Diabetes

Question 1

Micro vascular complications of diabetes (3)

Answer 1

Retinopathy
Nephropathy
Neuropathy

Question 2

Macrovascular complications of diabetes

Answer 2

Limb ischaemia
Renovascular disease
Heart disease
Stroke

Question 3

The WHO criteria for diagnosis of diabetes mellitus - 3 ways

Answer 3

1) symptoms of hyperglycaemia AND raised venous glucose detected once - fasting plasma glucose >=7 mmol/L or random >=11.1mmol/L

OR

2) Raised venous glucose on 2 separate occasions - fasting >=7mmol/L , Random >=11.1mmol/L or OGTT 2h value >=11.1mmol/L

OR

3) HbA1c>=48 mmol/L (6.5%) - in patients without symptoms, repeat to confirm diagnosis

Question 4

When would you avoid using HbA1c for the diagnosis of diabetes?

Answer 4

In:
Pregnancy
Children
Type 1 DM

Question 5

Define Impaired glucose tolerance (IGT).

Answer 5

Fasting plasma glucose <7mmol/L and OGTT 2h glucose >=7.8mmol/L but <11.1mmol/L

Due to muscle insulin resistance
Post prandial glucose regulation impairment

Question 6

Define impaired fasting glucose (IFG).

Answer 6

Fasting plasma glucose >=6.1mmol/L but <7mmol/L

Due to hepatic insulin resistance

Question 7

What are the symptoms of hyperglycaemia?

Answer 7

Polyuria
Polydipsia
Unexplained weight loss
Visual blurring
Genital thrush
Lethargy

Question 8

What genetic HLA association has been found with T1DM?

Answer 8

HLA D3 & D4

Question 9

What is LADA?

Answer 9

Latent autoimmune diabetes of adults

- a type of type 1 DM with slower progression to insulin dependence in later life

Question 10

What is MODY?

Answer 10

Maturity onset diabetes of the young- autosomal dominant condition wherein young patients with a positive family history develop type 2 diabetes

Question 11

What are the risks associated with gestational diabetes?

Answer 11

Miscarriage
Preterm birth
Pre eclampsia
Congenital malformation
Macrosomia
Worsening of diabetic complications - retinopathy, nephropathy

Question 12

What risk factors predispose to gestational diabetes?

Answer 12

Age >25 years
Positive family history
High BMI
Non-causasian 
HIV positive
Previous gestational diabetes

Question 13

How do you manage a pregnant woman with gestational diabetes?

Answer 13

5mg / d folic acid until 12 weeks
Control/decrease weight
Good glucose control
Metformin - other oral hypoglycaemics should be discontinued

6wk post partum- do a fasting blood glucose

Question 14

Define metabolic syndrome (syndrome X).

Answer 14

Central obesity - BMI>30 or increased waist circ
Plus 2 of:
- BP>=130/85
- triglycerides >=1.7mmol/L
- HDL <= 1.03(M)/ 1.29(F) mmol/L
- fasting glucose >=5.6mmol/L Or DM