Diabetes

Question 1

What’s Dm

Answer 1

Metabolic disorder of carbohydrates fat and protein as a result of deficiency in insulin production and or increased resistance to insulin

Question 2

Which cells secrete insulin?

Answer 2

Beta cells of islet of langerhans in pancreas.

Take note:
Alpha cells (15-20%) – Glucagon
Beta cells (60-80%) – Insulin
Delta cells (5-10%) – Somatostatin 
PP cells (15-20%) – Pancreatic polypeptid

Question 3

Types of Dm

Answer 3

Type 1 or IDDM

Type 2 or NIDDM

Question 4

TYPE 2 DIABETES IS MORE ASSOCIATED WITH YOUNGER AGE LESS THAN 30 YEARS. T/F?

Answer 4

FALSE, IT IS USUALLY ASSOCIATED WITH >30 YEARS OF AGE

Question 5

TYPE 1 DIABETES IS MORE ASSOCIATED WITH HLA DR3 OR DR4 IN GREATER THAN 90 PERCENT OF CASES? T/F

Answer 5

T

Question 6

TYPE 2 DIABETES IS AN AUTO IMMUNE DISEASE ASSOCIATED WITH ISLET CELL AUTO ANTIBODIES. T/F?

Answer 6

F

Question 7

WHAT ARE THE RISK FACTORS FOR DIABETES MELLITUS {TYPE 2}

Answer 7

RISK FACTORS:
AGE
RACE
Family history
MORDIAFIABLE
HYPERTENTION
OBESITY
DYSLIPIDEMIA
SEDEMENTARY LIFESTYLE
IMPAIRED GLUCOSE TOLERANCE
GESTATIONAL  DIABETES
AUTOIMMUNE DISEASES ASSOCIATED WITH TYPE 1 DM
VITILIGO
THYROIDUTIS
PERNICIOUS ANEMIA
ADDISONS DISEASE
Pcos

Question 8

WHAT ARE THE CLASSICAL TRIAD ASSOCIATED WITH DIABETES MELLITUS?

Answer 8

Polyuria
Polydipsia
Polyphagia

Question 9

What are the clinical features of diabetes?

Answer 9

Clinical Features
Nausea and vomiting
Kussmaul respiration
Acetone breath
Dehydration and shock
Abdominal Tenderness – may simulate acute surgical abdomen
Lethargy
Coma

TAKE NOTE: weight loss is associated with type 1 and obesity is associated with type 2.
Apart from 3P’s…. Obesity in type 2, weight loss in type 1

Question 10

What test do we do for DM diagnosis?

Answer 10

1. Oral glucose tolerance test
2. Fasting glucose test
3. 2 hours post prandial
4. Glycosylated hemoglobin HBA1C

NOTE WHO CRITERIA FOR DIAGNOSIS DM

Symptoms of DM + Random plasma glucose >200mg/dl (11.1mmol/l)
Fasting plasma glucose >7mmol (126mg/dl)
2hr plasma glucose >11.1 (200mg/dl) during 75g OGTT
If diagnosis is inconclusive, repeat

THE INVESTIGETIONS TO RULE OUT COMPLICATIONS INCLUDES:
Full blood count
E/U/Cr
Urinalysis [increased ketone and glucose]
Urine albumin excretion [increased
ECHO, ECG, Liver function test.

Question 11

Management of DM

Answer 11

Non pharmacological management

1. Decrease intake of simple sugar such as coke, Fanta etc
2. Exercise
3. Weight loss
4. Stop smoking
5. Reduce drinking
6. Use of well fitted slippers or shoes
7. Never walk barefooted
8. Ophthalmological exams
9. Surgery( anastomoses)
10. Reduce intake of carbohydrates and fats

Pharmacological management is divided into insulin and oral anti diabetic drugs
Now according to classifications of oral anti diabetic drugs, we have

1. Sensitizers
   - biguanides
   - thiazolidindiones
2. Secretogues
   - sulfynulurea
   - non sulfynulurea
3. Alpha glucosidase inhibitors
4. Incretin mimetics(peptides)

Question 12

What is the commonest cause of non traumatic amputation of the leg world wide?

Answer 12

Diabetic foot ulcer