diabetes mellitus

Question 1

what are the thresholds for diabetes diagnosis

Answer 1

> 7mmol/L fasting plasma glucose

11.1mmol/L 2hr plasma glucose

48mmol/mol HbA1c (5.8%)

*and are set on risk of developing diabetic retinopathy

Question 2

what is the difference in thresholds for gestational diabetes

Answer 2

they are a lot lower

*are set based of off risk to neonate

Question 3

what is a useful measure for endogenous insulin

Answer 3

C-peptide

Question 4

what is C-peptide

Answer 4

it is co-secreted with insulin and is not part of the insulin injection

so if C-peptide is present in the blood it must be coming from Beta cells ie pancreas is still working

Question 5

T1DM causes

Answer 5

genetic:
MODY
neonatal

Pancreatic disease:
alcohol and chronic pancreatitis
acute pancreatitis
pancreatic cancer
pancreatectomy
CF
Haemochromatosis

Question 6

can steroids induce diabetes T/F

Answer 6

T
exogenous GLCTCs can cause diabetes ie patients with COPD

Question 7

what is T1DM

Answer 7

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

onset in children and young adults but
can come on at any age

up to 95% have pancreatic antibodies in blood

requires insulin treatment (fatal if not)

Question 8

what is T2DM

Answer 8

ranges from insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance

do not need insulin to survive unlike T1DM

there is no typical person with T2DM

Question 9

who gets T2DM

Answer 9

obesity and sedentary lifestyle

onset in middle age and elderly

not autoimmune

Question 10

how does diabetes present

Answer 10

can be asymptomatic

symptoms of high blood glucose:
polyuria
polydipsia
blurred vision - osmotic shift and the lens contracts
genital thrush
fatigue
weight loss

symptoms/complications:
loss of vision
retinal bleeding

Question 11

how does DKA present

Answer 11

T1DM get it
breath smells like pear drops

Question 12

why treat diabetes

Answer 12

prevent acute symptoms and life threatening illnesses

to reduce burden of diabetes

Question 13

microvascular complications

Question 14

macrovascular complications

Question 15

what is HbA1c

Answer 15

blood glucose varies continuously - so taken at one point is largely unhelpful

haemoglobin + glucose = glycated (haemoglobin is altered)
amount of glycated haemoglobin is directly linked to exposure to glucose (HbA1c)
RBC turnover about 90 days

Question 16

A 58 year old Type 1 diabetic presents to his GP complaining of altered sensation in his legs.

Which of the following clinical features would most suggest a diagnosis of diabetic neuropathy?

Answer 16

sensory loss in a stocking distribution

this is a classical feature

Question 17

which test is useful in differentiating an endogenous from an exogenous cause of hypoglycaemia

Answer 17

serum C peptide

Question 18

An 18 year old male presents to his GP with a history of tiredness, polydipsia and polyuria.

Which of the following investigation results would on its own would be sufficient to diagnose diabetes mellitus in this patient?

Answer 18

random blood glucose of 12.5mmol/L

one measurement of blood glucose >11mmol/L in a SYMPTOMATIC patient is sufficient to diagnose diabetes mellitus

Question 19

which medication is most likely to cause a hypo

Answer 19

sulphonylureas ie gliclazide

Question 20

what’s the first line treatment for diabetic neuropathy

Answer 20

pregablin , duloxetine , gabapentin
for painful diabetes