54 - diabetes

Question 1

normal blood glucose level

Answer 1

5mmol/l

Question 2

hyperglycaemia when

Answer 2

> 11mmol/l

Question 3

Diabetes - symptoms

Answer 3

thirst, polyuria, weight loss, tiredness

signs: dry mouth, weight loss, glycosuria, hyperglycaemia

Question 4

Diabetes - who?

Answer 4

ethnic groups - asians, afro-caribbeans

Question 5

Diabetes - diagnosis

Answer 5

Fasting blood glucose >7mmol/l
75g OGTT
HbA1c 48 mmol/mol (6.5%)

Question 6

GTT stands for… OGTT…. IVGTT…

Answer 6

Glucose tolerance test
Oral GTT
IV GTT

Question 7

GTT process

Answer 7

Fasting
then 75 glucose load

Fasting 7mmol/l

2 hour post-glucose load: diabetic >11mmol/l

Question 8

Borderline diabetes

Answer 8

6-7mmol/l at fasting

Impaired glucose tolerance = 7.8 - 11.0mmol/l

Question 9

Diabetes - investigations

Answer 9

HbA1c
Renal function
Liver function
Lipids
Thyroid function

Question 10

Type One Diabetes - what is it?

Answer 10

Autoimmune destruction of the insulin producing islet beta cells

Question 11

Type One Diabetes - who?

Answer 11

Usually young but can be any age

Autoantibody test: ICA, IA2, GAD

Question 12

LADA - stands for

Answer 12

latent autoimmune diabetes in adults

Question 13

LADA - who?

Answer 13

older patients, often female

FH of: T1DM, thyroid, PA, addison’s, coeliac, vitiligo

T2DM who progresses out of control

Question 14

LADA - autoantibodies

Answer 14

GAD, ICA, tTG, TPO

Question 15

Type 2 Diabetes - what is it

Answer 15

insulin resistance/deficient

Question 16

Type 2 Diabetes - who

Answer 16

not absolutely insulin dependent

strong FH

often obese
hypertensive, hyperlipidaemic

Question 17

Type 2 Diabetes - variant: ketosis-prone type 2

Answer 17

Often obese, ethnic minority

Ketosis when physically stressed with intercurrent illness and temporarily needs insulin

Question 18

Diabetes secondary to pancreatic disorders - what disorders

Answer 18

chronic/acute pancreatitis
calcific, tropical pancreatitis
pancreatectomy
pancreatic cancer
CF
haemochromatosis

Question 19

Haemochromatosis reminder

Answer 19

Hereditary iron overload storage disorder

Question 20

Drug induced diabetes

Answer 20

Diuretics
Steroids
Antipsychotics e.g. Olanzapine
Psychiatric drugs: weight gain

Question 21

Endocrine disorders -

Answer 21

Acromegaly
Cushing’s syndrome
Phaeochromocytoma

Question 22

Acromegaly

Answer 22

High growth hormone levels cause diabetes

Question 23

Cushing’s syndrome is

Answer 23

High cortisol levels cause diabetes

Question 24

Ethnic variants of diabetes

Answer 24

J type: Jamaican, afro-caribbeans

Flatbush: US afro-american

MRDM - malnutrition-related diabetes, tropical diabetes

Chronic calcific pancreatitis: 2° diabetes

Z type diabetes

Question 25

J type Jamaican diabetes

Answer 25

Ketosis prone
not particularly obese
On and off insulin therapy

Variable insulin req.
Also called flatbush diabetes

Question 26

Genetic syndromes

Answer 26

Friedreich’s ataxia

Dystrophia myotonica

Question 27

Gestational diabetes

Answer 27

diabetes appears during preg but resolves.

At risk of diabetes in later pregnancy w/ risk of diabetes in future

Question 28

MODY stands for

Answer 28

maturity onset diabetes in the young

Question 29

MODY genetics

Answer 29

AD pattern

1-2% of diabetic cases

Question 30

MODY who?

Answer 30

under 25

Question 31

MODY - treatment

Answer 31

insulin not req. initially

Question 32

MODY - pathogenesis

Answer 32

Glucokinase probs
HNF 1A
HNF 4A