CP 54 - Diabetes

Question 1

Definition of Diabetes?

Answer 1

Medical conditions with chronic high blood glucose levels

Question 2

diabetes = ?

Answer 2

hyperglycaemia

Question 3

what is the normal conc of glucose in blood ?

Answer 3

5 mmol/l

Question 4

where is insulin produced in the body?

Answer 4

a hormone produced in the pancreas

Question 5

what is insulin ?

Answer 5

a hormone which controls the release of glucose from the liver & promotte glucose uptake in the muscle tissues

Question 6

what is the function of glucagon?

Answer 6

promote break down of glycogen which then releases glucose raising blood sugar level

Question 7

what level of blood sugar classify as hypoglycaemia

Answer 7

less than 4 mmol/l

Question 8

what level of blood sugar classify hyperglycaemia?

Answer 8

greater than 11mmol/l

Question 9

what is diabetes?

Answer 9

a snydrom of raised blood glucose, hyperglycaemia, due to various causes

Question 10

what is a syndrome?

Answer 10

a syndrome is a collection of symptoms and signs that may be due to more than one causes

Question 11

what are the symptoms of diabetes

Answer 11

polyuria, thirst, weight loss, tiredness

Question 12

what are the signs of diabetes?

Answer 12

dry mouth, weight loss, glycosuria, hyperglycaemia

Question 13

what tests can be used to diagnose diabetes?

Answer 13

fasting blood glucose > 7mmol/l, 75g OGTT, HbA1c - 48 mmol/mol

Question 14

what is OGTT

Answer 14

oral glucose tolerance test

Question 15

how is OGTT carried out?

Answer 15

fasting at first and then is given a solution of 75g glucose load to drink - blood glucose will be taken at fasting and then at intervals and at 2 housrs later - diabetics >11mmol/l

Question 16

what is glycated haemoglobin?

Answer 16

sugar deposit onto haemoglobin due to high blood sugar level - normal appearance but in diabetics higher ratio of glycated to non-glycated

Question 17

what is the normal level of HbA1c

Answer 17

7 / 48 mmol/mol ie diabetic > 48mmol/mol

Question 18

what is the haemoglobin which is used for investigation for glycated haemoglobin?

Answer 18

HbA1c

Question 19

what are the different types of diabetes?

Answer 19

Type 1 - insulin dependent, LADA - latent autoimmune diabetes in adults, Type 2 - non-insulin dependent, Pancreatic disorders, drug induced (steroids, anti-pychotic) , endocrine disorders (steroid related), ethnic variants of diabets, genetic syndromes

Question 20

what is the cause of Type 1 diabetes?

Answer 20

autoimmune destruction of the insulin producing islet beta cells in pancreas

Question 21

why is Type 1 diabets insulin dependent?

Answer 21

as islet beta cells have been destroyed, no insulin produced ie insulin deficiency

Question 22

what test can be used to test for T1 diabetes?

Answer 22

autoantibodies test - ICA (Islet Cell antibodies), IA2(islet antigen 2), GAD

Question 23

what does LADA stand for?

Answer 23

Latent autoimmune diabetes in adults

Question 24

what is the difference between LADA and T1 diabetes?

Answer 24

LADA often appear in older patients and often female whereas T1 diabetes tend to be younger patients

Question 25

What do LADA and T1-diabetes have in common?

Answer 25

they both have family history of related conditions whereas LADA can also have medical history too.

Question 26

what are the characteristic of LADA

Answer 26

can present as T2 diabetes & progress deterioration in control leading to increasing therapy.

Question 27

what are the diagnosatic test for LADA

Answer 27

autoantibodies test - GAD, ICA, tTG (tissue transglutaminease), TPO (thyroid peroxidase)

Question 28

what characteristic for T2 Diabetes?

Answer 28

insulin resistant.deficient, not absoultely insulin dependent, often over-weight

Question 29

what is Ketosis-Prone Type 2 Diabetes?

Answer 29

Ketosis when physically stressed with intercurrent illness and temporarily requites insulin but not insulin dependent

Question 30

what are some of the pancreatic disorder which leads to diabetes?

Answer 30

chronic/acute pancreatitis, calcific, tropical pancreatitis, pancreatectomy, pancreatic caner, cystic fibrosis - blocked ducts, haemochromatosis

Question 31

what is haemochromatosis

Answer 31

familial condition where excess iron is absorbed and can deposit in many places staring from the skins to pancreas causing a whole host of many conditions - leading to diabetes.

Question 32

what are some of the drugs which can cause diabetes?

Answer 32

diuretics, steroids, antipsychotics eg Olanzapine & psychaitric drugs causing weigh gain

Question 33

what are some of the endocrine disorders which cause diabetes?

Answer 33

acromegaly, cushing’s syndrome, phaeochrocytoma

Question 34

how does acromegaly causes diabetes?

Answer 34

High GH levels causes diabetes

Question 35

how does cushings’ syndrome cause diabetes

Answer 35

high cortisol level causes diabetes

Question 36

what is the Jamaican & Afro-Caribbeans specific diabetes?

Answer 36

J type diabetes

Question 37

what are the genetic syndrome which causes diabetes?

Answer 37

Friedreich’s Ataxia & Dystrophia myotonica

Question 38

what is dystrophia myotonia ?

Answer 38

a genetic diabetes syndrome

Question 39

what is gestational diabetes?

Answer 39

diabetes arising during pregnancy which then resolves after pregnancy

Question 40

what risks will gestational diabetes bring about?

Answer 40

risk of diabetes in later pregnancy & risk of diabetes in future

Question 41

when is the onset of MODY?

Answer 41

under 25

Question 42

what is MODY?

Answer 42

Maturity onset diabetes in the young - autosomal dominant pattern (1-2% of diabetic cases)

Question 43

what are the diagnosis test for MODY

Answer 43

antibodies test - Glucokinase, HNF 1A, HNF 4A