Diabetes Mellitus

Question 1

define diabetes mellitus

Answer 1

a group of metabolic disease of multiple aetiologies characterised by hyperglycaemia together with the disturbance of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion and/or action.

Question 2

what are the symptoms of hyperglycaemia?

Answer 2

> polydipsia
> polyuria
> blurred vision
> weight loss
> infections

Question 3

what fasting venous plasma glucose level would suggest diabetes?

Answer 3

7mmol/l or more

Question 4

what random venous plasma glucose level would suggest diabetes?

Answer 4

11.1mmol/l or more

Question 5

what oral glucose tolerance test result would be seen in a diabetic?

Answer 5

11.1mmol/l

Question 6

what is the diagnostic HbA1c for diabetes?

Answer 6

48mmol/mol or more

Question 7

what is normoglycaemia used for?

Answer 7

describing glucose levels associated with low risk of developing diabetes/cardiovascular disease

Question 8

how is diabetes diagnosed?

Answer 8

ONE: diagnostic lab glucose plus symptoms

TWO: diagnostic lab glucose or HbA1c levels without symptoms

Question 9

what is HbA1c?

Answer 9

glycated haemoglobin.

Question 10

what does HbA1c indicate?

Answer 10

blood glucose levels over last 8-12 weeks

Question 11

when can HbA1c no be used for diagnosis?

Answer 11

> children
> pregnancy
> short duration of symptoms
> patients who are high risk and ill
> patients on medication that may cause rapid glucose rise (corticosteroids)
> pancreatic damage
> renal failure
> HIV infection

Question 12

what risk is there of developing type 1 diabetes if your monozygotic twin has it?

Answer 12

30-50%

Question 13

what is the risk of developing diabetes type 1 if your father has it?

Answer 13

6%

Question 14

your mum has type 1 diabetes, what is your risk of developing it?

Answer 14

1%

Question 15

if your sibling has type 1 diabetes what is your risk of developing it?

Answer 15

8%

Question 16

what is your risk of developing type one diabetes if your non-identical twin has it?

Answer 16

10%

Question 17

what is your risk of developing type 1 diabetes if both your parent have it?

Answer 17

30%

Question 18

what is the effect of insulin of adipose tissue?

Answer 18

reduced lipolysis

Question 19

what is the effect of insulin on the liver?

Answer 19

reduced glucose production

Question 20

what is the effect of insulin on muscle?

Answer 20

increased glucose uptake

Question 21

what symptoms could be seen in type 1 diabetes?

Answer 21

> thirst
> tiredness
> polyuria/nocturia
> weight loss
> blurred vision
> abdominal pain

Question 22

what could be seen on examination in type 1 diabetes?

Answer 22

> ketones on breath
> dehydration
> increased respiratory rate
> tachycardia
> hypotension
> low grade infections (thrush)

Question 23

what is the risk of type 2 diabetes if your identical twin has it?

Answer 23

90-100%

Question 24

what is the risk of developing type 2 diabetes if one parent has it?

Answer 24

15%

Question 25

what is the risk of developing type 2 diabetes if your sibling has it?

Answer 25

75%

Question 26

what is the risk of developing type 2 diabetes if your sibling or non-identical twin has it?

Answer 26

10%

Question 27

what is the effect of increased cellular insulin resistance in type 2 diabetes?

Answer 27

> altered lipolysis > increased glucose production > reduced glucose uptake

Question 28

what are the symptoms of hyperglycaemia?

Answer 28

``` > thirst > tiredness > polyuria/nocturia > weight loss (sometimes) > blurred vision ```

Question 29

what signs might be seen in type 2 diabetes?

Answer 29

> not ketotic > usually overweight but not always > low grade infection (thrush) > could see microvascular or macrovascular complications

Question 30

what are the risk factors for type 2 diabetes?

Answer 30

``` > overweight > family history > over 30 (Asian/maori) > over 40 (if European) > previous history of diabetes in pregnancy > had a big baby (>4kg) > inactive lifestyle > previous impaired glucose intolerance ```

Question 31

what is MODY?

Answer 31

maturity onset diabetes in the young

Question 32

true or false: | MODY is autosomal recessive

Answer 32

false it is autosomal dominant

Question 33

how are beta cells affected in MODY?

Answer 33

it is impaired due to a single gene defect

Question 34

what is the onset of glucokinase mutation MODY?

Answer 34

at birth

Question 35

what is seen in glucokinase mutation MODY?

Answer 35

stable hyperglycaemia

Question 36

what treatment is there in glucokinase mutation MODY?

Answer 36

diet treatment

Question 37

what is the onset of transcription factor mutations MODY?

Answer 37

adolescence/ young adult

Question 38

what is seen in transcription factor mutation MODY?

Answer 38

progressive hyperglycaemia with frequent compllications

Question 39

how is transcription factor mutation MODY managed?

Answer 39

> diet > oral hypoglycaemic agents > insulin

Question 40

what can cause secondary diabetes mellitus?

Answer 40

> drug therapy (corticosteroids) > pancreatic destruction > genetic syndromes (DIDMOAD) > endocrine disorders

Question 41

what can cause pancreatic destruction leading to secondary diabetes mellitus?

Answer 41

> haemochromatosis > cystic fibrosis > chronic pancreatitis > pancreatectomy

Question 42

what endocrine disorders can cause secondary diabetes mellitus?

Answer 42

> cushings syndrome > acromegaly > pheochromocytoma

Question 43

what is gestational diabetes?

Answer 43

increasing insulin resistance in pregnancy

Question 44

when does gestational diabetes develop?

Answer 44

2nd or 3rd trimester

Question 45

what at the risk factors for gestational diabetes?

Answer 45

> overweight | > inactive

Question 46

what neonatal problems is gestational diabetes associated with?

Answer 46

> macrosomia > respiratory distress > neonatal hypoglycaemia