Diabetes

Question 1

What is Diabetes and another name of it?

Answer 1

An elevation of blood glucose above a diagnostic threshold
AKA Diabetes Mellitus

Question 2

Diabetes is—– disease

Answer 2

endocrine/hormones

Question 3

How to diagnose diabetes?

Answer 3

Thresholds for Diagnosis of Diabetes: (having symptoms)
* Fasting Plasma Glucose = 126mg/dl = 7mmol/L
* 2 hr plasma glucose = 200mg/dl = 11.1 mmol/L
* HbA1c = 5.8% = 48 mmol/mol

If asymptomatic a repeat confirmatory test is required
Random or 2 hr (after 75g Oral Glucose) glucose >=11.1.
OR
A fasting glucose of >=7.0mmol/L
OR
An HbA1c >= 48mmol/mol

Question 4

Gestational Diabetes criteria

Answer 4

Threshold levels are NOT set by retinopathy risk but rather by risk to the foetus/neonate
NB:the G level’s mother is down to 5mmol/mol

Question 5

Hormones control G?

Answer 5

Glucagon- releases from alpha cells in low G
Insulin- releases from beta cells when G is high. to tell the organs absorb more G

Question 6

c-peptide

Answer 6

is the endogenouse of level of insulin in liver

Question 7

Type 2 Diabetes is the most common one . T/F

Answer 7

T

Question 8

90% of ppl with T2DM have IR.

Answer 8

T

Question 9

People in their 60s and 70s have higher risk of T2DM. T/F

Answer 9

T

Question 10

Diabetes is one of the sig signs of pancreatic disease. T/F

Answer 10

T

Question 11

What happens in Diabetes?

Answer 11

• Diabetes can be caused by a pure disorder of beta cells
• Diabetes can be caused by increased Insulin resistance, with an inability to compensate by increasing beta-cell function

Question 12

Define T1DM?

Answer 12

• Onset in Children and Young adults
• Not associated with overweight
• T cell mediated Autoimmune (autoimmune destruction of beta cells = insulin deficiency)
• Requires insulin treatment – can be fatal if untreated

Question 13

Diagnosis of T1DM?

Answer 13

Measuring pancreatic autoantibodies in the blood

Question 14

Define T2DM?

Answer 14

*95% of diabetes
* Onset in middle aged and elderly
* Insulin resistance+beta cell dysfunction=relative insulin deficiency
* Associated with obesity and sedentary lifestyle
* Not Autoimmune destruction of beta cell
* Mostly do not need insulin but usually managed with lifestyle modification and non-insulin treatments
* No known cause

Question 15

Symptoms and Presentation of Diabetes?

Answer 15

• Often asymptomatic – esp. Type 2 diabetes
• Symptoms of high blood glucose
  Polyuria
  Thirst and polydipsia
  Blurred vision
  Genital Thrush
  Fatigue
  Weight loss
• Symptoms/signs of complications (rarely)
  Loss of vision/retinal bleed or retinal changes found by optician

Question 16

Presentation with Diabetes Emergencies?

Answer 16

Diabetic Ketoacidosis (mainly in T1D)
Hyperosmolar Hyperglycaemic State

Question 17

2 main causes of diabetes?

Answer 17

• Diabetes can be caused by a pure disorder of beta cells
• Diabetes can be caused by increased Insulin resistance, with an inability to compensate by increasing beta-cell function

Question 18

Disorders of insulin secretion?

Answer 18

• Type 1 Diabetes
• Genetic disorders
  MODY
  Neonatal Diabetes
• Pancreatic disease (the first signs of pancreatic disease is diabetes)
  Alcohol and chronic pancreatitis
  Acute pancreatitis
  Pancreatectomy
  Pancreatic cancer
  Cystic Fibrosis (Genetic)
  Haemochromatosis (Genetic)

Question 19

Disorders of insulin actions?

Answer 19

Pure disorders are rare and mostly genetic

Donohue Syndrome
Rabson-Mendenhall Syndrome
Familial Partial Lipodystrophy
Congenital Lipoatrophy
Acquired Lipoatrophy

• Insulin Resistance
  Feature of Obesity, Type 2 Diabetes,
  NAFLD
• Endocrinopathies
  Cushings Syndrome, Acromegaly, Phaeochromocytoma, Glucagonoma
• Steroid induced
  i.e. exogenous glucocorticoids

Question 20

How to diagnose distinguish T1DM and T2DM?

Answer 20

Question 21

Why treat diabetes?

Answer 21

• To prevent the acute symptoms and life-threatening illness
• To reduce the ‘burden of diabetes’ such as :
  1. Microvascular Complications
  “Diabetes Specific”
  Largely driven by chronic hyperglycaemia
  e.g. Retinopathy, Neuropathy, Nephropathy

2.Macrovascular
Increased risk in all diabetes
Due to hyperglycaemia, high blood pressure and dyslipidemia e.g. Myocardial Infarction/ACS, Stroke, Peripheral Vascular Disease

Question 22

What is HbA1c?

Answer 22

*Blood glucose varies continuously in response to meals, exercise, so it is not informative. therefore we use HbA1c.
* Glycated Haemoglobin
Haemoglobin exposed to glucose becomes glycated
The amount of glycation is proportional to the glucose
* As a red blood cell survives for ~90 days the HbA1c gives a measure of glucose exposure over the last 90 days
* Caution in conditions of increased or reduced red cell turnover e.g. haemolytic anaemia; Haemoglobinopathies may give spurious (false) results

Question 23

Unit and conversion of HbA1C?

Answer 23

Each 1% increase is an 11mmol/mol increase

Question 24

Summary of this lecture

Answer 24

Diabetes is a diagnostic label defined by hyperglycaemia above a fasting glucose of 7 mmol/L – a threshold set in relation to the risk of diabetic retinopathy
There are many different causes for diabetes – that can be due to impaired insulin secretion, impaired insulin action or both
Type 1 diabetes results from an autoimmune destruction of the pancreatic beta-cells and can occur at any age
Type 2 diabetes is a mixed bag – what is left after ruling out other causes
Diabetes can present with ‘osmotic symptoms’ although often is only diagnosed at incidental blood testing or screening
Treatment aims to reduce the blood sugar and cardiovascular risk factors to minimize micro and macrovascular disease
Diabetes is monitored using HbA1c