diabetes mellitus

Question 1

what are the complications for diabetes mellitus ?

Answer 1

end stage renal disease 
amputations 
blindness 
diabetic neuropathy 
artheroscleortic damage -heart disease and cerebrovascular disease

Question 2

what is the classification of diabetes mellitus ?

Answer 2

type 1 diabetes - immne mediaed and idiopathic
beta cell destruction - absolute insulin deficiency

type 2 -insulin resistance , relative insulin deficiency

MODY (maturity onset diabetes of young) - usually below the age of 25
genetic defect of beta cell function or glucokinase gene converts glucose to
genetic mutation in any of the 4 genes which encodes transcription factors involved in pancreatic development and insulin regulation
glucose 6 phosphate in the pancreas
autosomal dominant trait

gestational diabetes

pancreatitis

acromegaly

down syndrome sometimes associated with diabetes

infections - congenital rubella , cmv

drug or chemical induced

Question 3

what is the criteria of diagnosis for diabetes mellitus ?

Answer 3

fasting plasma glucose level of more than 7 mmol /L on atleast TWO OCCASIONS diagnostic for diabetes
obtained after 8 hour of fasting

symptoms of hyperglycaemia -
polyuria , polydpsia , polyphagia
unexplained weight loss

casual plasma glucose of above 11.1mmol/L - indicate diabetes

Hba1c equal to or more that 6.5 percent

normal

fasting plasma glucose less than 100mg/dl (less than 5.6mmol/l)

2 hour plasma glucose level after 75g glucose load
less than 140mg/dl (less than 7.8mmol)

prediabetes
HbA1c 5.7-6.4 percent

impaired fasting glucose
fasting plasma glucose
5.6-6.9 mmol/L

impaired glucose tolerance
2 hour plasma glucose level after 75g glucose load
7.8-11.0 mmol

Question 4

what is pre diabetes ?

Answer 4

condition in which glucose homeostasis is abnormal

but serum glucose levels are not yet high enough to be classified as diabetes

Question 5

pre diabets have what impairment in diagnostic testing for diabetes ?

Answer 5

impaired fasting glucose

impaired glucose tolerance

Question 6

criteria for gestational diabetes testing ?

Answer 6

1 hour plasma glucose level after 50 g glucose load
more than 7.2mmol/l = 90 percent detection for gestational diabetes

more than 7.8 mmol/l = 80 percent

oral glucose tolerance 
100g OGTT 
fasting more than or equal to 5.3mmol/l  
1 hour more than or equal to  10 
2 hours more than or equal to  8.6 
3 hours more than or equal to 7.8

75g OGTT
fasting more than or equal to 5.3mmol/l
1 hour more than or equal to 10 mol/l
2 hour more than or equal to 8.6mmol/l

Question 7

what are the risk factor for gestation diabetes ?

Answer 7

greater than 25
prediabetes - elevated blood sugar precursor to diabetes type2
parent or sibling having diabetes type 2
gestational diabetes during previous pregnancy
baby weighing more than 9 pounds
unexplained still birth
BMI 30 or higher
non white race

Question 8

when do gestational diabetes usually occur ?

Answer 8

in the second trimester
mothers blood brings extra glucose to the baby
as there is an insulin resistance by pregnancy hormones released from placenta - cortisol and progesterone

foetus makes more insulin to handle the extra glucose

Question 9

how can we distinguish type 1 diabetes from type 2 diabetes ?

Answer 9

type 1
risk factors - genetic ,
autoimmune - destruction of beta cells

C peptide levels are very low

pre diabetes - autoantibodies
present - IAA, IA-2

medication - insulin necessary
multiple daily injection

therapy to prevent and day onset of diabetes - none known

type 2
risk factors - genetic , obesity , lifestyle , race , hypertension , dyslipidemia , polycystic ovarian syndrome

c peptide levels - detectable

autoimmune antibodes not present

medication therapy - oral agents and insulin commonly needed

therapy to prevent - weightless , physical activity
metoformin - oral medication useful

Question 10

what is the genetic susceptibility in detecting type 1 diabetes ?

Answer 10

specific immune response genes HLA- DR/DQ on chromosome 6

viral exposure , toxin exposure ,or other environmental influence triggering autoimmune response

Question 11

antibody markers of beta cell destruction are present when ?

Answer 11

before and at the time of onset of diabetes

Question 12

autoantibody assay to which antibody is available ?

Answer 12

GAD65 - glutamic acid decarboxylase - highest sensitivity more common i adults

insulin antibodies - IAA
more common in children

islet cell antigen - ICA512

detection of two - increased risk of type 1 diabetes forming

because these autoantibodies are not present does not exclude it from not being type 1 diabetes !

Question 13

people with type 2 diabetes can be free of symptoms ?

Answer 13

yes

Question 14

who should be screened for

Answer 14

in any overweight or obese

recommend for 45 or older- screened every 3 years

Question 15

why should home devices not be used to diagnose diabetes ?

Answer 15

10-15 percent lower than plasma glucose level

Question 16

preventing or delaying the progression of microvascular complications in diabetes is by what ?

Answer 16

improved glycemic control

Question 17

lowering glucose levels in patients with type 1 diabetes slows or prevents the development of?

Answer 17

retinopathy, neuropathy, and nephropathy

Question 18

what is HBA1c ?

Answer 18

irreversibly glycosilated at n terminal of b chain in haemoglobin A

Question 19

GHb assays vary in reliability in the presence of a variety of factors which are ?

Answer 19

carbamylated hemoglobin can occur with uremia, hypertriglyceridemia, and hyperbilirubinemia, and
salicylates can cause interference by acetylated species

Hemoglobinopathies - high red blood cell turnover and the need for transfusions

chronic alcohol or opiate use, iron deficiency, and lead poisoning

Vitamins C and E can falsely lower levels by inhibiting glycosylation

hemolysis,
recovery from acute blood loss,
splenectomy, will lower the HbA1c level as the result of reduced exposure to plasma glucose

Question 20

what are the ketone bodies ?

Answer 20

β-hydroxybutyric acid, acetoacetic acid, and acetone are products of fatty acid degradation

Question 21

what are the ketone testing specimens ?

Answer 21

using urine or blood

Question 22

symptoms for diabetic ketoacidosis ?

Answer 22

ausea, vomiting, abdominal pain, electrolyte disturbances, and severe dehydration
requiring urgent treatment

Question 23

what are the procedures for ketone testing ?

Answer 23

most commonly used strips and tablets use sodium nitroprusside and turn purple in the presence of elevated levels of acetoacetic acid

Question 24

False-negative results in ketone testing how ?

Answer 24

old strips and with strips that have had excessive contact with air, and after ingestion of large amounts of vitamin C

Question 25

False-positive results in ketone testing how ?

Answer 25

angiotensin-converting enzyme inhibitors and other sulfhydryl medications

Question 26

strip test not useful in monitoring the therapy for diabetic ketoacidosis why ?

Answer 26

β-hydroxybutyric acid levels fall and acetoacetic acid and acetone levels rise during the treatment of DKA

Question 27

what is used form monitoring the therapy for diabetic ketoacidosis?

Answer 27

serum electrolytes, including bicarbonate with calculation of the anion gap

Question 28

In diabetic patients, microalbuminuria is associated with

Answer 28

four- to sixfold increase in cardiovascular mortality, and is an independent risk factor for renal mortality.
It is also more prevalent in hypertensive subjects

Question 29

because of he day to day variability of albumin excretion how can the testing of microalbuminurea be diagnostically accurate

Answer 29

two of three albumin levels measured within a three-month to six-month period should be abnormal before considering a patient to have crossed a diagnostic threshold

Question 30

what can cause microalbuminurea other than diabetes ?

Answer 30

Physical exercise during the previous 24 hours 
infection, 
fever,
 congestive heart failure
marked hypertension