Diabetes

Question 1

what is the prevalence of DM in the population?

Answer 1

4.5%

Question 2

which ethnicity is more at risk of DM?

Answer 2

South asian

Question 3

what proportion of DM diagnosis are type 2?

Answer 3

90%

Question 4

what are the symptoms of type 2?

Answer 4

polydipsia, polyuria, fatigue, recurrent infections

Question 5

what features indicate type 1?

Answer 5

1. Weight loss (with polydipsia and polyuria).
2. Hyperglycaemia despite diet and medications.
3. Islet cell antibodies (ICAs) and anti-glutamic acid decarboxylase (GAD) antibodies.
4. Ketosis: ketonuria on urine dipstick.
5. If older, ketotic and unresponsive to hypoglycaemics, consider LADA and measure above antibodies.

Question 6

what is the most common cause of beta cell destruction in type 1 DM?

Answer 6

Autoimmunity

Question 7

which HLA immune mediated gene are associated with type 1 DM? (90%)

Answer 7

HLA DR3/DR4

Question 8

when level of blood sugar indicates hyperglycaemia?

Answer 8

> 11mol/L

Question 9

what are the characteristics of DKA?

Answer 9

Vomiting, nausea, kussmaul breathing, ketones on breath, abdo pain

Question 10

which 6 investigations should be performed in suspected DM?

Answer 10

• fasting blood glucose >7mmol/l
• random blood glucose > 11mol/l
• urine dipstick : shows ketones and glucose
• blood glucose post OGTT >11mol/l after 2 hours
• HbA1c- >48 mmol/l
• check for autoantibodies

Question 11

what are the three possible diagnostic requirements for DM type 1?

Answer 11

• Classical symptoms (polyuria, polydipsia, weight loss) + 1 raised glucose measurement (hyperglycaemia = random blood glucose >11; fasting blood glucose >7; OGTT >11) OR
• No classical symptoms + 2 raised glucose measurements.
• HbA1c ≥48mmol/L but lower doesn’t exclude DM

Question 12

Name the three main types of insulin side effects with relevant examples.

Answer 12

Hypoglycaemia (blood glucose <4mmol/L). Adrenergic (sweating, tachycardia, palpitations, pallor, hunger restlessness) -occurs early on.
Neuroglycopenic: confusion, slurred speech, drowsiness, yawning, anxiety, blurred vision, numbness of nose lips and fingers, can lead to seizures and death, occurs later on.

Question 13

What is the goal level of HbA1c and cholesterol?

Answer 13

HbA1c< 48mmol / l

cholesterol <4 mmol/l

Question 14

why is there an increased in liver production of glucose in type 2 DM?

Answer 14

It is in response the inadequate suppression of gluconeogenesis due to insulin resistance

Question 15

what is MODY?

Answer 15

maturity onset diabetes of the young

Question 16

what are the risk factors for type 2 dm?

Answer 16

obesity, lack of exercise, high calorie diet, family history, polygenic genetics, Hx of gestational diabetes, IGT/ IFG, smoking, PCOS