Diabetes Milletus

Question 1

Definition

Answer 1

Increased glucose level and decreased tolerance due to defects in insulin secretion or due to resistance or both

Question 2

Clinical picture of dm

Answer 2

Polyuria
Polydipsia
Polyphasic
Weight loss
Delayed wound heal
Fatigue
Weakness

Question 3

Fasting and 2 hour postprandial blood glucose level

Answer 3

Fasting normal is less than 100mg/dl
Prediabteces or it’s are between 10p & 126 mg/dl
Diabetes is more than 126mg
Two hour post prandial normal is less than 140 mg/dl
Prediabetecs and its are between 140 & 200 mg/dl
Diabetes are above 200 mg

Question 4

Prediabetec and igts

Answer 4

Increased risk of t2d

Question 5

Suitable blood test tube

Answer 5

Grey tube which contains fluoride to inhibit enolase enzyme

Question 6

Hb a1c

Answer 6

Non enzymatic glycation of hemoglobin of terminal n valine in beta chain of hemoglobin
It reflects blood glucose for last w 2 months, 8-12 weeks or 60 days
Normal value is between 4 and 5.7% percent
Prediabetecs or igts are between 5.7 and 6.5% percent
Diabetics are more than 6.5% percent
Target for diabetes are between 6.5 and 7% percent
Uncontrolled diabetes Milletus is above 8% percent

Question 7

Measurement of fructosamine

Answer 7

Fructosamine is when carbonyl group of glucose reacts with amino group of plasma proteins as albumin
Fructosamine reflects blood glucose level for last 2-3 weeks
Normal values is between 1.5 and 2.4 mmol/liter

Question 8

When to perform fructosamine

Answer 8

Change in medications or diet for last 6 weeks
Problems in red blood cells as in sickle cell anemia, hemolytic anemia as thalassemia or hereditary spherocytosis
Pregnancy

Question 9

Oral glucose tolerance test ogtt

Answer 9

Fast for 8-12 hours and take blood and urine sample
Drink solution of 350ml made of 75 grams of glucose in a period of 5 minutes
Take blood and urine samples every 30 minutes for hours

Question 10

Normal results

Answer 10

Plasma glucose rise for first 30 and 60 minutes
Then drop afterward due to decreased intake and effect of insulin
No glucosuria in normal results of a normal person

Question 11

Abnormal ogtt results are

Answer 11

For diabetics where curve points obey plasma glucose levels of dm plus glucosuria and delayed decline of glucose in blood
Igt curve points obeys plasma glucose level of igt patients
Renal glucosuria plasma glucose level is at 180 at all git yet glucosuria is seen
Curve looks normal

Question 12

Additional tests

Answer 12

Random blood glucose
Self monitoring blood glucose
Urine analysis
Lipid profile
Cpeptide measurment
Islet cells antibody

Question 13

Random blood sugar rbs

Answer 13

It’s is defines as without regards to last meal ingestion
Used in emergencies
Plasma glucose level in rbs along classic symptoms of dm of 200 or more could be an indicator to diagnose dm

Question 14

Self monitoring blood glucose

Answer 14

Capillary blood glucose measurement performed by patients themselves in t1d for tight metabolic regulation or controlling if blood glucose levels

Question 15

Urine analysis

Answer 15

Glucosuria allows for first line screening test for diabetes mellitus
Normally glucose does not appear in urine till its level exceeds 180gm/dl in bloood plasma so diabetes patient present with glucosuria
Renal threshold can decrease so people with normal blood level can be presented with glucosuria
Old peoples have high threshold so diabetes do not have glucosuria

Question 16

Test for glucosuria

Answer 16

Urine dip stick is specific and convenient

Question 17

Ketonuria

Answer 17

Quantitative detection of ketone bodies in urine can be done by nitroprusside test
Present in normal person with prolonged starvation
Patients with uncontrolled diabetes mellitus

Question 18

Albumin in urine

Answer 18

Normal levels is between 2.5 and 25 mg per day
Microalbuminuria between 25 and 250 mg per day
Marcoalbuminuria are above 250 mg per day

Used by simple albumin stick test
Done by 24 hour urine specimen

Question 19

Relation between diabetes and albuminuria types

Answer 19

Macroalbuminuria present in t1d which is an indication of early reversible renal damage
Microalbuminuria is present in t2d where it might be sign for macro vascular disease especially coronary arteries of heart

Question 20

Albumin to creatinine ratio

Answer 20

Used for detection of renal disease for diabetes complications

Question 21

Lipid profile

Answer 21

Obese patients with type 2 diabetes have diabetic dyslipidemia due to insulin resistance
Reveals high cholesterol total
High tags
High ldl
Low hdl

Question 22

C peptide measurement

Answer 22

Serum insulin or c peptide measurements do not distinguish between t1d and t2d

Low c peptide measurement confirm patients need for insulin

Many patients with new onset of t1d show some c peptide levels

Question 23

Measurement of islet cell antibody

Answer 23

Antibodies to insulin or glutamic acid decarboxylase maybe present in type 1 diabetes and absent in type 2 diabetes