diabetes - epidemiology and presentation

Question 1

define diabetes mellitus?

Answer 1

a group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both

Question 2

symptoms of hyperglycaemia?

Answer 2

polydipsia
polyuria
blurred  vision
weight loss
infections

Question 3

long term microvascular complications of hyperglycaemia?

Answer 3

retinopathy
neuropathy
nephropathy

Question 4

long term macrovascular complications of hyperglycaemia?

Answer 4

stroke
MI
PVD

Question 5

describe the - 
1 - impaired fasting GLC 
2 - Impaired GLC tolerance
3 - HbA1c
for intermediate hyperglycaemia

Answer 5

1 - 6.1-7 mmol/l
2 - =/>7.8 and <11 mmol/l
3 - 42-47 mmol/mol

Question 6

advantages of GLC testing as a diagnostic tool?

Answer 6

well established
smaller variations between labs
feasible in developing countries

Question 7

disadvantages of GLC testing as a diagnostic tool?

Answer 7

requires fasting state
OGTT required
higher variability between individuals

Question 8

advantages of HbA1c testing as a diagnostic tool?

Answer 8

no fasting
marker of glycemic control
lower variability between individuals

Question 9

disadvantages of HbA1c testing as a diagnostic tool?

Answer 9

misleading results in cases of anaemia, renal failure
costly
may differ with age and ethnicity

Question 10

% of Scottish population with diabetes?

Answer 10

5.5%

Question 11

risk if father only has type 1?

Answer 11

6%

Question 12

risk if mother only has type 1?

Answer 12

1%

Question 13

risk if both parents have type 1?

Answer 13

30%

Question 14

risk if sibling has type 1?

Answer 14

8%

Question 15

risk if identical twin has type 1?

Answer 15

30-50%

Question 16

risk if non-identical twin has type 1?

Answer 16

10%

Question 17

symptoms presented in type 1 diabetes?

Answer 17

SHORT duration of:

polydipsia/thirst
tiredness 
polyuria
weight loss
blurred vision 
abdo pain

Question 18

examination findings type 1 diabetes?

Answer 18

ketones on breath 
dehydration 
increased resp. rate 
tachycardia
hypotension
low grade infections - e.g. thrush

Question 19

describe the structure insulin?

Answer 19

alpha (21) and beta (30) chains

linked together with disulphide bonds

Question 20

genetic risk of type 2 diabetes - identical twin?

Answer 20

90-100%

Question 21

genetic risk of type 2 diabetes - one parent?

Answer 21

15%

Question 22

genetic risk of type 2 diabetes - both parents?

Answer 22

75%

Question 23

genetic risk of type 2 diabetes - sibling?

Answer 23

10%

Question 24

genetic risk of type 2 diabetes - non-identical twin?

Answer 24

10%

Question 25

symptoms of type 2 diabetes?

Answer 25

``` asymptomatic thirst tiredness polyuria nocturia weight loss blurred vision symptoms of complications ```

Question 26

signs of type 2?

Answer 26

not ketotic usually overweight low grade infections micro/macro-vascular complications

Question 27

which groups should have risk assessment for screening of diabetes?

Answer 27

eligible adults > 40yrs, EXCEPT pregnant women those aged 25-39yrs of high-risk ethnic groups, South African, black African, Chinese adults with conditions that have a high risk of diabetes

Question 28

particular conditions that increase risk of type 2?

Answer 28

``` CVD hypertension obesity stroke polycystic ovary syndrome history of gestational diabetes mental health issues ```

Question 29

what is MODY?

Answer 29

Maturity Onset Diabetes in the Young

Question 30

cause of MODY?

Answer 30

single gene defect - impaired beta-cell function

Question 31

glucokinase mutations of MODY - onset, stage of hyperglycaemia, treatment and complications?

Answer 31

onset @ birth stable hyperglycaemia diet treatment complications are rare

Question 32

transcription factor mutations of MODY - onset, stage of hyperglycaemia, treatment and complications?

Answer 32

onset @ adolescence/ young adult progressive hyperglycaemia 1/3 diet, 1/3 OHA, 1/3 insulin complications are frequent

Question 33

hyperglycaemia of pregnancy -cause?

Answer 33

increasing insulin resistance in pregnancy

Question 34

hyperglycaemia of pregnancy - associations?

Answer 34

associated with FH of type 2

Question 35

hyperglycaemia of pregnancy - when does it usually develop?

Answer 35

2nd/3rd trimester

Question 36

hyperglycaemia of pregnancy - when is it more common?

Answer 36

if overweight and inactive

Question 37

hyperglycaemia of pregnancy - resulting neonatal problems?

Answer 37

macrosomia, resp distress, hypoglycaemia

Question 38

examples of exocrine pancreas diseases and their effect on diabetes?

Answer 38

associated with they development of diabetes - CF haemochromatosis chronic pancreatitis

Question 39

examples of endocrinopathies and their effect on diabetes?

Answer 39

associated with they development of diabetes - acromegaly Cushing's syndrome glucagonoma Pheochromocytoma