Diabetes-Basic Principles

Question 1

what is diabetes?

Answer 1

an elevation of blood glucose above a diagnostic threshold

Question 2

what do young girls tend to have as a fasting plasma glucose?

Answer 2

4 mmol/l

Question 3

what is the threshold for diagnosing diabetes?

Answer 3

based upon the risk of developing retinopathy

Question 4

what is retinopathy?

Answer 4

a specific complication only seen in diabetes

Question 5

what is the fasting plasma glucose threshold?

Answer 5

7 mmol/l

Question 6

what is the 2 hour plasma glucose threshold?

Answer 6

11.1 mmol/l

Question 7

what is the HbA1c threshold?

Answer 7

5.8% or 48 mmol/mol

Question 8

what is particular about diagnosing diabetes if the patient is asymptomatic?

Answer 8

must have a repeat confirmatory test

Question 9

what is normal fasting plasma glucose?

Answer 9

6.0 mmol/l and below

Question 10

what is a normal 2 hour plasma glucose?

Answer 10

7.7 mmol/l and below

Question 11

what is a normal HbA1c?

Answer 11

41 mmol/mol and below

Question 12

what is different about gestational diabetes?

Answer 12

threshold is risk to the foetus/neonate and not the risk of retinopathy

Question 13

what cells secrete insulin?

Answer 13

beta cells in pancreatic islets

Question 14

what cells secrete glucagon?

Answer 14

alpha cells in pancreatic islet

Question 15

what is C-peptide useful for?

Answer 15

a way to measure endogenous insulin secretion

Question 16

why do we need to measure C-peptide?

Answer 16

to find out how much insulin the body is producing on its own. if insulin levels are measured it includes exogenous insulin too.

Question 17

what is C-peptide?

Answer 17

co-secreted with insulin and is then cleaved from insulin and remains in the blood

Question 18

what is involved the diabetes balance?

Answer 18

insulin secreted from beta cells, insulin resistance (impaired insulin action)

Question 19

what is the most common disorder of insulin secretion?

Answer 19

type one diabetes

Question 20

what are the other two types of insulin secretion disorders?

Answer 20

genetic and pancreatic

Question 21

which disorder is a mix between insulin secretion disorder and insulin action disorder?

Answer 21

type 2 diabetes

Question 22

what is a key feature of type 1 diabetes?

Answer 22

autoimmune destruction of the pancreatic beta cells resulting in beta cell deficiency

Question 23

what age group does type 1 diabetes occur in?

Answer 23

all age groups of similar incidences

Question 24

how many people have pancreatic autoantibodies in. their blood at diagnosis?

Answer 24

95%

Question 25

how is type 2 diabetes diagnosed?

Answer 25

diagnosis of exclusion

Question 26

what type of disorder is type 2 diabetes?

Answer 26

consists of insulin deficiency and insulin resistance

Question 27

which is the most common diabetes?

Answer 27

type 2 (90-95%)

Question 28

is there autoimmune destruction of the beta. cells in type 2 diabetes?

Answer 28

no

Question 29

what are common characteristics of type 1 diabetes?

Answer 29

onset in children and young adults, not associated with overweight, autoimmune, requires insulin treatment and can be fatal if left untreated

Question 30

what are common characteristics of type 2 diabetes?

Answer 30

onset in middle age and elderly, associated with obesity and sedentary lifestyle, not autoimmune, may require insulin but usually can be managed with lifestyle modifications and non-insulin treatment

Question 31

are diabetic patients commonly symptomatic or asymptomatic?

Answer 31

asymptomatic

Question 32

is type 1 or 2 diabetes more commonly asymptomatic?

Answer 32

type 2

Question 33

what are some common symptoms of diabetes

Answer 33

polyuria, thirst and polydipsia, blurred vision, genital thrush, fatigue, weight loss

Question 34

what are some signs and symptoms of complications (rare)?

Answer 34

loss of vision/retinal bleed, retinal changes found by an optician

Question 35

what are two diabetic emergencies?

Answer 35

diabetic ketoacidocis and hyperosmolar hyperglycaemic state

Question 36

what diabetic emergency is more common in type 1?

Answer 36

diabetic ketoacidosis

Question 37

what diabetic emergency is more common in type 2?

Answer 37

hyperosmolar hyperglycaemic state

Question 38

why treat diabetes?

Answer 38

to prevent acute symptoms and life-threatening illness

Question 39

what are some microvascular complications of diabetes?

Answer 39

retinopathy, neuropathy and nephropathy

Question 40

what are microvascular complications largely driven by?

Answer 40

chronic hyperglycaemia

Question 41

where does retinopathy affect?

Answer 41

back of the eye

Question 42

where does neuropathy affect?

Answer 42

numbness in feet and pain in legs

Question 43

where does nephropathy affect?

Answer 43

kidneys

Question 44

what are some macrovascular complications?

Answer 44

MI, ACS, stroke, PVD

Question 45

what are microvascular complications driven by?

Answer 45

hyperglycaemia, HBP and dyslipidaemia

Question 46

how is HbA1c measured?

Answer 46

blood test

Question 47

why is HbA1c measured?

Answer 47

to test how good someones blood sugar control is

Question 48

what is special about testing the HbA1c?

Answer 48

gives a measure of the blood sugar levels over the last few months

Question 49

what does the HbA1c test?

Answer 49

glycated haemoglobin in the blood

Question 50

what forms glycated haemoglobin?

Answer 50

glucose in blood binds to haemoglobin

Question 51

where should you be cautious measuring glycated haemoglobin?

Answer 51

conditions that cause increased red cell turnover e.g haemolytic anaemia and haemoglobinopathies

Question 52

what is HbA1c called now?

Answer 52

IFCC HbA1c

Question 53

what is HbA1c measured in?

Answer 53

mmol/mol not %age anymore

Question 54

what does 1% equal in mmol/mol?

Answer 54

11

Question 55

what is good control of blood sugar?

Answer 55

53-58mmol/mol or 7-7.5%

Question 56

what is the first step of treatment in type 2 diabetes?

Answer 56

therapeutic lifestyle changes

Question 57

what %age of weight loss can result in remission of type 2 diabetes?

Answer 57

10-15

Question 58

what weight loss can improve health outcomes in a year?

Answer 58

5-10kg