Diabetes Introduction

Question 1

Why does diabetes develop?

Answer 1

Insufficient insulin to maintain glucose homeostasis

Question 2

What type of insulin deficiency is type 1 diabetes?

Answer 2

Absolute

Question 3

What type of insulin deficiency is type 2 diabetes?

Answer 3

Relative

Question 4

What is MODY?

Answer 4

Failure of insulin synthesis, release or activity

Question 5

What are 2 causes of type 2 diabetes?

Answer 5

Inadequate insulin production, or insulin resistance

Question 6

Overall, DM is a group of disorders characterised by what?

Answer 6

Hyperglycaemia

Question 7

What HbA1c is diagnostic of diabetes? What is normal?

Answer 7

48mmol/mol or more (normal 41 or less)

Question 8

What fasting glucose is diagnostic of diabetes? What is normal?

Answer 8

7mmol/l or more (normal 6 or less)

Question 9

What 2 hour glucose in OGTT is diagnostic of diabetes? What is normal?

Answer 9

11.1mmol/l or more (normal 7.7 or less)

Question 10

What random glucose is diagnostic of diabetes?

Answer 10

11mmol/l or more

Question 11

With regards to HbA1c, fasting glucose and 2 hour glucose in OGTT, if a patient does not have the score which is diagnostic of diabetes, but are not within normal limits, what are they said to have?

Answer 11

Pre-diabetes

Question 12

Briefly describe pre-diabetes?

Answer 12

A stage which can last for 15-20 years, with increased CV risk

Question 13

What can be the causes of type 1 diabetes?

Answer 13

Autoimmune or idiopathic

Question 14

There is destruction of what in type 1 diabetes? What does this result in?

Answer 14

Destruction of pancreatic beta cells, resulting in loss of insulin production

Question 15

Type 1 diabetes can be characterised by the presence of what antibodies?

Answer 15

Anti-GAD // Anti-islet cell

Question 16

What must you rule out in order to diagnose type 2 diabetes?

Answer 16

Type 1, MODY, any condition or treatments which would cause secondary diabetes

Question 17

What are some pancreatic diseases which can cause secondary diabetes?

Answer 17

Pancreatitis, haemochromatosis

Question 18

What are some endocrine diseases which can cause secondary diabetes?

Answer 18

Cushing’s, acromegaly, phaeochromocytoma, glucagonoma

Question 19

What are some drugs which can cause secondary diabetes?

Answer 19

Glucocorticoids, diuretics, beta blockers

Question 20

What are some genetic diseases which can cause secondary diabetes?

Answer 20

Turner’s, CF, myotonic dystrophy

Question 21

Who does MODY occur in?

Answer 21

Generally young people (neonate to adulthood) with a strong family history

Question 22

Will people with MODY have antibodies? Will they have C-peptide?

Answer 22

No antibodies, yes C-peptide

Question 23

Neonatal diabetes occurs before what age?

Answer 23

< 6 months

Question 24

What is gestational diabetes?

Answer 24

Any degree of glucose intolerance arising or diagnosed during pregnancy

Question 25

What are the 4 main clinical features of diabetes? (4 T's)

Answer 25

Tired, thirsty, toilet, thinner

Question 26

As well as the 4 Ts, what are some other clinical features of diabetes?

Answer 26

Polyuria, weakness, blurred vision, infections

Question 27

What else may patients present with, specific to type 2 diabetes?

Answer 27

Signs of complications

Question 28

Weight loss is most likely a presentation of what type of diabetes?

Answer 28

Type 1

Question 29

Ketonuria is seen in what types of diabetes?

Answer 29

Mainly type 1, sometimes secondary

Question 30

What are 3 useful tests for type 1 diabetes?

Answer 30

GAD/islet cell antibodies, ketones, C-peptide

Question 31

Is C-peptide always a sensitive test for type 1? Why/why not?

Answer 31

No- some people with type 1 will retain C-peptide for a few years after they stop producing insulin

Question 32

What are the diagnostic tests for diabetes?

Answer 32

Random lab BG, fasting BG, OGTT, HbA1c

Question 33

What does HbA1c provide?

Answer 33

A measure of glycemic control over the past 2-3 months

Question 34

An HbA1c score of what implies bad control?

Answer 34

> 75mmolmol

Question 35

Explain the oral glucose tolerance test?

Answer 35

Measure fasting BG. Take a very sweet tasting glucose drink. Take further BGs at 30 or 60 minute intervals for at least 2 hours.

Question 36

In individuals without diabetes, what should happen to BG levels after 2 hours in the OGTT?

Answer 36

BG should have lowered, similar to the fasting state again (action of insulin)

Question 37

In individuals with diabetes, what will happen to BG levels after 2 hours in the OGTT?

Answer 37

The BG will remain high, as there is no insulin allowing it to enter cells

Question 38

Give 2 examples of macroscopic complications?

Answer 38

Heart disease and stroke (atheroma)

Question 39

What are the 3 types of microvascular complications?

Answer 39

Retinopathy, nephropathy, neuropathy

Question 40

Retinopathy can ultimately cause what? Nephropathy can ultimately cause what?

Answer 40

Ret = blindness, neph = kidney failure (preventable with screening)