Diabetes - Clinical Aspects

Question 1

What do alpha cells produce?

Answer 1

Glucagon

Question 2

What do beta cells produce?

Answer 2

Insulin and amylin

Question 3

What do delta cells produce?

Answer 3

Somatostatin

Question 4

What do gamma cells (AKA PP cells) produce?

Answer 4

Pancreatic polypeptide

Question 5

What do epsilon cells produce?

Answer 5

Ghrelin

Question 6

What does the insulin tyrosine kinase receptor get activated by and what does it need to start the cascade?

Answer 6

By insulin and IGFs, and needs JAK for the cascade

Question 7

HNF-1-alpha gene defect (chromosome, onset, progression)

Answer 7

Chromosome 12, hyperglycaemia puberty/adulthood, progressive and may become severe

Question 8

Glucokinase “glucose sensor” gene (chromosome, onset and progression)

Answer 8

7, in utero, mild and persistent

Question 9

HNF-4-alpha gene defect (chromosome, onset and progression)

Answer 9

20, puberty/young adults, progressive and may become severe

Question 10

What drugs cause DM?

Answer 10

GCs, sypathomimetics, diazoxide, dilantin, thyroxine

Question 11

What diseases cause DM via beta-cell destruction?

Answer 11

CF, thalassemia, trauma/pancreatectimy, pancreatitis

Question 12

What endocrine issues cause DM?

Answer 12

Cushing’s, pheochromocytoma, hyperthyroidism, acromegaly, somatostatinoma

Question 13

What immune cells are involved in insulin-dependent DM?

Answer 13

CD4, CD8 and macrophages

Question 14

What are the 4 antibodies secreted by B cells against beta-cells?

Answer 14

Glutamic acid decarboxylase (GAD)
Islet cell autoantigen (ICA)
Insulin autoantibodies (IAA)
Protein tyrosine phosphatase (IA2)

Question 15

What are the two genes that are risk factors for T1DM?

Answer 15

HLADR3/4

HLADQ-beta-1

Question 16

What syndromes are associated with AI T1DM?

Answer 16

Turner’s syndrome, Down syndrome, Klienfelter syndrome

Question 17

What is the peak incidence of T1DM?

Answer 17

4-6yo and 10-14yo, slightly more in females

Question 18

What are the 4 stages of T1DM?

Answer 18

1. Pre-diabetes
2. Clinical diabetes
3. Partial remission
4. Permanent phase of insulin dependence

Question 19

Pre-diabetes

Answer 19

No symptoms (need 80% beta cell loss for this)
Transient hyperglycaemia with food/drugs

Question 20

What fasting/random glucose levels do we diagnose DM at?

Answer 20

Fasting >7.8 mmol/L

2 hr PP >11.1 mmol/L

Question 21

Clinical diabetes

Answer 21

Typical presentation and S&S, including ketosis

Question 22

Partial remission

Answer 22

Remaining beta cells make insulin so can be managed

Question 23

Permanent phase

Answer 23

All beta cells gone, patient dependent on insulin and BGL less stable

Question 24

What are some of the long-term complications of T1DM?

Answer 24

Retinopathy
Nephropathy
Neuropathy
Microalbuminuria

Question 25

What pH do proteins have poor function?

Answer 25

<7

Question 26

How do we treat DKA in adults?

Answer 26

Fluid bolus for perfusion then rehydrate over 12-24 hrs

Question 27

How do we treat DKA in children?

Answer 27

Fluid bolus for perfusion the rehydrate over 48-72 hrs

Question 28

How do we define hypoglycaemia?

Answer 28

BSL <3.2 mmol/L

Question 29

What is the function of amylin?

Answer 29

Slows gastric emptying
Suppresses post-meal glucagon secretion
Increases satiety