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Endocrine week 1 > What is diabetes ? > Flashcards

What is diabetes ? Flashcards

1
Q

Appreciate that in scotland over 250,000 people have diabetes and the prevalence is increasing

A

.

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2
Q

Define what diabetes mellitus is

A

It is a group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both

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3
Q

List the different diagnostic criteria for diabetes

A
  • 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

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4
Q

What are the different types of diabetes mellitus ?

A
  • Type 1
  • Type 2
  • Other specific types e.g. MODY, LADA etc
  • Gestational diabetes
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5
Q

What are the main points of the pathogenesis in T1DM and T2DM ?

A
  • Type 1 = cell failure ===> absolute insulin deficiency
  • Type 2 = hyperinsulinaemia + insulin resistance
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6
Q

Describe the typical presenting features of T1DM

A
  • 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
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7
Q

Describe the typical presenting features of T2DM

A
  • 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
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8
Q

What are the risk factors for the development of T2DM ?

A
  • 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
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9
Q

What is the typical signs of diabetes mellitus in general ?

A
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10
Q

What autoantibodies is T1DM characterised by ?

A

Anti-GAD/ anit-islet cell antibodies

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11
Q

What are some useful discriminatory tests in diagnosing different types of diabetes ?

A
  • GAD/ Anti-Islet Cell antibodies
  • Ketones
  • C-peptide (plasma)
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12
Q

If there is ketones present what type of diabetes are you thinking ?

A

T1DM

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13
Q

What is LADA ?

A
  • 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

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14
Q

What is meant by Type 3 diabetes ?

A

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
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15
Q

What is monogenic diabetes ?

A
  • Known as MODY
  • It is diabetes caused by a single gene mutation usually in HNF1A or GCK
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16
Q

What are factors which would point you towards a diagnosis of MODY ?

A
  • Strong fam history
  • Young-onset
  • GAD negative
  • C-peptide positive
17
Q

What is type 4 (gestational) diabetes ?

A

DIabetes affecting women during pregnancy, they dont have diabetes before and usually don’t after the pregnancy

18
Q

What causes gestational diabetes ?

A
  1. Horomones produced during pregnancy make it difficult to utilise insulin correctly
  2. This increases risk of insulin resistance
  3. Women is less able to produce enough insulin to overcome the insulin resistance
  4. Hence increased levels of glucose in the blood resulting in gestational diabetes
19
Q

What does HBA1c mean ?

A

Provides a measure of glucose control over 2-3 months

20
Q

Define what micro and macrovascular means

A
  • Microvascular = disease of any small blood vessels
  • Macrovascular = a disease of any large blood vessels
21
Q

What are some of the macrovascular complications of diabetes ?

A

Heart disease and stroke

22
Q

Define what is meant by nephropathy and neuropathy

A
  • Nephropathy = kidney disease or damage
  • Neuropathy = disease or dysfunction of one or more peripheral nerves
23
Q

What are some of the microvascular complications of diabetes ?

A

Retinopathy, nephropathy, neuropathy

24
Q

What is the 4 T’s which would make you suspect Type 1 diabetes in a kid ?

A
  • Increased Toilet frequency
  • Increased Thirst
  • Increased Tiredness
  • Thinner
25
Q

What is the main killer of people with diabetes ?

A

50-70% of people with diabetes die from CVD (cardiovascular disease)

Endocrine week 1 (8 decks)

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