clinically useful (2)

A

to see how the disease is progressing and to confirm the autoimmune basis of the diabetes

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11
Q

Factors affecting risk of diabetes?

A

Genes, location, time of year, other environmental factors

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12
Q

Which alleles increase risk of diabetes significantly?

A

DR3 and DR4

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13
Q

Which chromosome is the HLA-DR gene on

A

Chromosome 6

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14
Q

Markers that can be used to diagnose which type of diabetes? (4)

A
  • Islet cell antibodies (ICA)- group O human pancreas
  • Insulin antibodies (IAA)
  • Glutamic acid decarboxylase antibodies (GADA)- widespread neurotransmitter
  • Insulinoma-associated-2 autoantibodies (IA-2A)- receptor like family
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15
Q

Symptoms of diabetes? (7)

A 
Polyuria
Nocturia
Polydipsia
Blurring of vision
Thrush
Weight loss
Fatigue
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16
Q

Signs of diabetes? (6)

A 
Dehydration
Cachecia
Hyperventilation
Smell of ketones
Glycosuria
Ketonuria
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17
Q

Why do diabetic patients get thrush

A

Increased risk of infections

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18
Q

Why do diabetic patients Hyperventilate

A

they have metabolic acidosis so the body tries to get rid of the acid by blowing off CO2

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19
Q

What is Kussmaul breathing

A

they have metabolic acidosis so the body tries to get rid of the acid by blowing off CO2

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20
Q

Where is glucose stored

A

Muscle, liver and adipose tissue

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21
Q

Insulin has a negative effect on: (4)

A

Hepatic glucose output
Protein breakdown in the muscle
Glycerol being taken out from the fatty tissue into the periphery to be converted to glucose in the liver
FA being taken out of adipose to be converted to acetyl CoA in the liver

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22
Q

Insulin has a positive effect on:

A

Glucose being taken up by the muscle

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23
Q

Hormones that increase hepatic glucose output: (4)

A

Catecholamines
Cortisol
Glucagon
Growth Hormone

24
Q

Mechanism of Diabetic Ketoacidosis?

A

Glucose isn’t taken up into cells and utilised so a lot of our energy comes from fatty acids
So the lipid in the adipocytes is broken down
Normally, you get glycerol coming out of the adipocytes and going to the liver but in the case of insulin deficiency, you get FATTY ACIDS coming out of the adipocytes into the circulation
Fatty acids then go to the liver where they are converted to ketones and glucose (this process is normally inhibited by insulin)

25
Q

What is needed to not die in T1DM

A

exogenous insulin

26
Q

Sign of T1DM?

A

 KETONES IN THE BLOOD OR URINE

27
Q

Insulin is needed in T1DM to prevent long term complications such as: (4)

A

Retinopathy
Nephropathy
Neuropathy
Vascular Disease

28
Q

DIET ADVICE IN T1DM: (2 + AND 2 -)

A
  • Reduce calories as fat
  • Reduce calories as refined carbohydrate
  • Increase calories as complex carbohydrate
  • Increase soluble fibre
29
Q

When do you administer short acting insulin

A

WITH MEALS

30
Q

When do you administer long acting insulin

A

BACKGROUND (at various times)

31
Q

Which is actual human insulin, Long or short acting insulin

A

Short

32
Q

What machine would you give someone with very severe T1DM

A

INSULIN PUMP

33
Q

Pros of an insulin pump?

A

don’t have to inject multiple times, gives better control

34
Q

Con of insulin pump?

A
  • Does NOT measure glucose, so it isn’t like a feedback loop

and can also just stop working

35
Q

How is an islet cell transplant performed? What must the patient take?

A

Islet cells are harvested, isolated and injected into the liver

There is a risk of rejection so patients must be on immunosuppressants for life
36
Q

Who is eligible for a liver islet cell transplant

A

long term type 1 diabetes mellitus with complications and occurrences of severe hyopglycaemia that can’t be controlled by the instant pump

37
Q

What is used to monitor blood glucose in diabetics? What blood glucose is it reflective of

A

Capillary monitoring

Venous

38
Q

Which is more accurate, measurement from a capillary glucose monitor or capillary prick glucose measurement

A

capillary prick glucose measurement

39
Q

Long‐term blood glucose control is monitored by measuring…

A

HbA1c

40
Q

How does HbA1c monitoring of glucose work

A

More glucose, more HbA1c attaches to red blood cells through irreversible covalent bonds

41
Q

What time period does HbA1c measure glucose over

A

3 months

42
Q

What can cause inaccuracies in Hb1Ac test? (2)

A
  • Haemoglobinopathy/renal failure

- haemolytic anaemia

43
Q

Lower HbA1c is associated with a lower risk of complication, particularly XX

A

microvascular complication

44
Q

ACUTE COMPLICATIONS OF T1DM- KETOACIDOSIS:

A
  • Hyperglycaemia

- Metabolic acidosis

45
Q

HYPOGLYCAEMIA- PLASMA GLUCOSE BELOW…

A

3.6mmol/L

46
Q
  • Reccurent hypos result in ….
A

LOSS OF WARNINGS e.g. not clear to the patient that their glucose is falling very low

47
Q

When is a hypoglycaemic episode common in diabetics?

A
  • Can occur at any time but often a clear pattern
  • Pre-lunch is common
  • Nocturnal is very common but not often recognised
48
Q

What can cause hypoglycaemia? (5)

A
  • Unaccustomed exercise
  • Missed meals
  • Inadequate snacks
  • Alcohol
  • Inappropriate insulin regime
49
Q

Cortisol increases blood glucose by…

A

encouraging protein breakdown in muscle to be used in the liver

50
Q

catecholamines increases blood glucose by… (3)

A

Increasing hepatic glucose output
Increasing glycerol output from adipocytes
increasing FA output from triglycerides in adipocytes

51
Q

Glucagon increases blood glucose by… (2)

A

Increasing hepatic glucose output

Increasing fatty acid metabolism in liver to produce acetyl CoA

52
Q

GH increases blood glucose by… (2)

A

Increasing glycerol output from adipocytes

increasing FA output from triglycerides in adipocytes

53
Q

Hypoglycaemia signs (6)

A 
Palpitations
Tachycardia
Tremor
Sweating
Palor/cold extremities
Anxiety
54
Q

Hypoglycaemia symptoms (5)

A 
Drowsiness
Confusion
Altered behaviour
Focal neurology
Coma
55
Q

Treating hypoglycaemia

A

If conscious feed ! Glucose and complex carbs

If unconscious administer IV dextrose and glucose, avoid concentrated glucose

Endocrinology Y2 (18 decks)

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