Diabetes 1 and 2

Question 1

What is hyperglycaemia?

Answer 1

Too high blood glucose

Question 2

What are the symptoms of hyperglycaemia?

Answer 2

Polydipsia (excessive thirst)
Polyuria (excessive peeing) 
Blurred vision 
Weight loss 
Infections

Question 3

What diagnostic test is used for diabetes?

Answer 3

Measure blood glucose or HbA1c ( average levels for last 2/3 months)

• one diagnostic lab glucose plus symptoms
• two diagnostic lab glucose or HbA1c levels without symptoms

Question 4

When can HbA1c not be used for diagnosis?

Answer 4

Children and young people
Pregnancy 
Short duration of symptoms
Acutely ill and high risk of diabetes
Medications that cause rapid glucose rise e.g. corticosteroids (only long term) 
Renal failure 
HIV
Acute pancreatic damage or surgery

Question 5

What is insulins key role in cellular metabolism?

Answer 5

Binds to receptors on cell surfaces and controls a range of intracellular processes

Question 6

What is the cause of type 1 diabetes?

Answer 6

Autoimmune

- positive auto antibodies

Question 7

What does the development of Type 1 Diabetes mellitus require?

Answer 7

Genetic pre-disposition PLUS Trigger, and auto immunity

Question 8

What is Type 1 diabetes characterised by?

Answer 8

Insulin deficiency causing Increased lipolysis in adipose tissue
Raised glucose production in the liver
Reduced glucose uptake in muscle.
Hyperglycaemia ketonaemia

Question 9

Clinical presentation of Type 1 diabetes mellitus

Answer 9

Short duration of:
Thirst, tiredness, polyuria, weight loss, blurred vision, abdominal pain
On examination:
Ketones on breath, dehydration, may have increased RR, hypotension.
Low grade infection, thrush.

Question 10

What is type 2 diabetes?

Answer 10

Underlying insulin resistance and subsequent Beta cells dysfunction

Question 11

Type 2 diabetes clinical presentation

Answer 11

May have no symptoms
But could get: 
Thirst, tiredness, polyuria, weight loss, blurred vision
Signs:
Not ketotic
usually overweight but not always 
low grade infections
May have micro vascular or microvascular complications

Question 12

How can we screen for diabetes in asymptomatic populations?

Answer 12

Look for risk factors - any 2 present:
Overweight
Family history 
Over 40 
Gestational diabetes 
Inactive lifestyle, lack of exercise 
Previous High BP

Question 13

What is MODY?

Answer 13

Maturity onset diabetes in the young:
Autosomal dominant
Single gene defect
Impaired beta-cell function

Question 14

Glucokinase mutations in MODY

Answer 14

Onset at birth
Stable hyperglycaemia
diet treatment
complications rare

Question 15

Transcription factor mutations in MODY

Answer 15

Adolescence/young adult onset
Progressive hyperglycaemia
1/3 diet, 1/3 OHA, 1/3 insulin
complications frequent

Question 16

What can cause secondary diabetes mellitus?

Answer 16

Drug therapy e.g. corticosteroids 
Pancreatic destruction 
- Haeochromatosis - excess iron deposition 
- cystic fibrosis 
- Chronic pancreatitis 
Recognised genetic syndrome 
Rare endocrine disorders e.g. Cushings

Question 17

What is Gestational diabetes?

Answer 17

Hyperglycaemia of pregnancy.
Increasing insulin resistance in pregnancy 
Associated with family history of type 2
Increased risk of type 2 later in life
Develops 2nd/3rd trimester
Neonatal problems:
macrosomia / resp distress.

Question 18

What skin conditions are associated with diabetes?

Answer 18

Acanthuses nigricans 
Diabetic bull 
Diabetic dermopathy 
Eruptive xanthomas 
Necrobiosis lipoidica

Question 19

What symptoms do we look for in children with type 1 diabetes?

Answer 19

Thirsty
Thinner
Tired
Using toilet more 
(The 4 Ts) 
Bed wetting is red flag symptom.

Question 20

What test should be done immediately if symptoms present in kids?

Answer 20

Finger prick capillary glucose test

If over 11mmol/l - need same day review.

Question 21

What are the symptoms of Diabetic Ketoacidosis? DKA

Answer 21

Nausea and vomiting 
abdominal pain 
Sweet smelling "ketotic" breath 
Drowsiness 
Rapid, deep "sighing" respiration 
Coma