diabetes principles

Question 1

what is diabetes?

Answer 1

An elevation of blood glucose above a diagnostic threshold

Question 2

what are the thresholds for diabetes diagnosis?

Answer 2

fasting plasma glucose=7mmol/l
2hr plasma glucose=11.1mmol/l
HbA1c=48mmol/mol

Question 3

what is a normal HbA1c?

Answer 3

41mmol/mol and below

Question 4

what is the difference between gestational diabetes and diabetes?

Answer 4

in diabetes threshold levels are set by retinopathy risk and in gestational the threshold is set by the risk to foetus

Question 5

how is the level of insulin that beta cells are secreting measured?

Answer 5

by measuring the C peptide level (C-peptide is co-secreted with insulin and is not part of injected insulin – so if c-peptide is present in the blood it must be coming from the person’s beta-cells)

Question 6

can diabetes be caused by a pure disorder of the beta cells?

Answer 6

yes

Question 7

is type 1 a disorder of insulin action?

Answer 7

no-its a disorder of insulin secretion

Question 8

what are the disorders of insulin secretion?

Answer 8

diabetes T1
genetic disorders (MODY, neonatal diabetes)
pancreatic diseases (pancreatitis, cancer)

Question 9

pure disorders of insulin action are rare-true or false?

Answer 9

true

Question 10

what are some disorders of insulin action?

Answer 10

Donohue Syndrome
Rabson-Mendenhall Syndrome
Familial Partial Lipodystrophy
Congenital Lipoatrophy
Acquired Lipoatrophy

cushings syndrome
acromegaly

can be steroid induced

Question 11

is type 2 diabetes an insulin secretion or insulin action disorder?

Answer 11

mixed-ranging from predominant beta cell deficiency to predominant insulin resistance

Question 12

what is T1 diabetes?

Answer 12

autoimmune destruction of the pancreatic beta cells resulting in beta cell deficiency

Question 13

what % of people with T1 have pancreatic autoantibodies in the blood at diagnosis?

Answer 13

95%

Question 14

what are the features of T1 diabetes?

Answer 14

onset in children and young adults
not associated with overweight
autoimmune
requires insulin treatment

Question 15

what are the features of type 2 diabetes?

Answer 15

onset in middle aged and elderly
associated with obesity and sedentary lifestyle
not autoimmune
may require insulin but can usually be managed with lifestyle changes

Question 16

can diabetes be asymptomatic?

Answer 16

yes

Question 17

what are the symptoms of high blood glucose?

Answer 17

polyurea
thirst and polydipsia
blurred vision
genital thrush
fatigue
weightloss

Question 18

what other diseases are driven by chronic hyperglycaemia?

Answer 18

retinopathy
neuropathy
nephropathy

Question 19

what is HbA1c?

Answer 19

glycated haemoglobin

Question 20

is the amount of glycation measured in Hb1Ac proportional to glucose level?

Answer 20

Yes

Question 21

how many days of glucose exposure does Hb1Ac measure?

Answer 21

90 days

Question 22

what are diabetes emergencies?

Answer 22

diabetes ketoacidosis
hyperosmolar hyperglycaemic state

Question 23

what are the main aims of diabetes management?

Answer 23

treat symptoms
prevent microvascular complications
prevent CV complications
screen for complications early while treatable eg eye disease

Question 24

how much weight loss can result in T2 diabetes remission?

Answer 24

10-15%

Question 25

by how much do lifestyle interventions lower the odds of developing T2 diabetes

Answer 25

50%

Question 26

what is the HbA1c target in those who have T2?

Answer 26

7% (53mmol/mol)