Type 1 Diabetes and MODY Flashcards
(105 cards)
1
Q
If a child has a first degree family member with T1DM, chances of the child getting type 1 also is
A
5-6%
2
Q
What is the chance of the other twin getting type 1 in dizygotic twins
A
5-10%
3
Q
what is the chance of the other twin getting type 1 in monozygotic twins
A
30-40%
4
Q
What is the symptoms of type 1 DM
A
polydipsia polyuria weight loss thrush weakness/fatigue/lethargy blurred vision infections Kussmauls breathing
5
Q
Why does thrush occur in T1DM
A
due to the increased levels of glucose
6
Q
Why does blurred vision occur in someone with T1DM
A
the high levels of glucose are absorbed by the lens and cause it to change shape leading to acute short sightedness
7
Q
Infections most commonly occur where
A
UTI and respiratory tract
8
Q
When does Kussmauls breathing occur in someone with T1DM
A
during DKA
9
Q
Which onset does type 1 diabetes usually have
A
acute
10
Q
When does type 1 usually present
A
pre-school/pre-puberty
11
Q
Is type 1 and autoimmune condition
A
yes
12
Q
What is used for the investigation of type 1
A
fasting blood glucose
urinalysis (ketones)
oral glucose tolerance test
anti-islet testing
13
Q
what is the treatment for type 1
A
insulin
14
Q
What are the two types of long-acting twice daily analogue insulins called
A
detemir/glargine (levemir/lantus = brand name)
15
Q
What are long acting insulin analogues used as
A
basal therapy
16
Q
What else can also be used as basal therapy
A
long acting human insulins
17
Q
What are the 2 names of long acting human insulins
A
insulatard and humulin I
18
Q
What are the 2 names and their brand names of the rapid acting insulin analogues
A
lispro (humalog) and aspart (novorapid)
19
Q
What are the rapid acting insulin analogues used for
A
bolus therapy (before meals)
20
Q
What else can be used for bolus therapy
A
rapid acting human insulin
21
Q
what are the 2 names of rapid acting human insulin
A
Humulin S and actrapid
22
Q
how many times a day is a mixed insulin regimen given
A
twice daily
23
Q
What are the mixed insulin analogues called
A
Humalog mix 25
Humalog mix 50
Novomix 50
24
Q
What are the human mixed insulins called
A
Humulin M2, M3, M5
25
What does an insulin pump do
gives a constant flow of insulin throughout the day which the patient can top up before meals
26
An insulin pump does what to the blood pressure
helps to control it better
27
When should IV insulin be given
DKA
Hyperosmolar hyperglycaemic state
Acute illness
28
Patients should be encouraged to inject insulin into the same site but to rotate. Why is this
to avoid lipohypertrophy (can delay absorption)
29
What should a patient be encouraged to do
monitor blood glucose
to do physical activity
to keep a food diary
to take part in a carb counting programme (e.g. DAFNE)
to meet with a dietician to control weight
30
The poyol pathway is also known as the
aldose-reductase pathway
31
when does the poyol pathway occur
when intracellular glucose is high
32
Where is the poyol pathway found
nerves
retina
blood vessel walls
(these are insulin dependant)
33
What is the function of the poyol pathway
to decrease glucose levels at its sites
34
Huge amounts of glucose are needed to activate the poyol pathway. why is this
its enzyme, aldose reductase has a very high km compared to glucokinase
35
What does aldose reductase do in the poyol pathway
changes glucose to sorbitol (some change into methylglyoxal and acetol)
36
What does sorbitol do in the poyol pathway
exerts osmotic pressure onto the cell which damages the cell over time
37
What is sorbitol changed to, to prevent the damage to the cell overtime
fructose (a glycating sugar)
38
What is the enzyme that catalyses the change from sorbitol to fructose
sorbitol dehydrogenase
39
The change from sorbitol to fructose allows what
it to diffuse out of the cell
40
HbA1c is what
the extent to which Hb is bound to glycating sugars
41
HbA1c is used to indicate what in diabetes
glycaemic control over the past 2-3 months
42
What is the normal HbA1c of someone
<42mmol/l
43
What HbA1c describes pre-diabetic
42-47 mmol/l
44
What HbA1c describes diabetic
>/= 48mmol/l
45
What HbA1c should patients with diabetes aim for
<48 mmol/l
46
What are the symptoms of hypoglycaemia
```
shaking
sweating
anxious
dizzy
hungry
tachycardic
impaired vision
weakness/fatigue
headache/irritable
may look drunk
```
47
What is the lower level of glucose that describes hypoglycaemia
4 is the floor
48
What is the treatment for hypoglycaemia
consume 15-20g of glucose (in sachet or gel) or eat simple carbs e.g. bread
49
When should blood glucose be checked after a hypoglycaemic attack
after 15 min
50
what correlates to 15g of sugar
```
2tbsp raisins
4oz of coca cola
1tbsp of honey, sugar, corn syrup
8oz non fat/1% milk
hard sweets
jelly beans
gumdrops
```
51
What is the treatment for a severe hypoglycaemic attack
glucagon 1mg injection (stored in fridge) into buttock, arm or thigh
IV glucose is infused after 10-15 min
52
Diabetic ketoacidosis can be described as
Absolute/relative insulin deficiency + increase in counter regulatory hormones
53
What will ketones looks like in DKA
ketonaemia - >3 mmol/l or significant ketonuria - >2 on dipstix
54
What will blood glucose look like in DKA
>11mmol/l (diagnostically but will usually be up at 40)
55
What will bicarbonate look like in DKA
<15 mmol/l (<10 in severe)
56
pH will be what in DKA
<7.3
57
What is the most common cause of DKA
non-adherance with treatment
58
What are other causes of DKA
illness
alcohol
newly diagnosed diabetes
59
What are the symptoms of DKA
```
thirst and polyuria
dehydration
flushed
vomiting
abdominal pain and tenderness
Kussmauls respiration
+/- ketones on breath
```
60
What will potassium be greater than in DKA
>5.5 mmol/l
61
what else may be increased in DKA
creatinine
lactate
amylase
62
Is sodium increased or decreased in DKA
decreased
63
What is the treatment for DKA
replace fluids - with saline then dextrose once glucose <15mmol/l
Replace insulin and potassium
Address risks
64
What are the 2 ways ketones can be monitored
urine and blood
65
what is being measured in urine ketone monitoring
acetoacetone
66
What is measured in blood ketone monitoring
hydroxybutyrate (measured with an optium meter)
67
What is the norm for ketones
<0.6 mmol/l
68
There is hospital admission for type 1 if
unable to tolerate oral fluids
persistent vomiting and hyperglycaemia
persistent increase of ketones
abdominal pain and breathlessness
69
Hyperglycaemic hyperosmolar syndrome usually occurs in what age group
older
70
When does hyperglycaemic hyperosmolar syndrome usually occur
right after a high refined carb intake
71
what is included in hyperglycaemic hyperosmolar syndrome
hypovolaemia + hyperglycaemia (without significant acidosis/ ketonaemia) + hyperosmolar
72
what is the blood glucose in HHS usually
>30 mmol/l
73
WHat is the osmolality in HHS usually
>320 mosmol/kg
74
What is usually the cause of HHS
fizzy drinks
diuretics
steroids
75
what organ is damaged in HHS
significant renal impairment
76
Does HHS have higher or lower glucose than DKA
higher
77
What is the normal range of osmolality
285-295
78
What is the osmolality in HHS
around 400
79
What is the calculation for osmolality
2x (Na +/- K) + urea + glucose
80
What is the long term treatment for HHS
diet
| possibly insulin
81
What is the acute treatment for HHS
IV saline
low dose IV insulin once glucose <15 mmol/l
prophylactic anti-coagulation
82
Why do you give K in DKA
as you give insulin, it causes an increase in the Na/K pump causing increase efflux of K and Na influx in the cell. This K then has to be replaced
83
What is lactic acidosis
the build up of lactic acid in the body that results in a low pH
84
lactic acidosis is what type of acidosis
metabolic acidosis
85
Clearance of lactate occurs how
hepatic uptake
| aerobic conversion of it to pyruvate
86
what is the normal lactate level
0.6-1.2 mmol/l
87
When is lactate lowest
when fasting
88
when is acidosis most likely
when lactate >5 mmol/l
89
What is type A lactic acidosis associated with
tissue hypoxaemia
| e.g. infarcted tissue, cardiogenic shock, hypovolaemic shock
90
When might type B lactic acidosis occur
liver disease
| leukaemic states
91
Which type of lactic acidosis is associated with diabetes
type B
92
In lactic acidosis, bicarbonate is
decreased
93
In lactic acidosis, phosphate is
increased
94
There is an ________ anion gap in lactic acidosis
increased
95
What is the treatment for lactic acidosis
IV fluids
IV antibiotics
withdrawal of offending medications and treat the underlying cause
96
MODY is a monogenic genetic defect in what
beta cell function
97
what can MODY present as
early type 2 diabetes (defective glucose sensing) and primary defects in secretion of insulin
98
In MODY2, what is impaired
glucokinase activity
| blood glucose threshold for insulin is increased (above 5mM)
99
What kind of inheritance is MODY
Autosomal dominant inheritance
100
Can MODY get progressive micro and macrovascular complications
yes
101
What kind of onset does MODY have
slow
102
What is the treatment for MODY
responds to sulphonylureas
103
Is C peptide present in type 1
no
104
Is C peptide present in type 2
yes
105
Is C peptide present in MODY
yes
