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The Endocrine System > Type 1 Diabetes > Flashcards

Type 1 Diabetes Flashcards

1
Q

What usually causes the inception of type 1 diabetes?

A

An environmental trigger in a genetically susceptible individual leading to an autoimmune process involving pancreatic beta cell destruction

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2
Q

The days of patients frequently dying from ketoacidosis induced comas are gone. What are patients with type 1 diabetes most likely to ultimately die from now?

A

Cardiovascular or renal disease

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3
Q

Histologically how do the islet cells appear in type 1 diabetes?

A

The islet cells are filled with lymphocytes

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4
Q

Histologically how do the islet cells look with type 2 diabetes?

A

There is amyloid deposition around the islet cells

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5
Q

Which genotypes are associated with increased type 1 diabetes risk?

A
  1. HLA DR3-DQ2
  2. HLA DR4-DQ8
  3. Insulin gene (on chromosome 11)
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6
Q

Incidence rates for type 1 diabetes are worse at which time of the year?

A

Winter

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7
Q

Which islet cell antibodies may be detected in type 1 diabetes?

A
  1. IA2
  2. IAA
  3. GAD65
  4. ZnT8
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8
Q

Which antibodies for T1DM are more commonly sensitive for younger patients?

A
  1. IA2
  2. IAA
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9
Q

Which antibodies for T1DM are more commonly sensitive for older patients?

A
  1. GAD65
  2. ZnT8
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10
Q

Clinical type 1 diabetes can be accelerated by which factors?

A
  1. Infection
  2. Insulin resistance
  3. Puberty
  4. Diet/weight
  5. Stress
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11
Q

What are the foetal risk factors which cause there to be an increased chance of developing diabetes?

A
  1. Infection
  2. Older mother
  3. ABO mismatch
  4. Birth order (1st child more suseptible)
  5. Stress
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12
Q

If a patient is prediabetic, what are the risk factors which could cause them to beome clinical diabetics?

A
  1. Viral infection
  2. Vitamin D deficiency
  3. Diet
  4. Environmental toxins
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13
Q

What is the typical triad of symptoms in T1DM?

A
  1. Polyuria
  2. Polydipsia
  3. Weight loss
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14
Q

How does polyuria manifest in children?

A

As enuresis - inability to control urination e.g. wetting the bed

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15
Q

As well as the classic triad of T1DM symptoms, which other symptoms may be experienced?

A
  1. Fatigue
  2. Blurred vision
  3. Candidal infection
  4. Ketoacidosis
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16
Q

Candidal infection may cause which conditions in males and females with T1DM?

A
  1. Pruritis vulvae
  2. Balanitis
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17
Q

What are the key features of clinical diabetes?

A
  1. Raised glucose
  2. Ketones
  3. Decreased insulin secretion
  4. Decreased beta cell mass
  5. Decreased C-peptide
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18
Q

An annual review assessment for someone with T1DM should include which tests?

A
  1. Weight
  2. BP
  3. Bloods - HbA1c, renal function, lipids
  4. Retinal screening
  5. Foot risk assessment
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19
Q

Children are more likely to develop type 1 diabetes if their __________ has the condition

A

Children are more likely to develop type 1 diabetes if their father has the condition

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20
Q

What are the microvascular complications of chronic poor glycaemic control?

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy
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21
Q

At which age is type 1 diabetes diagnosed most often?

A

5-15 years

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22
Q

Describe the onset of T1DM

A

Short with severe symptoms

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23
Q

At presentation with T1DM, there are ________ complications

A

At presentation with T1DM, there are rarely complications

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24
Q

Type 1 diabetes is associated with weight ______

A

Type 1 diabetes is associated with weight loss

25
Q

What is LADA?

A

Latent onset diabetes of adulthood

26
Q

Type 2 diabetes is usually diagnosed at which age?

A

>25years

27
Q

Describe the onset of type 2 diabetes

A

Insidious onset with (initially) mild symptoms

28
Q

At presentation with T2DM there are __________ complications

A

At presentation with T2DM there are commonly complications

29
Q

Which factors are most associated with LADA?

A
  1. Male
  2. 25-40 years
  3. Non-obese
  4. AA +ve
  5. Other autoimmune conditions
  6. Not requiring insulin at presentation
30
Q

In which autoimmune condition is there a very high chance of also suffering from type 1 diabetes?

A

Cystic fibrosis

31
Q

In those with cystic fibrosis, which screening test can aid in picking up T1DM?

A

OGTT from the age of 10

32
Q

Which autoimmune conditions can be commonly associated with T1DM?

A
  1. Thyroid disease
  2. Coeliac disease
  3. Pernicious anaemia
  4. Addison’s disease
  5. IgA deficiency
  6. Cystic fibrosis
33
Q

Which rare auto-immune conditions may be implicated in those with T1DM?

A
  1. Polyglandular endicrinopathy syndromes (types 1 and 2)
  2. AIRE mutations
  3. IPEX syndrome
34
Q

By which other name is Wolfram syndrome known?

A

DIDMOAD

35
Q

What is Wolfram syndrome?

A

An autosomal recessive disorder encompassing:

  1. Diabetes insipidius
  2. Diabetes mellitus
  3. Optic atrophy
  4. Deafness
  5. Neurological abnormalites
36
Q

What is Bardet-Biedl syndrome?

A

A ciliopathic human genetic disorder associated with:

  1. Obesity
  2. Polydactyly
  3. Hypogonadal
  4. Visual impairment
  5. Hearing
  6. Mental retardation
  7. Diabetes
37
Q

On which continent is type 1 diabetes most common?

A

Europe

38
Q

Which viruses have the strongest association as triggers for T1DM?

A
  1. Congenital rubella syndrome
  2. Human enteroviruses
39
Q

Coeliac disease shares which genotype with T1DM?

A

HLA-DQ2

40
Q

What is insulitis?

A

Inflammation of the beta cell

41
Q

At which stage will hypeglycaemia develop in type 1 diabetes?

A

When 80-90% of the pancreatic beta cells are destroyed

42
Q

Why is it that patients with type 1 diabetes present with hyperglycaemia and ketoacidosis?

A

Patients cannot utilise glucose in peripheral glucose and adipose tissues

There is no insulin to allow this storage to happen

Instead, the secretion of counter-regulatory hormones increases

Examples include glucagon, adrenaline, cortisol and growth hormone

These hormones can induce gluconeogenesis, glycogenolysis and ketogenesis in the liver

This means patients will have increased blood glucose levels and a metabolic acidosis due to the by products of glucose production in this way

43
Q

Long term hyperglycaemia can lead to what type of complications?

A

Vascular complications

44
Q

Why do vascular complications occur with chronic hyperglycaemia?

A
  1. Glycosylation of proteins in tissue and serum
  2. Production of sorbitol (reduced glucose)
  3. Free radical damage
45
Q

What are macrovascular complications of chronic hyperglycaemia?

A
  1. Cardiovascular disease
  2. Cerebrovascular disease
  3. PVD
46
Q

Why is it that chronic hyperglycaemia causes atheroma formation and PVD?

A

Hyperglycaemia causes oxidative stress by neutralising nitric oxide

This results in dysfunctional endothelium which allows LDL entry into the vessel wall

This induces a slow inflammatory process which results in atheroma formation

47
Q

What are the two types of type 1 diabetes?

A
  1. Autoimmune/classical
  2. Idiopathic
48
Q

How common is idiopathic type 1 diabetes, which population is it most common in and how is it characterised?

A

Not common

Asians

Abscence of antibodies, yet beta cell destruction

49
Q

Why is early diagnosis possible in type 1 diabetes?

A

Glucose and HbA1c rise well before symptoms commence

50
Q

If a patient presents with ketoacidosis, how will you know?

A

Smell of ketones on breath like pear drops

Dehydration and acidotic symptoms:

  1. Nausea and vomiting
  2. Abdominal pain
  3. Tachypnoea
  4. Tachycardia
  5. Lethargy
51
Q

In a symptomatic patient, in which 4 ways can T1 diabetes be confirmed?

A
  1. Random plasma glucose >11mmol/l
  2. Fasting plasma glucose >6.9mmol/l
  3. 2hr OGTT (75mg glucose) >11mmol/l
  4. HbA1c > 48mmol/mol
52
Q

In type 1 diabetes, what can there be autoantibodies for?

A
  1. Glutamic acid decarboxylase (GAD)
  2. Insulin (IAA)
  3. Islet antigens (IA2)
  4. Zinc transporter ZnT8
53
Q

John, an obese teenager with a family history of T2DM has high blood glucose. How do you differentiate between type 1 and 2 diabetes?

A
  1. Low C-peptide levels
  2. Anti-GAD antibodies

Both of these indicate T1DM

54
Q

What is the typical age of presentation for T1DM?

A

5 - 15 years

55
Q

Which genes are considered susceptibilty genes?

A
  1. DR4-DQ8
  2. DR3-DQ2
56
Q

Which infectious agents have beens associated with triggering T1DM?

A

Congenital rubella and human enteroviruses

57
Q

How is fasting defined?

A

No calorific intake for at least 8 hours

58
Q

What value of random plasma glucose is diagnostic of T1DM?

A

11mmol/l

59
Q

What value of fasting plasma glucose is diagnostic for T1DM?

A

>6.9mmol/l

The Endocrine System (35 decks)

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