Diabetes Mellitus

Question 1

Diabetes Mellitus describes…

Answer 1

diseases of abnormal carbohydrate metabolism that are characterized by hyperglycemia.

Question 2

4 types of DM

Answer 2

1. Type 1 DM
2. Type DM
3. Specific types of diabetes due to other causes e.g. monogenic diabetes syndromes = maturity-onset diabetes of the young (mody).
4. Gestational DM

Question 3

Children with T1DM often present with the hallmark symptoms of?

Answer 3

• polyuria
• polydipsia
  (approx. present with DKA)

Question 4

Type 1 DM - features

Answer 4

• younger age at diagnosis (<35 years)
• lower BMI (<25 kg/m2)
• unintentional weight loss
• ketoacidosis
• glucose >20 mmol/L

Question 5

Prediabetes

Answer 5

• term used for individuals whose glucose levels don’t meet the criteria for diabetes.
• defined by the presence of impaired fasting glycemia (IFG) &/or impaired glucose tolerance (IGT) &/or A1C 5.7-6.4% (39 - 47 mmol/mol).

Question 6

Prediabetes is associated with:
(3)

Answer 6

1. Obesity (especially abdominal or visceral obesity)
2. Dyslipidemia with high triglycerides &/or low HDL cholesterol.
3. Hypertension

Question 7

Criteria for the diagnosis of Diabetes

Answer 7

A) Fasting Plasma Glucose (FPG) = 7 mmol/L
- no caloric intake for at least 8hrs.

B) 2hr Postprandial during OGTT = 11.1 mmol/L

C) AIC = >- 6.5% or 48 mmol/mol

D) Classic symptoms of hyperglycemia, random plasma glucose 11.1 mmol/L

Question 8

Criteria defining prediabetes

Answer 8

A) FPG = 5.6 - 6.9mmol/L

B) 2hr PG OGTT = 7.8 - 11.0mmol/L

C) A1C = 5.7 - 6.4%

Question 9

Acute complications of DM (3)

Answer 9

• Diabetic ketoacidosis (DKA)
• hypoglycemia
• hyperosmolar, hyperglycemia, nonketotic coma (HHNK)

Question 10

Chronic complications of DM
- Microvascular vs Macrovascular

Answer 10

Microvascular - retinopathy, nephropathy, neuropathy, dermopathy.

Macrovascular - cardiovascular dx, cerebrovascular, peripheral vascular dx.

Question 11

Hypoglycemia

Answer 11

• abnormally low plasma glucose concentration <3.9mmol/L with or without symptoms.
• the onset of symptoms usually occurs at 2.8 - 3.0 mmol/L
• most common in type 1 DM

Question 12

Symptoms of Hypoglycemia

Answer 12

• Neurogenic = tremors, palpitations, anxiety, sweating, hunger.
• Neuroglycopenic = cognitive & behavioral changes (difficulty concentrating, incoordination, weakness, confusion), reduced conscious state (coma), seizures (brain damage).
• Patient may not recall

Question 13

Clinical signs of Hypoglycemia

Answer 13

• diaphoresis (excessive sweating)
• pallor
• altered behavior or conscious state

Question 14

Causes of Hypoglycemia (3)

Answer 14

• exogenous insulin
• insulin secretagogues (e.g. sulphonylureas)
• alcohol

Question 15

Treatment for Hypoglycemia

Answer 15

• Have fast-acting carbohydrates available & take them if suggestive symptoms (e.g. lolly)
• Long-acting carbohydrate (e.g. rice, taro)
• If unable to safely take oral intake, use:
  a. Glucagon 1mg (0.5mg in children) sc or IM stat (may be marked by nausea & vomiting)
  b. 20ml of 50% dextrose (10% in children) IV, then dextrose infusion (or food if able).