Diabetes

Question 1

Normal blood glucose level

Answer 1

Roughly 5mmol/L

Question 2

Pancreatic cells

Answer 2

• Alpha cells produce glucagon
• Beta cells produce insulin
• Delta cells produce somatostatin
• Gamma cells produce pancreatic polypeptide

Question 3

Is diabetes a syndrome?

Answer 3

Yes - Collection of symptoms and signs due to more than one condition/disease

Question 4

75g OGTT (oral glucose tolerance test)

Answer 4

• Can be oral (OGTT) or IV (IVGTT)
• Blood glucose levels before and after 75g oral glucose load
• 2-hour post-glucose load >11mmol/l = impaired glucose tolerance (IGT) - diabetes

Question 5

HbA1c criteria

Answer 5

higher HbA1c – more likely to have diabetes as less control of glucose
- 48mmol/mol (6.5%) = diabetes

Question 6

Type 1 diabetes

Answer 6

• Autoimmune destruction of the insulin producing islet beta cells (Langerhans) - only beta cells are affected in the islets

Question 7

Type 1 diabetes presentation

Answer 7

• rapid onset, weight loss (but may be obese), low energy, abdominal pain, often slim, may present with diabetic ketoacidosis (DKA)

Question 8

Test for T1DM

Answer 8

• Insulin autoantibodies - GAD, IA-2

- Transporter autoantibodies

Question 9

Type 2 diabetes

Answer 9

Inulin resistance - strong family history with weight and obesity. Usually high BP or high lipids

Question 10

Symptoms of T2DM

Answer 10

minimal weight loss, complications such as vision loss or foot ulcers or fungal infection. State of Hyperosmolar Hyperglycaemia State (HHS) or HONK

Question 11

Management of T2DM

Answer 11

• Exercise and diet
• Oral therapy = metformin
• Once a day insulin

Question 12

Gestational diabetes

Answer 12

• Appears during pregnancy, resolves after pregnancy - risk of diabetes in later life

Question 13

Diagnosis of Gestational diabetes

Answer 13

• OGTT after fasting - between 5.6 and 7.8 mmol
• Do not use HbA1c
• Criteria is lower glucose level as there is an increased risk to foetus

Question 14

Consequences of Gestational diabetes

Answer 14

• short term = macrosomia, pre-eclampsia, still birth, neonatal morbidity
• Long term = obesity in child, T2DM in mother

Question 15

Management of Gestational diabetes

Answer 15

• diet, limited oral option (metformin or glibenclamide), majority require insulin

Question 16

Genetic diabetes

Answer 16

• Maturity onset diabetes in the young
• Maternal Inherited diabetes and deafness
• Wolfram syndrome

Question 17

Diabetes secondary to pancreatic disorders

Answer 17

• Chronic/acute pancreatitis
• Calcific pancreatitis
• Pancreatectomy
• Pancreatic cancer
• Fibrosis of pancreatic duct
• Haemochromatosis

Question 18

What is Haemochromatosis

Answer 18

• hereditary iron overload storage disorder) – accumulates in tissues- grey skin, damage pituitary, cardiomyopathy, pancreatic fibrosis and low testosterone.
• Blue staining of islet for iron

Question 19

Counter regulatory hormones

Answer 19

Hormones that usually oppose the action of insulin

• Secreted as a result of stress response
• Release stimulated by glucose, ketones, vagal nerve stimulation
• Stimuli for inhibition = Sympathetic stimulation, alpha-adrenergic agents

Question 20

Glucagon

Answer 20

• Counter regulatory hormone

- increase secretion of insulin (negative feedback) and growth hormone = increase glucose levels

Question 21

Glucose homeostasis

Answer 21

• If hyperglycaemia, insulin released = lower levels
• If hypoglycaemia, Glucagon released. Sends ACTH to adrenal cortex to release cortisol = increase levels. Along with GH anf adrenaline/catecholamines