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Year Two - Endocrine System > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

What is diabetes mellitus?

A

It refers to a group of metabolic diseases characterised by hyperglycaemia due to insulin insensitivity or decreased insulin secretion

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2
Q

What is pre-diabetes?

A

A condition in which individuals have a raised blood glucose level, however this level is not considered high enough to be classified as diabetes

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3
Q

What is the pathophysiological consequence of pre diabetes?

A

These individuals have an increased risk of developing future diabetes and its associated complications

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4
Q

What are the two classifications of pre-diabetes?

A

Impaired Fasting Glucose (IFG) Prediabetes

Impaired Glucose Tolerance (IGT) Prediabetes

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5
Q

What is impaired fasting glucose pre diabetes?

A

It is is related to hepatic insulin resistance

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6
Q

What investigation result indicates impaired fasting glucose pre-diabetes?

A

A fasting glucose level between 6.1 mmol/l – 7 mmol/l

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7
Q

What is impaired glucose tolerance pre-diabetes?

A

It is is related to muscle insulin resistance

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8
Q

Which pre-diabetes classification has a an increased risk of future type two diabetes mellitus development and cardiovascular disease?

A

Impaired glucose tolerance pre-diabetes

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9
Q

What investigation result indicates impaired tolerance glucose pre-diabetes?

A

A fasting plasma glucose level < 7mmol/l

AND

An oral glucose tolerance test 2-hour level between 7.8mmol/l and 11.1 mmol/l

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10
Q

What are the five risk factors associated with pre-diabetes?

A

Older Age > 45

Black, Chinese, South Asian Ethnicity

Family History

Central Obesity, BMI > 30

Reduced Physical Activity

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11
Q

What are the three investigations used to diagnose pre-diabetes?

A

HbA1C Test

Fasting Blood Glucose Test

Oral Glucose Tolerance Test (OGTT)

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12
Q

What is the HbA1C test?

A

It measures the quantity of glucose bound to haemoglobin

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13
Q

What information does a HbA1c test provide? How?

A

It indicates an average glucose levels for the past two to three months

This is due to the fact that glucose permanently binds to haemoglobin, which last up to a period of three months

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14
Q

What HbA1c test result indicates pre-diabetes?

A

5.7% to 6.4% (42mmol/mol – 48mmol/mol)

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15
Q

In which five circumstances can a HbA1c test not be used to diagnose pre-diabetes?

A

Children

Pregnant Patients

HIV Patients

Pancreatic Disease Patients

Patients with A Short Duration of Diabetes Symptoms

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16
Q

How long after pregnancy is a HbA1c test no longer contraindicated?

A

> 2 Months

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17
Q

What is a fasting blood glucose test?

A

It involves taking a blood sample after an individual has fasted overnight.

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18
Q

What fasting blood glucose result indicates pre-diabetes?

A

Between 6.1mmol/L – 6.9mmol/L

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19
Q

What pre-diabetes classification is indicated by an abnormal fasting blood glucose result?

A

Impaired fasting glucose prediabetes

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20
Q

What is an oral glucose tolerance test (OGTT)?

A

It involves taking a patient’s baseline fasting plasma glucose, giving them a 75g glucose drink and then measuring their plasma glucose two hours later

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21
Q

What oral glucose tolerance test result indicates pre-diabetes?

A

Between 7.8mmol/L – 11.1mmol/L

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22
Q

What pre-diabetes classification is indicated by an abnormal oral glucose tolerance test result?

A

Impaired glucose tolerance prediabetes

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23
Q

How do we manage pre-diabetes?

A

Conservative management

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24
Q

What are the four conservative management options of pre diabetes?

A

Weight Loss

Increased Exercise

Dietary Changes

Annual Follow-Up Blood Tests

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25
Q

When is metformin recommended to manage prediabetes?

A

It is recommended that individuals who are still progressing towards type two diabetes mellitus, despite their participation in an intensive lifestyle-change programme

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26
Q

What is gestational diabetes?

A

It is a condition in which high blood glucose levels occur for the first-time during pregnancy

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27
Q

In which two trimesters does gestation diabetes tend to occur?

A

Second

Third

28
Q

What are the five risk factors of gestational diabetes?

A

Black, Chinese, South Asian Ethnicity

Obesity, BMI > 30

Previous Macrosomic Baby > 4.5kg

Previous Gestational Diabetes

First Degree Family History of Diabetes

29
Q

During antenatal screening what is the most appropriate management option following urinalysis glucose trace results? Why?

A

Reassurance and safety net

This is due to the fact that this is normal in pregnancy due to the increased GFR and reduction in tubular reabsorption of filtered glucose

30
Q

What is the gold standard investigation used to diagnose gestational diabetes?

A

Oral Glucose Tolerance Test (OGTT)

31
Q

In which two circumstances do we screen for gestational diabetes with an OGTT?

A

Previous Gestational Diabetes

Gestational Diabetes Risk Factors

32
Q

When do we conduct an OGTT in pregnant patients, who have had previous gestational diabetes?

A

As soon as possible after the booking date

AND

Between 24 – 28 weeks’ gestation, if the first test is normal

33
Q

When do we conduct an OGTT in pregnant patients, who have gestational diabetes risk factors?

A

Between 24 – 28 weeks’ gestation

34
Q

What OGTT result indicates gestational diabetes?

A

A fasting glucose > 5.6 mmol/l

OR

A 2-hour glucose > 7.8 mmol/l

‘5678’

35
Q

What are the four conservative management options of gestational diabetes?

A

Weekly Antenatal & Diabetic Clinics

Blood Glucose Self-Monitoring

Diet Advice

Exercise Advice

36
Q

What are the three pharmacological management options of gestational diabetes?

A

Metformin

Insulin

Glibenclamide

37
Q

What is the management option of gestational diabetes, in patients with a fasting plasma glucose < 7?

A

A trial of diet and exercise should be offered

In cases where glucose targets are not obtained within 1-2 weeks, metformin should then be commenced

If glucose targets are still not met, insulin should be added

38
Q

In which circumstance do we treat gestational diabetes, in patients with a fasting plasma glucose < 7, with insulin?

A

In cases where there is evidence of complication development

39
Q

What is the management option of gestational diabetes, in patients with a fasting plasma glucose > 7?

A

Insulin

40
Q

When is glibenclamide used to manage gestational diabetes?

A

It should only be offered for women who cannot tolerate metformin

OR

It should be offered to those who fail to meet the glucose targets with metformin but decline insulin treatment

41
Q

What is the target fasting glucose level in gestational diabetes?

A

5.3 mmol/l

42
Q

What is the target glucose level 1 hour > meals in gestational diabetes?

A

7.8 mmol/l

43
Q

What is the target glucose level 2 hour > meals in gestational diabetes?

A

6.4 mmol/l

44
Q

How do we manage diabetic patients who go into premature labour?

A

Admit

x2 IM steroids

Monitor blood glucose levels closely

45
Q

What is a marker for early labour?

A

Fetal Fibronectin (fFN)

46
Q

What are the five fetal complications of gestational diabetes?

A

Macrosomia > 9 Pounds

Respiratory Distress Syndrome

Surfactant Deficient Lung Disease

Neonatal Hypoglycaemia

Future Type Two Diabetes

47
Q

How do we manage neonatal hypoglycaemia, which is asymptomatic?

A

Normal feeding

Monitor blood glucose

48
Q

How do we manage neonatal hypoglycaemia, which is symptomatic or severely low?

A

Admit to neonatal unit

IV 10% dextrose

49
Q

What are the three maternal complications of gestational diabetes?

A

Future Gestational Diabetes

Future Diabetes Mellitus

Hypertension

50
Q

How often do we advise type one diabetes to check their blood glucose levels throughout their pregnancy?

A

Daily Fasting

Pre-Meal

1-Hour Post-Meal

Bedtime

51
Q

What does MODY stand for?

A

Maturity onset diabetes of the young

52
Q

What is MODY?

A

It is a genetic condition, in which there is impairment of pancreatic beta-cell function and therefore insulin synthesis

53
Q

What is the inheritance of MODY?

A

Autosomal dominant

54
Q

What are the two classifications of MODY?

A

Glucokinase MODY

Transcription Factor MODY

55
Q

What is glucokinase?

A

A gene involved in recognising how high blood glucose levels are

56
Q

What is glucokinase MODY?

A

It is a defect within the glucokinase gene, which results in the body allowing blood glucose levels to rise slightly above normal, generally between 5.5 mmol/l – 8mmol/l

57
Q

How does glucokinase MODY present?

A

Asymptomatically

58
Q

How do we diagnose glucokinase MODY?

A

It is usually identified incidentally via routine resting during pregnancy

59
Q

Do we treat glucokinase MODY? Why?

A

No

There is a rare chance of complication development

60
Q

What is transcription factor MODY?

A

A defect within the transcription factor gene, in which the amount of insulin secreted by the pancreas is reduced and the hyperglycaemia is progressive

61
Q

What are the three classifications of transcription factor MODY?

A

HNF-1α

HNF1β

HNF4 α

62
Q

Do we treat transcription factor MODY? Why?

A

Yes

There is a high risk of complication development

63
Q

What are the three treatment options of transcription factor MODY?

A

Dietary adjustments

Oral hypoglycaemic agents

Insulin injections

64
Q

What is latent autoimmune diabetes of adults (LADA)?

A

It is an autoimmune related diabetes

65
Q

When does LADA tend to present?

A

Young age

However, there are a small group of patients who present later in life

66
Q

What is secondary diabetes?

A

It is diabetes that results as a consequence of another medical condition

67
Q

What seven conditions are associated with secondary diabetes?

A

Cystic Fibrosis

Hemochromatosis

Chronic Pancreatitis

Pancreatectomy

Cushing’s Syndrome

Acromegaly

Phaeochromocytoma

Year Two - Endocrine System (17 decks)

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