Diabetes

Question 1

How common is diabetes?

Answer 1

-Type 2 accounts for 85%
-Increasing prevalence

Question 2

Who does diabetes affect?

Answer 2

Type 1 = most common among caucasian, Northern European, usually juvenile onset
Type 2 = most common among South Asian, Afro-Caribbean, Middle Eastern origin

Question 3

What causes type 1 diabetes?

Answer 3

-Gradual destruction of beta cells –> insulin deficiency
-Genetic predisposition, viruses, dietary factors and autoimmune factors contribute
-Associated with islet cell antibodies

Question 4

What causes type 2 diabetes?

Answer 4

-Insulin resistance, often with normal or increased levels of insulin
-Associated with obesity and physical inactivity
-Caused by impaired insulin secretion and insulin resistance
-Gradual onset

Question 5

What risk factors are there for type 2 diabetes?

Answer 5

-Obesity (esp truncal)
-Lack of exercise
-Ethnicity
-PMH of gestational diabetes
-Drug therapy
-Low fibre, high sugar diet
-PCOS
-FH

Question 6

How does diabetes present?

Answer 6

-Polyuria
-Polydipsia
-Frequent, prolonged infections
-Poor wound healing
Type 1 especially:
-Weight loss
-Dehydration
-Ketonuria (+DKA)

Question 7

What signs might a diabetic patient have on examination?

Answer 7

-Slow-healing bruises / wounds
-Weight loss

Question 8

How would you investigate this patient?

Answer 8

-Random / fasting glucose
-HbA1c

Question 9

What treatments would you consider for a patient with diabetes?

Answer 9

Both:
-Patient education
Type 1:
-Insulin therapy
–BD therapies = isophane or long-acting insulin analogues
–Multiple injection therapies = modified insulin or rapid acting analogues
Type 2:
-Diet and lifestyle advice
-Measure HbA1c 3-6 monthly
-Maximise glucose control - metformin and/or pioglitazone