Diabetes In Clinical Practice

Question 1

How many people have diabetes but are undiagnosed

Answer 1

Half

Question 2

How many people have diabetes in low income families

Answer 2

3/4

Question 3

Micro vascular complications of diabetes

Answer 3

Retinopathy

Nephropathy

Neuropathy

Question 4

Macrovascular complications of diabetes

Answer 4

Cerebrovascular disease

Ischaemic heart disease

Peripheral vascular disease

Question 5

Life expectancy in diabetes

Answer 5

Type 2 at 40 years (5-6) years lower

Type 1 at 20 years 11 -13 years shorter

Question 6

Type 2 diabetes types

Answer 6

Some very insulin deficient

Some v insulin resistant

Question 7

Other types of diabetes

Answer 7

Neonatal: neonates

Mono genie: effect B cells on insulin

Mitochondrial: often include deafness and stature

Question 8

Exocrine and endocrine ways to get diabetes

Answer 8

Exo - diseases of the pancreas

Endo- hormonal problems

Question 9

Absence of insulin action

Answer 9

Uncontrolled endogenous glucose production

Tissue deprivation
Lipolysis
Proteolysis

Question 10

How do we diagnose diabetes

Answer 10

Typical symptoms of hyperglycaemia

Unequivocally high blood glucose conc or HbA1c

Question 11

Diagnosis in absence of typical symptoms

Answer 11

Abnormal blood glucose

Abnormally high amount of glucose circulating proteins on circulating proteins

Question 12

Diagnosis criteria

Answer 12

Symptoms : random venous plasma glucose > 11.1 mol/l or
HbA1c> 48mmol/mol

Asymptomatic: 2 occasions of any of :

HbA1c over 48 mmol/mol (6.5%)
Fasting venous plasma glucose over 7 mmol/l

Random or 2h post 75 g glucose load >11.1 mmol love

PREDIABETES:

High risk = HbA1c 43-47 mmol/mol (6.1-6.4%)
Impaired glucose tolerance
Fasting venous plasma glucose <7

Impaired fasting glucose
Fasting venous plasma glucose 6.1-6.9 mmol/l

Question 13

Oral glucose tolerance test method

Answer 13

180 carbs for 3 days

Fast overnight

Fasting venous plasma glucose

75g anhydrous glucose over 5 min

2 hour venous plasma glucose test

Question 14

Clinical features type 1

Answer 14

Insulin deficient

Ketones in urine or blood (ketosis)

HLA markers

Autoimmune

Onset peak in adolescence

Weight loss

Question 15

Aims of management of diabetes

Answer 15

Remove symptoms of uncontrolled diabetes

Avoid diabetic emergencies

Reduce risk of development/ progression of complications

Early detection and effective management of complications

Avoid adverse effects on quality of life

Question 16

Modifiable risk factors

Answer 16

Glycemic control
Blood pressure 
Lipid profile
Smoking 
Exercise 
Diet
Overweight

Question 17

Hard endpoint in clinical trail

Answer 17

Something does t need measuring. Patient cares

Death
Stroke
MI
Blindness

Question 18

Surrogate end point

Answer 18

Bio marker intended. To substitute for hard end point

Question 19

Type 1 susceptibility genes

Answer 19

HLA DR3

HLA DR4

Question 20

Complications of chronic diabetes

Answer 20

Sweating 
Postural dizziness
Tingling in hands and feet 
Diahorrea 
Numbness

Question 21

Measurements taken from

Answer 21

Plasma not whole blood

Question 22

Drug to remember

Answer 22

Metformin