diabetes mellitus in clinical practice

Question 1

what is diabetes mellitus broadly speaking

Answer 1

A group of conditions characterised by
HIGH BLOOD GLUCOSE
and other metabolic and vascular derangements secondary to insufficient insulin action

Question 2

name microvascular complications of diabtetes

Answer 2

retinopathy, nephropathy, neuropathy

Question 3

what are macrovascular complications of diabetes

Answer 3

ischaemic heart disease, cerebrovascular disease, peripheral vascular disease

Question 4

what is difference between type 1 type a DM vs type 1 type b DM

Answer 4

Type a: autoimmune

Type b: idiopathic (no markers of autoimmunity)

Question 5

describe type 2 diabetes

Answer 5

combination of insulin deficiency and resistance sometimes more resistance than deficiency and vice versa

Question 6

how might patients with diabetes present to healthcare

Answer 6

with severe hyperglycaemia emergency, symptoms of hyperglycaemia(osmotic symptoms), detected by screening, or symptoms of diabetes complications

Question 7

what does absence of insulin do to stored lipids

Answer 7

Lipolysis

Question 8

what does absence of insulin do to proteins

Answer 8

Proteolysis

Question 9

why do tissues become glucose deprived in abscense of insulin

Answer 9

less uptake due to less transcription of glut protiens and recruitment to cell surface

Question 10

name osmotic symptoms of diabetes

Answer 10

polyuria and thirst and polydipsia

Question 11

what is polyuria

Answer 11

is excessive or an abnormally large production or passage of urine

Question 12

what is polydypsia

Answer 12

is excessive thirst or excess drinking

Question 13

why are diabetic people at greater risk of infection

Answer 13

hyperglycaemia facilitates pathogens

Question 14

how can a diabetic person become hypotensive

Answer 14

because hyperglycaemic, causes glycosuria which causes osmotic diuresis, they become dehydrated, reduced blood volume causes hypotension

Question 15

why do diabetics suffer from weight loss use key terms

Answer 15

proteolysis, lipolysis due to insulin being absent and dehydration

Question 16

what causes nausea in diabetic patients

Answer 16

acidosis as a result of ketosis which originates from lipolysis

Question 17

what causes hyperventilation

Answer 17

acidosis as a result of ketosis, body attempting to compensate

Question 18

a patient with diabetes reports symptoms of tingling in hands and feet, numb, abnormal sweat, errectile dysfunction, postural dizzyness, gastroparesis, pain weakness, diplopia what is this likely to be considering the patient has diabetes

Answer 18

microvascular complication of neuropathy

Question 19

how do you diagnose diabetes

Answer 19

clinical symptoms of hyperglycaemia, polyuria, polydipsia etc and hba1c or unequivocally random high blood glucose conc >11.1

Question 20

to be diagnosed with dm what does hba1c have to be typically

Answer 20

HbA1c ≥ 48 mmol/mol

Question 21

In the absence of typical symptoms how do you diagnose diabetes

Answer 21

On 2 separate occasions:
• Abnormal blood glucose
• Abnormally high amount of glucose on
circulating proteins:
• Glycated haemoglobin or HbA1c

Question 22

what is prediabetes

Answer 22

high risk of getting diabetes .
HbA1c 43 – 47 mmol/mol (6.1-6.4%)
Impaired glucose tolerance
fasting venous plasma glucose < 7 and 2 hr ≥7.8 and
< 11.1 mmol/l
Impaired fasting glucose
fasting venous plasma glucose 6.1 - 6.9 mmol/l

Question 23

what does glucose tolerance mean

Answer 23

how well body cells can absorb glucose

Question 24

why is the sample that we test glucose conc from important

Answer 24

Glucose concentrations are

different in different samples

Question 25

upon examination a patients shows hla markers, insulin deficiency, ketosis prone, the onset of diabetes peaked in teenage years and weight loss is this more likely type one or 2

Answer 25

type 1

Question 26

describe clinical features of type 2 diabetes

Answer 26

insulin resistant & deficient
• not ketosis prone
• Polygenic
• S Asians > Aficans &
Caribbeans > Europids
• Increases with ageing younger
in ethnic groups with high prevalence
• associated with obesity

Question 27

what are the aims of diabetes management

Answer 27

remove symptoms of uncontrolled diabetes, prevent complications, prevent diabetic emergencies, avoid impact on quality of life

Question 28

what diabetes complication risk factors are modifiable

Answer 28

Glycaemic control
• Blood pressure / Hypertension
• Lipid profile/ dyslipidaemia
• Smoking(especially!!)
• Exercise
• Diet
• Overweight/obesity

Question 29

what Risk factors for long term diabetes

complications are non modifiable

Answer 29

Non-modifiable
• Age
• Gender
• Family history
• Ethnicity

Question 30

what is a hard endpoint

Answer 30

outcome important to patients such as death, blindness, MI, amputation

Question 31

what is a surrogate endpoint in a clinical trial

Answer 31

biomarker intended to

substitute for a hard endpoint