Diabetes and hypoglycaemia

Question 1

what is the problem in type I diabetes?

Answer 1

A pancreatic beta cell deficiency

Question 2

what is the problem in type II diabetes?

Answer 2

Insulin resistance or a beta cell secretory defect of insulin

Question 3

what is MODY?

Answer 3

maturity onset diabetes of the young

Question 4

what is the age of onset of MODY?

Answer 4

under 25

Question 5

how many parents are affected in MODY?

Answer 5

1

Question 6

Is there insulin treatment given for MODY?

Answer 6

Not for the initial few years

Question 7

what is the inheritance pattern for MODY?

Answer 7

autosomal dominant

Question 8

what genes are involved in MODY?

Answer 8

NF1A
HNF4A
glucokinase
HNF1B
IPF1
NeuroD1

Question 9

who are the at risk groups for gestational diabetes?

Answer 9

• obese
• previous GD
• previous baby birthweight >4.5kg
• fh of diabetes
• south Asian, black or African Caribbean or middle eastern

Question 10

what is the fasting plasma glucose above in gestational diabetes?

Answer 10

5.6

Question 11

what is the 2 hour plasma glucose above in gestational diabetes?

Answer 11

7.8

Question 12

what is the fasting glucose in diabetes?

Answer 12

Above 7.00mmol/l

Question 13

what is the random glucose above in diabetes?

Answer 13

11.1

Question 14

what are advantages of HBA1C testing?

Answer 14

• standardised
• better index of overall glycaemic exposure
• less pre-analytical instability
• no need for fasting
• relatively unaffected by acute changes

Question 15

what factors affect HBA1c levels?

Answer 15

• abnormal haemoglobin
• altered life span of RBC
• a recent blood transfusion
• anaemia
• ethnicity
• aging

Question 16

when is HBA1c not appropriate for diagnosing diabetes?

Answer 16

• All young people
• suspected type 1
• symptoms under 2 months duration
• acutely ill
• medications that increase glucose such as steroids
• acute pancreatic damage
• pregnancy

Question 17

what are clinical features of HONK?

Answer 17

• insidious onset
• vomiting
• confusion
• hypercoaguable state
• venous thrombosis

Question 18

what is the biochemical diagnosis for HONK?

Answer 18

• hyperglycaemia
• high serum osmolality
• no acidosis or ketonaemia

Question 19

what prevents ketone production in HONK?

Answer 19

Its due to insulin deficiency, but there is a small amount still that stops ketone production

Question 20

what causes HONK?

Answer 20

• high sugar drinks
• intercurrent infection
• MI
• initial diagnosis
• medications such as glucocorticoids

Question 21

what is the management for HONK?

Answer 21

• rehydration
• prophylactic heparin
• gentle insulin regime
• broad spectrum antibiotics

Question 22

what are the microvascular complications of diabetes?

Answer 22

• nephropathy
• retinopathy
• neuropathy

Question 23

what are the macrovascular complications of diabetes?

Answer 23

• heart
• head
• legs (peripheral vascular disease)

Question 24

what are the three stages of diabetic retinopathy?

Answer 24

1. background retinopathy
2. diabetic maculopathy
3. proliferative retinopathy

Question 25

what three things make up whipples triad?

Answer 25

1. symptoms of hypoglycaemia at time of low glucose
2. symptoms relieved by glucose
3. low plasma glucose

Question 26

what are causes of hypoglycaemia with hyperinsulinaemia?

Answer 26

• islet cell tumour

- sulphonylureas

Question 27

what causes hypoglycaemia with no hyperinsulinaemia?

Answer 27

• endocrine deficiency
• starvation
• IGF2 secreting tumour

Question 28

what causes of hypoglycaemia will cause a raised C peptide?

Answer 28

Endogenous insulin

Sulphonylureas