Diabetes

Question 1

define

Answer 1

chronic, metabolic disease characterised by elevated levels of blood glucose which overtime leads to serious damage to heart, blood vessels, eyes, kidneys and nerves

Question 2

why does diabetes develop?

Answer 2

when there is insufficient insulin to maintain glucose homeostasis

Question 3

classification of diabetes

Answer 3

mellitus (insulin resistance/lack)

insipidus (lack of ADH)

Question 4

define T1DM

Answer 4

AI disorder with T lymphocyte infiltrate that causes destruction of pancreatic beta cell

Question 5

presentation of T1DM

Answer 5

polyuria
increased thirst
malaise
severe weight loss
acute onset
ketonuria +/- metabolic acidosis

Question 6

autoimmune markers of T1DM

Answer 6

islet cell autoantibodies
autoantibodies to GAD65
HLA association with DQA DQB genes

Question 7

markers of T1DM

Answer 7

ketones (only type 1)

C-peptides (plasma)

Question 8

define LADA

Answer 8

late onset type 1 diabetes that is commonly mis-diagnosed as T2DM

Question 9

what age does T1DM present?

Answer 9

preschool
peri-puberty
late 30s
consider LADA

Question 10

typical type 2 diabetes mellitus presentation

Answer 10

middle-aged/elderly
usually obese
pre-diagnosis duration 6-10 years/ insidious onset
evidence of microvascular disease
managed with diet and tablets initially

Question 11

classification of diabetes

Answer 11

T1DM
T2DM
gestational diabetes mellitus (GDM- type 3)
specific types

Question 12

define GDM

Answer 12

diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation

Question 13

examples of specific types of diabetes due to other causes

Answer 13

• monogenic diabetes syndromes e.g. neonatal diabetes and MODY
  disease of the exocrine pancreases e.g. CF, haemochromatosis and pancreatitis
• endocrine disease e.g. Cushing’s, acromegaly, phaeochromocytoma or glucagonoma
• drug or chemical induced diabetes e.g. glucocorticoids, diuretics, beta blockers, treatment of HIV/AIDs or after organ transplantation
• genetic diseases e.g. CF, myotonic dystrophy and Turner’s syndrome

Question 14

define fasting

Answer 14

no calorific intake for at least 8 hours

Question 15

describe the results seen in positive diabetes

Answer 15

• HbA1c= 48m/m or above
• fasting= 7.0mmol/L or above
• 2-hr glucose OGTT= 11.1mmol/L or above
• random glucose= 11.1mmol/L or above

Question 16

describe the results seen in impaired/pre-diabetes

Answer 16

• HbA1c= 42-47mmol/mol
• fasting= 6.1-6.9mmol/L
• 2-hr glucose in OGTT= 7.8-11.0mmol/L

Question 17

normal results in diabetes testing that signify no diabetes

Answer 17

HbA1c= 41m/m or below
fasting= 6.0mmol/L or below
2hr-fasting glucose in OGTT= 7.7mmol/L or below

Question 18

what is the glucose drink made of?

Answer 18

75g anhydrous glucose dissolved in water

Question 19

what does diagnosis of diabetes require in terms of testing samples?

Answer 19

two abnormal test results from same sample or two separate test samples

Question 20

who should testing be considered in?

Answer 20

• overweight or obese (BMI >25 or >23 in Asian Americans)
• first degree relative with diabetes
• high risk race/ethnicity e.g. African American, Latino, Native American, Asian American, Pacific Islander
• history of CVD or hypertension
• HDL cholesterol <35mg/dL (0.9mmol/L) and/or triglycerides level >250mg/dL (2.82mmol/L)
• women with PCOS
• physical inactivity
• other conditions associated with insulin resistance e.g. severe obesity, acanthosis nigricans

Question 21

how often should those with “pre-diabetes” be tested?

Answer 21

yearly

Question 22

follow-up for GDM

Answer 22

6-week post natal check

lifelong testing at least every 3 years

Question 23

what does HbA1c show?

Answer 23

measure of glucose control over the past 2-3 months and control reduces complications

Question 24

macrovascular disease

Answer 24

TIA
stroke
angina
MI
HF
peripheral vascular disease

Question 25

microvascular disease

Answer 25

retinopathy
micro/macroalbuminuria
end stage renal disease
erectile dysfunction
neuropathy- diabetic foot ulcers
osteomyelitis
amputation