Diabetes Principles

Question 1

what is diabetes

Answer 1

an elevation of blood glucose above a diagnostic threshold

Question 2

what is the defining threshold for diagnosing diabetes based on

Answer 2

on the risk of developing retinopathy

Question 3

what different blood tests can be used to diagnose diabetes (3)

Answer 3

Fasting plasma glucose(FPG), 2hr plasma glucose(2hPG), HbA1c

Question 4

what are the diagnostic thresholds for diabetes in the FPG, 2hPG and the HbA1c blood tests

Answer 4

FPG >/= 7 mmol/L
2hPG >/= 11.1 mmol/L
HbA1c >/= 48 mmol/mol

Question 5

how is diagnosis of diabetes different in asymptomatic patients

Answer 5

if asymptomatic repeat confirmation test is required

Question 6

what type of diabetes do the normal diagnostic thresholds not apply, and why

Answer 6

gestational diabetes(developed in pregnancy), threshold set by risk to foetus/neonate instead of retinopathy

Question 7

what is the 2 main hormones involved in diabetes

Answer 7

insulin and glucagon

Question 8

what is insulin produced by and in response to what

Answer 8

released by pancreas from beta-cells in the pancreatic islet, in response to rise in blood glucose

Question 9

what is glucagon produced by and in response to what

Answer 9

released by pancreas from alpha cells in pancreatic islet, in response to low blood glucose

Question 10

what blood test is used to measure endogenous insulin secretion

Answer 10

C-peptide, because it is co-secreted with insulin from pancreas

Question 11

what are the 2 different mechanisms that lead to diabetes

Answer 11

disorder of pancreatic beta cells, not secreting enough insulin
or
increased insulin resistance, with compensation of increased production(but still not enough)

Question 12

what causes of diabetes involve the mechanism of disorder of insulin secretion

Answer 12

Type 1 diabetes, genetic disorders(eg neonatal diabetes), pancreatic disease(eg pancreatitis)

Question 13

what causes of diabetes involve the mechanism of disorder of insulin action

Answer 13

genetic disorders(eg Donohue syndrome), insulin resistance(eg obesity, type 2 DM), endocrinopathies, steroid induced

Question 14

describe the mechanism of pathology in type 1 diabetes

Answer 14

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

Question 15

describe the mechanism of pathology in type 2 diabetes

Answer 15

ranging from predominantly insulin resistance with relative insulin secretory defect to predominantly insulin secretory defect with insulin resistance

Question 16

what % of diabetes is type 2 diabetes

Answer 16

90-95%

Question 17

describe what is NOT seen in type 2 diabetes

Answer 17

no autoimmune destruction of beta-cells and no other known cause of diabetes
(diagnosis of exclusion)

Question 18

describe some of the features of type 1 diabetes

Answer 18

usually onset in children/young adults, not associated with obesity, autoimmune, requires insulin(can be fatal if not)

Question 19

describe some of the features of type 2 diabetes

Answer 19

usually onset middle aged/elderly, associated with obesity/sedentary life, not autoimmune, may need insulin but usually other treatment

Question 20

what are the symptoms associated with

diabetes/high blood glucose

Answer 20

can be asymptomatic, polyuria, thirst, blurred vision, genital thrush, fatigue, weight loss