Diabetes Mellitus

Question 0

What is diabetes?

Answer 0

Chronic hyperglycaemia

At levels able to cause specific microvascular complications

Question 1

How many people have diabetes in Wales?

3 million people live in Wales

Answer 1

150,000

5%

Question 2

Diabetic 2hr/random glucose

GTT (glucose tolerance test)

Answer 2

> 11.1 mmol/L

Question 3

Diabetic fasting plasma glucose

Answer 3

> 7 mmol/L

Question 4

Symptoms of diabetes

Answer 4

Polydipsia 
Polyuria 
Blurred vision- changes in lense due to osmotic affect of high sugar - rectified when glucose is controlled
Thrush 
Weight loss in T1

Question 5

Diabetic random HbA1c

Answer 5

> 6.5%

Doesn’t work in sickle cell or anaemia

Question 6

Impaired glucose tolerance

Answer 6

Fasting b g 7
Random 7.8-11.1

Cardiovascular risk

Question 7

Impaired fasting glycaemia

Answer 7

F b g 6.8

Question 8

Types of diabetes

Answer 8

T1- damages Beta cells- can’t make insulin- immune mediated

T2- insulin resistance- have insulin, doesn’t work too well. Sometimes can’t make it too we’ll either.

Other- MODY, exocrine pancreas disease, pancreatitis, endocrineopathies (eg Cushing’s), drugs, genetic syndromes

Gestational - hormonal pressure of pregnancy- more insulin resistance- come out of it after placenta is delivered

Question 9

Autoimmune cause of diabetes

Answer 9

T cells destroy Beta cells

Anti GAD, IA2, ZnT8, islet cell Abs

Question 10

Genetics of diabetes

Answer 10

Caucasian
HLA DR3
Lots of genes involved- all contribute
HLA has the biggest effect
All genes (bar 1) are to do with the immune system
Affects insulin expression in THYMUS gland

Question 11

Clinical features of T1

Answer 11

Slim
Age 0.5-70
Median age is around 12 
Present with weight loss 
Rapid onset (pathogen exist goes on for a long time though) 
Ketoacidosis prone 
Absolutely insulin dependant - can reduce dose if not eating but NEVER stop
85% have no family history

Question 12

What causes type 2 diabetes?

Answer 12

Insulin resistance
Lipotoxicity? Affect of FA?
Adipokines made by fat?
Liver fat deposition :( liver becomes insulin resistance
Affects liver function- insulin goes to liver first
Genetic predispositions
Non Caucasians

Question 13

Genes that increase weight

Answer 13

FTO

Question 14

Genes that increase insulin resistance

Answer 14

PPARG

Question 15

2 things required to get T2 diabetes

Answer 15

Insulin resistance &

Impairment of insulin production

Question 16

Key clinical feature of T2 diabetes

Answer 16

BMI >25 (usually >30)
Family history
Asian/afrocarribean
Asymptomatic (70%)
Diet controlled initially- red glucose & red weight 
Can be reversed by marked weight loss

Question 17

Why can someone with T2 look thin?

Answer 17

Lipodystrophy

Large livers stuffed with fat

Question 18

Treatment of diabetes

Answer 18

Diet- carb input (T1), red calories (T2)

Exercise (especially T2) - protect against CV disease

Insulin sensitising agents- T2 only: metformin, (glitazones)

Insulin secreting agents - T2 only: sulphonylureas, incretin mimetics

Calorie intake reduction agents

Insulin

Question 19

Problem with glitazones

Answer 19

Weight gain

Question 20

Name a sulphonylurea

Answer 20

Gliclazide

Question 21

Drugs that treat diabetes by reducing calorie intake

Answer 21

Orlistat…

Question 22

Additional treatments to lower CV risk

Answer 22

Statins
BP tablets
Stop smoking