What is diabetes ? Flashcards
Appreciate that in scotland over 250,000 people have diabetes and the prevalence is increasing
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Define what diabetes mellitus is
It is a group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both
List the different diagnostic criteria for diabetes
- HBA1c - ≥ 48m/m
- Fasting glucose - ≥ 7 mmol/L
- Oral glucose tolerance test (OGTT) - ≥ 11.1 mmol/L
- Random glucose - ≥ 11.1 mmol/L
Note repeat tests are usually required, don’t think they usually diagnose off of one round of testing
What are the different types of diabetes mellitus ?
- Type 1
- Type 2
- Other specific types e.g. MODY, LADA etc
- Gestational diabetes
What are the main points of the pathogenesis in T1DM and T2DM ?
- Type 1 = cell failure ===> absolute insulin deficiency
- Type 2 = hyperinsulinaemia + insulin resistance
Describe the typical presenting features of T1DM
- Generally young
- Usually lean body
- Severe weight loss
- Acute onset
- Ketonuria ± metabolic acidosis
- No evidence of microvascular disease at diagnosis
- Immediate and permanent insulin required
Describe the typical presenting features of T2DM
- Usually obese
- Pre-diagnosis duration (6-10 years) so not acute
- Ketonuria minimal or absent
- 20% of the time microvascular disease present at diagnosis
- Managed initially with diet and tablets
What are the risk factors for the development of T2DM ?
- OBESITY (esp central (around the abdomen)
- Family history (type 2 has a strong er fam link than type 1)
- Gestational Diabetes
- Age
- Ethnicity (Asian, African, Afro-Caribbean)
- PHx of MI/ Stroke
- Medications e.g. antipsychotics
What is the typical signs of diabetes mellitus in general ?
What autoantibodies is T1DM characterised by ?
Anti-GAD/ anit-islet cell antibodies
What are some useful discriminatory tests in diagnosing different types of diabetes ?
- GAD/ Anti-Islet Cell antibodies
- Ketones
- C-peptide (plasma)
If there is ketones present what type of diabetes are you thinking ?
T1DM
What is LADA ?
- Stands for latent autoimmune diabetes of adulthood
- It is a form of Type 1 diabetes that develops later in adulthood.
- Defined as initially non-insulin requiring diabetes diagnosed in people aged 30-50 with presence of anti-GAD antibodies
Note - usually initially diagnosed as diabetes but the presence of elevated pancreatic autoantibodies using GAD antibody test, points to its diagnosis
What is meant by Type 3 diabetes ?
Diabetes caused by a numebr of different conditions and factors - list below is some of the different causes:
- Pancreatic disease - chronic or recurent pancreatitis, haemochromatosis, cystic fibrosis
- Endocrine disease - cushings, acromegaly, phaemchromocytoma, glucagonoma
- Drug induced - glucocorticoids, diuretics, B-lockers
- Abnormalities of insulin and its receptor - cystic fibrosis, myotonic dystrophy, turners syndrome
What is monogenic diabetes ?
- Known as MODY
- It is diabetes caused by a single gene mutation usually in HNF1A or GCK
What are factors which would point you towards a diagnosis of MODY ?
- Strong fam history
- Young-onset
- GAD negative
- C-peptide positive
What is type 4 (gestational) diabetes ?
DIabetes affecting women during pregnancy, they dont have diabetes before and usually don’t after the pregnancy
What causes gestational diabetes ?
- Horomones produced during pregnancy make it difficult to utilise insulin correctly
- This increases risk of insulin resistance
- Women is less able to produce enough insulin to overcome the insulin resistance
- Hence increased levels of glucose in the blood resulting in gestational diabetes
What does HBA1c mean ?
Provides a measure of glucose control over 2-3 months
Define what micro and macrovascular means
- Microvascular = disease of any small blood vessels
- Macrovascular = a disease of any large blood vessels
What are some of the macrovascular complications of diabetes ?
Heart disease and stroke
Define what is meant by nephropathy and neuropathy
- Nephropathy = kidney disease or damage
- Neuropathy = disease or dysfunction of one or more peripheral nerves
What are some of the microvascular complications of diabetes ?
Retinopathy, nephropathy, neuropathy
What is the 4 T’s which would make you suspect Type 1 diabetes in a kid ?
- Increased Toilet frequency
- Increased Thirst
- Increased Tiredness
- Thinner
What is the main killer of people with diabetes ?
50-70% of people with diabetes die from CVD (cardiovascular disease)
