Diabetes Aetiology Diagnosis And Presentation

Question 1

Why type of diabetes usually presents acutely and which present subcutely and non specifically

Answer 1

T1 acute
T2 subacute and non specific symptoms

Question 2

What causes the classical symptoms of diabetes

Answer 2

Osmotic effects of hyperglycaemia

Question 3

Diabetes symptoms

Answer 3

Polyuria
Polydipsia
Nocturia
Weight loss
Fatigue
Blurred vision
Pruritis
Recurrent urinary/genitourinary infections

Question 4

2 types of diabetic emergency

Answer 4

Diabetic ketoacidosis DKA
Hyperosmolar hyperglycaemic syndrome HHS

Question 5

4 types of diagnostic tests for diabetes

Answer 5

FPG Fasting plasma glucose
RPG Random plasma glucose
OGTT 75g oral glucose tolerance test
HbA1c

Question 6

What period of time does HbA1c give information about glucose control over

Answer 6

3 month avergae

Question 7

Normal HbA1c

Answer 7

<42mmol/mol

Question 8

How many tests are required for diabetes diagnosis

Answer 8

No symptoms + 2 tests (but only 1 OGTT)
Symptoms + 1 test

Question 9

Fasting plasma glucose level in patients with diabetes, impaired glucose tolerance, impaired fasting glucose, and healthy

Answer 9

7+ Diabetes
<7 IGT
6.1-6.9 IFG
</=6 normal

Question 10

2 hr plasma glucose level in patients with diabetes, impaired glucose tolerance, impaired fasting glucose, and healthy

Answer 10

11.1+ Diabetes
7.8-11.0 IGT
<7.8 IFG
<7.8 normal

Question 11

Random plasma glucose level in patients with diabetes, impaired glucose tolerance, impaired fasting glucose, and healthy

Answer 11

11.1+ diabetes
RPG can’t be used to diagnose IGT or IFG
<7.8 normal

Question 12

HbA1c in patients with diabetes, impaired glucose tolerance, impaired fasting glucose, and healthy

Answer 12

48+ diabetes
42/47 IGT
can’t be used to diagnose IFG
<42 normal

Question 13

Which antibodies are involved in T1D

Answer 13

GAD
ICA

Question 14

Which HLA variants are linked to T1D and T2D

Answer 14

T1 - DR3 DR4
T2 - no HLA link

Question 15

Which type of diabetes in ketosis prone

Answer 15

T1

Question 16

Which type of diabetes has a stronger genetic link

Answer 16

T2

Question 17

Secondary causes of diabetes

Answer 17

Pancreatic disease
Endocrine disease
Drug induced
Genetic defects of B-cell function
Genetic defects of insulin action
Infections
Genetic syndromes
Gestational diabetes

Question 18

How can disease of exocrine pancreas cause diabetes

Answer 18

Damage B-cells

Question 19

Exocrine pancreas diseases

Answer 19

Pancreatitis
Trauma
Pancreatectomy
Neoplasia
Cystic fibrosis
Haemochromatosis/thalassaemia - due to iron overload
Fibrocalculous pancreatopathy

Question 20

Why is fibrocalculous pancreatopathy mainly only seen in developing countries

Answer 20

Associated with malnutrition

Question 21

Endocrine diseases that can cause diabetes

Answer 21

Acromegaly
Cushing’s
Glucagonoma
Phaeochromocytoma
Hyperthyroidism
Conns

Question 22

Drugs that can induce diabetes

Answer 22

Glucocorticoids
Beta blockers
Thiazide diuretics
Tacrolismus
Atypical psychotics

Question 23

What type of diabetes can be caused by tacrolismus

Answer 23

NODAT new onset diabetes after transplantation

Question 24

2 infections that can cause diabetes

Answer 24

Congenital rubella
CMV

Question 25

2 main features in the pathogenesis of T2D

Answer 25

Insulin resistance B cell failure

Question 26

Glucose toxicity

Answer 26

High levels of glucose lead to poorer B-cell function leading to reduced insulin secretion

Question 27

How hoes hyperglycaemia exacerbate diabetes

Answer 27

Glucose toxicity

Question 28

How does visceral adiposity contribute to T2D pathogenesis

Answer 28

Pro inflammatory cytokines from adipocytes contribute to insulin resistance

Question 29

How does B-cell and Acell population change in T2D

Answer 29

B-cell mass preserved A cell incr

Question 30

Why is excess glucagon released relative to insulin in T2D

Answer 30

A cell population increase

Question 31

Which protein is deposited in the pancreatic islets in late T2D

Answer 31

Amyloid peptide

Question 32

Features in metabolic syndrome

Answer 32

Central obesity + 2 of - low HDL conc, high triglycerides, high BP, high fasting glucose

Question 33

Which groups are screened for T2D

Answer 33

BMI 30+ Strong family hx GD South Asian/ Afro Caribbean Known vascular disease On steroids/ atypical antipsychotics / transplants Unexplained foot ulcers / recurrent Candida / skin abcesses

Question 34

Characteristics of LADA

Answer 34

Latent autoimmune diabetes in adults Diagnosed in adulthood Usually non acute ICA/GAD +ive Require insulin

Question 35

Which condition is LADA often misdiagnosed as

Answer 35

T2D

Question 36

T1D pathogenic sequence

Answer 36

Genetic susceptibility -> environmental insult -> insulinitis -> activation of autoimmunity -> immune attack on B-cells

Question 37

What proportion of B-cells can be destroyed before diabetes symptoms occur

Answer 37

90%