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D&E Pathology > What is Diabetes Mellitus? > Flashcards

What is Diabetes Mellitus? Flashcards

1
Q

What is diabetes mellitus?

A

A group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both

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2
Q

What are the symptoms of hyperglycaemia?

A 
Polydipsia
Polyuria
Blurred vision
Weight loss
Infections
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3
Q

What are the metabolic decompensations of hyperglycaemia?

A

DKA

HHS

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4
Q

What are the long term complications of hyperglycaemia?

A 
Microvascular:
- Retinopathy
- Neuropathy
- Nephropathy
Macrovascular:
Stroke, MI, PVD
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5
Q

What fasting venous plasma [Glucose] level is considered high?

A

> 7mmol/L

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6
Q

What random venous [Glucose] plasma level is considered high?

A

> 11.1mmol/L

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7
Q

What tests are used to measure blood glucose?

A

Fasted/Random plasma glucose
Glucose tolerance test
Diagnostic HbA1C

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8
Q

What is considered a high HbA1c?

A

> 48mmol/L

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9
Q

What is considered a high GTT?

A

> 11.1mmol/L

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10
Q

What is measured for a GTT?

A

2hrs after 75g CHO

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11
Q

What is intermediate hyperglycaemia?

A

Impaired fasting glucose 6.1-7mmol/L
Impaired GTT >7.8/<11mmol/L
HbA1c 42-47mmol/mol

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12
Q

What is the purpose of diabetes diagnostic criteria?

A

Identifies groups with significantly increased risks of mortality and microvascular complications

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13
Q

Intermediate hyperglycaemia identifies what?

A

Groups at higher risk of future diabetes and adverse outcomes

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14
Q

What is normoglycaemia?

A

Glucose levels associated with low risk of developing diabetes and cardiovascular disease

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15
Q

How is diabetes diagnosed?

A

ONE lab glucose WITH symptoms

TWO lab glucose/HbA1c WITHOUT symptoms

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16
Q

What does HbA1c tell us?

A

Indication of blood glucose levels over last 8-12 weeks

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17
Q

When can HbA1c not be used for diagnosis?

A
  • Young people
  • Current/recent pregnancy
  • Short duration of symptoms
  • High risk DM acutely ill
  • On medication which causes rapid glucose rise
  • Acute pancreatic damage/surgery
  • Renal failure
  • HIV infection
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18
Q

Which drugs cause a rapid rise in glucose? When can they be used?

A

Corticosteroids
Antipsychotics
Long term (>2months)

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19
Q

What is the breakdown of types of diabetes?

A

90% type 2
10% type 1
1% other

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20
Q

When does insulin dominate?

A

In the absorptive state

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21
Q

Which cells secrete insulin?

A

beta cells

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22
Q

Which cells secrete glucagon?

A

alpha cells

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23
Q

Insulin inhibits what?

A

Glycogenolysis and gluconeogenesis in the liver

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24
Q

What is the cause of T1DM?

A

Postive autoantibodies (anti GAD)

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25
Q

Incidence of diabetes is highest in which age group?

A

10-19y/os

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26
Q

What is the concordance in T1DM in monozygotic twins?

A

30-50%

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27
Q

What is the concordance in T1DM if the father has T1DM?

A

6% risk

28
Q

What is the concordance in T1DM if the mother has T1DM?

A

1% risk

29
Q

What is the concordance in T1DM if the sibling has T1DM?

A

8% risk

30
Q

What is the concordance in T1DM if the non-identical twin has T1DM?

A

10%

31
Q

What is the concordance in T1DM if both parents have T1DM?

A

30%

32
Q

Development of T1DM requires what?

A

Genetic disposition PLUS:
Trigger
Autoimmunity

33
Q

What effect does insulin have on adipose tissue?

A

Reduced lipolysis

34
Q

What effect does insulin have on the liver?

A

Reduced glucose production

35
Q

What effect does insulin have on muscle?

A

Increased glucose uptake

36
Q

What is the effect of insulin deficiency on the liver?

A

Raised glucose production

37
Q

What is the effect of insulin deficiency on adipose tissue?

A

Increased lipolysis

38
Q

What is the effect of insulin deficiency on muscle?

A

Reduced glucose uptake

39
Q

Which counter-regulatory hormones are raised in insufficient insulin intake?

A

Glucagon
Cortisol
Catecholamines
Growth hormones

40
Q

How does hyperglycaemia lead to impaired renal function?

A

High osmotic load (glucosuria) leading to loss of water and electrolytes –> consistent dehydration

41
Q

Increased lipolysis has what negative effect in diabetes?

A

Increases FFA levels to the liver, increasing gluconeogenesis
Increased ketogenesis

42
Q

What is the clinical presentation of T1DM?

A 
Thirst
Tiredness
Polyuria/nocturia
Weight loss
Blurred vision
Abdominal pain
SHORT DURATION
43
Q

How does T1DM present on examination?

A

Ketones on breath
Dehydration
May have increased RR/HR, H↓TN
Low grade infections

44
Q

What is the concordance in T2DM if an identical twin has T2DM?

A

90-100%

45
Q

What is the concordance in T2DM if one parent has T2DM?

A

15%

46
Q

What is the concordance in T2DM if both parents has T2DM?

A

75%

47
Q

What is the concordance in T2DM if a sibling has T2DM?

A

10%

48
Q

What is the concordance in T2DM if one non-identical twin has T2DM?

A

10%

49
Q

What are insulin levels like in T2DM?

A

Initially high, progressively decrease

50
Q

How do symptoms present in T2DM?

A 
OFTEN SYMPTOMLESS
Thirst
Tiredness
Polyuria / nocturia
Sometimes weight loss
Blurred vision
Symptoms of complications
51
Q

Which signs typically present in T2DM?

A

NOT KETOTIC
Usually overweight
Low grade infections
Micro/macrovascular complications

52
Q

What are the screening factors for asymptomatic patients in T2DM?

A 
Any TWO of:
Overweight
FH
>30 if Maori/asian
>40 if European 
Previous Hx gestational DM
High birth weight baby
Inactive lifestyle
Previously high [Glc]
53
Q

Which recognised genetic syndrome causes diabetes?

A

MODY

Maturity Onset Diabetes in the Young

54
Q

What is MODY?

A

Autosomal dominant single gene cause of beta-cell dysfunction

55
Q

How many diabetes patient have MODY/

A

5%

56
Q

Which types of mutations occur in MODY?

A

Glucokinase mutations

Transcription factor mutations

57
Q

How does glucokinase diabetes present?

A

Onset at birth
Stable hyperglycaemia
Diet treatment
Complications rare

58
Q

What cause transcription factor mutations?

A

HNF-1alpha
HNF-1beta
HNF-4alpha

59
Q

How does transcription factor diabetes present?

A 
Adolescence/young adult onset
Progressive hyperglycaemia
1/3 diet
1/3 OHA
1/3 insulin
Complications frequent
60
Q

What is the role of glucokinase?

A

Gluc –> G-6-P

61
Q

What causes secondary diabetes mellitus?

A

Drug induced
Pancreatic destruction
Genetic syndromes - DIDMOAD
Endocrine disorders

62
Q

What are the most common causes of pancreatic damage?

A

Haemochromatosis
Cystic fibrosis
Chronic pancreatitis
Pancreatectomy

63
Q

Which endocrine disorders can cause secondary diabetes mellitus?

A

Cushings syndrome
Acromegaly
Pheochromocytoma

64
Q

What is gestational diabetes?

A

Increasing insulin resistance in pregnancy

Developing in 2nd/3rd trimester

65
Q

Gestational diabetes is more common in who?

A

FH of T2DM

Overweight and inactive

66
Q

Which neonatal problems are associated with gestational diabetes?

A

Macrosomia
Respiratory distress
Neonatal hypoglycaemia

67
Q

Mothers suffering gestational diabetes are at increased risk of what?

A

T2DM later in life

D&E Pathology (18 decks)

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