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Endocrine > What is Diabetes? > Flashcards

What is Diabetes? Flashcards

1
Q

What is diabetes?

A

Disease that occurs when your blood glucose is too high = insufficient insulin to maintain glucose homeostasis

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2
Q

Why do different types of diabetes develop?

A

Type 1 = absolute insulin deficiency
Type 2 = relative insulin deficiency, inadequate insulin production and/or insulin release
MODY = failure of insulin synthesis, release or activity

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3
Q

What is diabetes mellitus?

A

Group of metabolic diseases characterised by hyperglycaemia = results from defects in insulin secretion or action (or both)

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4
Q

What is the diagnostic criteria for diabetes?

A

HbA1c = 48m/m or above
Fasting glucose = 7.0 mmol/L or above
2hr glucose in OGTT = 11.1 mmol/L or above
Random glucose = 11.1 mmol/L or above

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5
Q

What is the diagnostic criteria for impaired/pre-diabetes?

A

HbA1c = 42-47m/m or above
Fasting glucose = 6.1-6.9 mmol/L or above
2hr glucose in OGTT = 7.8-11.0mmol/L or above

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6
Q

What is the ADA criteria for diagnosing diabetes?

A

FPG >= 7.0mmol/L
2hr PG >= 11.1mmol/L during OGTT
A1C >= 48m/m
Patient with classic symptoms of hyperglycaemia or hyperglycaemic crisis, or random PG >= 11.1 mmol/L

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7
Q

What is the ADA classification of diabetes?

A

Type 1 = due to autoimmune beta cell destruction, usually leading to absolute insulin deficiency
Type 2 = due to progressive loss of beta cell insulin secretion

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8
Q

What is the ADA classification for gestational diabetes mellitus?

A

Diabetes diagnosed in the second or third trimester that was not clearly overt diabetes prior to gestation

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9
Q

What does the ADA as some other causes of diabetes?

A

Monogenic diabetes syndrome = neonatal diabetes, MODY
Disease of exocrine pancreas = cystic fibrosis
Drug/chemical induced = glucocorticoids

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10
Q

What is the WHO classification of type 1 diabetes?

A

Pancreatic beta cell destruction, usually characterised by presence of anti GAD/anti-islet cell antibodies

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11
Q

What is the WHO classification of type 2 diabetes?

A

Diagnosed if a person doesn’t have type 1 diabetes, monogenic diabetes or other medical condition/treatment suggestive of secondary diabetes

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12
Q

What is the pathogenesis of type 1 diabetes?

A

Innate immune cells enter pancreatic islets (priming)
T cells arrive from lymph nodes and insulitis ensues
Destructive insulitis occurs = without onset will cause disease onset

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13
Q

What is the typical presentation of type 1 diabetes?

A

Pre-school or pre-pubescent (small peak in late 30s), usually lean, acute onset, severe symptoms and weight loss, ketonuria (metabolic acidosis), no evidence of microvascular disease at diagnosis, immediate and permanent requirement for insulin

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14
Q

What is the clinical presentation of type 2 diabetes?

A

Middle aged/elderly, usually obese, pre-diagnosis duration of 6-10 years, insidious onset over weeks to years, ketonuria minimal/absent, managed initial by diet (then tablets), evidence of microvascular disease in 20% at diagnosis

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15
Q

How dos diabetes present?

A

Thirst, polyuria, thrush, weakness/fatigue, blurred vision, infections, possible weight loss, signs of complications if type 2 (neuropathy, retinopathy)

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16
Q

What is stage one of type 1 diabetes?

A

Characteristics = autoimmunity, normoglycaemia, pre-symptomatic
Diagnostic criteria = multiple autoantibodies, not IGT or IFG

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17
Q

What are the characteristics of stage 2 of type 1 diabetes?

A

Autoimmunity, dysglycaemia, pre-symptomatic

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18
Q

What is the diagnostic criteria for stage 2 of type 1 diabetes?

A

Multiple autoantibodies, IFG and/or IGT for dysglycaemia, FPG is 5.6-6.9mmol/L, 2hr PG is 7.8-11.0mmol/L, A1c is 39/47m/m or >= 10% increase in A1c

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19
Q

What is stage 3 of type 1 diabetes?

A

Characteristics = new-onset hyperglycaemia, symptomatic

Diagnostic criteria = clinical symptoms, diabetes by standard criteria

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20
Q

What are the risk factors when considering testing for diabetes in overweight or obese individuals?

A 
First degree relative affected
High risk ethnicity
History of CVD
Hypertension
HDL cholesterol < 0.9mmol/L and/or triglycerides > 2.82 mmol/L
Women with polycystic ovary syndrome
Physical inactivity
Other clinical conditions associated with insulin resistance
21
Q

What are high risk ethnicities for developing diabetes?

A

African American, Latino, Native American, Asian Americans, Pacific Islander

22
Q

How often should patients with pre-diabetes be tested for diabetes?

A

Yearly

23
Q

How should women diagnosed with gestational diabetes be tested for diabetes?

A

Lifelong testing at least every three years

24
Q

When should regular patients be tested for diabetes?

A

Should begin at age 45 = if results are normal, testing should be repeated at least every three years

25
Q

What are the risk factors for type 2 diabetes?

A

Obesity (central), family history, gestational diabetes, age, ethnicity (African, afro-Caribbean, Asian), history of MI/stroke, medications (antipsychotics), IGT/IFG

26
Q

What score on the ADA risk calculator would indicate a patient is at risk of type 2 diabetes?

A

A score of five or more

27
Q

What should be considered in asymptomatic patients at risk of type 2 diabetes?

A

Screening for type 2 diabetes with an informal assessment of risk factors or validated tools

28
Q

What tests should be done for type 2 diabetes?

A

Fasting plasma glucose, 2hr plasma glucose during 75g oral glucose tolerance test (OGTT), A1C

29
Q

What should also be identified and treated in patients with diabetes?

A

CV disease risk factors

30
Q

When should testing for type 2 diabetes be considered in children?

A

If they are overweight or obese, and if they have additional risk factors for diabetes

31
Q

What are some discriminatory tests that can be done for diabetes?

A

Autoimmune markers, ketones, C-peptide

32
Q

What are the autoimmune markers that can be used for diabetes?

A

Islet cell autoantibodies, autoantibodies to GAD65, insulin, tyrosine phosphatases IA-1 and IA-2 beta, ZnT8

33
Q

What does type 1 diabetes have a genetic link with?

A

Strong HLA association with linkage to DQA DGB genes

34
Q

What is LADA?

A

Latent autoimmune diabetes in adults

35
Q

How is LADA distinguished from other forms of diabetes?

A

Late onset type 1 diabetes is probably quite common in patients presenting with “typical” type 2 diabetes
If there is ketosis, then its type 1 diabetes

36
Q

What is idiopathic type 1 diabetes?

A

Diabetes of no known aetiology = patients have permanent insulinopenia and are prone to DKA, but have no evidence of beta cell autoimmunity

37
Q

How do most patients with idiopathic type 1 diabetes present?

A

Most are of African or Asian ancestry = suffer from episodic DKA and exhibit varying degrees of insulin deficiency between episodes

38
Q

What are the genetic features of idiopathic type 1 diabetes?

A

Strongly inherited and has no HLA association

39
Q

What is type 3 diabetes?

A

Gestational diabetes = any degree of glucose intolerance arising or diagnosed during pregnancy

40
Q

What conditions are grouped under type 4 diabetes?

A

Pancreatic and endocrine diseases, drug induced diabetes, genetic diseases, abnormalities in insulin and its receptor

41
Q

What are some examples of pancreatic and endocrine disease that cause diabetes?

A 
Pancreatic = chronic or recurrent pancreatitis, haemochromatosis, cystic fibrosis
Endocrine = Cushing's syndrome, acromegaly, phaechromocytoma, glucagonoma
42
Q

What are some genetic diseases and drugs that can induce diabetes?

A

Genetic diseases = cystic fibrosis, myotonic dystrophy, Turner’s syndrome
Drugs = glucocorticoids, diuretics, beta blockers

43
Q

What are the risk factors for monogenic diabetes?

A

Strong family history, associated features (renal cysts etc), young onset, GAD negative, C-peptide positive

44
Q

What is HbA1C?

A

Measure of average blood glucose over the past two to three months

45
Q

What are some rapid acting and long acting insulin analogues?

A 
Rapid = Humalog, novorapid, apidra
Long = lantus, levemir
46
Q

What are some short and intermediate acting insulin analogues?

A

Short (soluble) = Humulin S, actrapid, insuman rapid

Intermediate (isophane) = insulatard, Humulin I, insuman basal

47
Q

What are some examples of rapid acting analogue-intermediate mixtures?

A

Humalog mix 25 or 50, novomix 30

48
Q

What are some examples of short acting-intermediate mixtures?

A

Humulin M3, insuman comb 15,25 or 50

49
Q

What are some complications of diabetes?

A

Macrovascular = heart disease stroke
Microvascular = retinopathy, neuropathy, nephropathy
Psychiatric = anxiety depression
Peripheral vascular disease, kidney failure, blindness

Endocrine (42 decks)

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