Patho of Type 1
What causes the destruction of beta-cells
Autoimmune destruction of pancreatic beta endocrine cells
What is the main transporter involved in the pathophys of Type II diabetes?
When can patients present with Type 1 Diabetes? When is it most commonly presented?
Commonly childhood and adolescence, can present at any age.
True or False: Fatigue is a commonly reported symptom of T2DM.
True
State 3 different investigations used, and the parameters required for a diagnosis of diabetes
Hb1Ac (>6.5%)
Random (>11.1 mmol/L)
Fasting (>7% mmol/L)
Where are beta cells located in the pancreas
In Islets of Langerhans alongside beta and delta cells
What happens to β cells in Type II diabetes and why?
β cell failure occurs when islets are unable to sustain β cell compensation for insulin resistance. Hyperglycemia leads to poorly functioning, de-differentiated β cells and loss of β cell mass from apoptosis.
Explain the pathophysiology behind polyuria and glucose in urine in uncontrolled diabetes
Too much glucose in blood, spilled over into urine, glucose in urine.
True or False. Poor wound healing is a commonly reported symptom of T2DM.
True
Upon general inspection of the legs, name 5 signs you may look for in a diabetic patient?
Necrobiosis, Ulcers, Fungal/Bacterial infections, Charot's joint, Hair loss, Peripheral cyanosis
What other pancreatic hormone is affected in type 1 diabetes
Hint: produced in pancreatic alpha cells and failure of its secretion can lead to hypoglycemia
Glucagon
What is/are the receptor(s) controlling insulin secretion in β cells?
G protein coupled receptors (GPCRs)
Name 5 signs of diabetes
Skin lesions on the axilla, Acanthosis nigricans, Necrobiosis L. D., Charcot foot, Colour/hair loss, ulcers (look at pressure areas, including between toes), Infections (especially fungi), Muscle wasting (particularly quads), Joint deformity (ankle and knee), poor capillary return, poor lower limb pulse
List any 3 symptoms of T2DM that patients report upon clinical presentation?
Polyphagia
Polydipsia
Polyuria
Unintended weight loss.
Fatigue.
Blurred vision.
Slow-healing sores.
Frequent infections.
Numbness or tingling in the hands or feet.
Acanthosis nigricans
Name two other autoimmune conditions associated w diabetes type II
PCOS
In a genetically susceptible individual, what environmental factor can induce the development of type 1 diabetes
Viral infection
How is incretin reduced in Type II diabetes patients?
This is due to decreased secretion of GLP-1 and loss of the insulinotropic effects of GIP.
What is Haemachromatosis? How is it relevant to Diabetes?
Hemochromatosis is a disorder in which the body can build up too much iron in the skin, heart, liver, pancreas, pituitary gland, and joints. On inspection the patient will present with a bronzed colouration. This can present as diabetes as the function of the pancreas is impacted by the iron build up and cannot produce enough insulin.
What is Acanthosis nigricans and how does it relate to T2DM?
Acanthosis nigricans is characterised by darkening of the skin at particular areas such as the neck and armpits and is associated with insulin resistance.
You are in a GP consultation with a new patient, who has been diagnosed with Type II diabetes 5 years ago. List 5 questions that you would ask during a patient history?
When were you first diagnosed? What was your initial presentation? Can you describe to me your management plan? Has it changed recently? Have you had any recent complications/episodes of hypo/hyperglycaemia or recent changes in symptoms?
Two types of type 1 and percentage of each
Autoimmune-90%
Idiopathic 10%
Where are GIP and GLIP-1 secreted? (bonus marks for cell type)
enteroendocrine cells in the gut
Why is there high HbA1C in type 2 diabetes?
HbA1c is short for glycated haemoglobin. Essentially too much glucose in blood -> blood and glucose binds together.
Estimate the percentage of diabetic patients with peripheral diabetic neuropathy.
A: Any number between 20-50% depending on source.
What will a patient with hyperosmolar hyperglycaemia non ketotic syndrome present with?
It is not a medical emergency? T/F
F - It is a emergency
Pt presents with HIGH glucose (>25-30mmol/L), high serum osmolarity + no ketones. Key differentiating symptoms: neurological deficits - seizures, delirium, stroke like-symptoms