DM

Question 1

What is diabetes

Answer 1

Group pf metabolic disorders characterised by presence of hyperglycaemia in the absence oc treatment

Question 2

What is MODY

Answer 2

maturity onset diabetes of the young.Are autosomal dominantly inherited causes of diabetes resulting in defects in ẞ cells function rather than insulin action. It usually affects those below 25 years of age. Mutations can occur in the Glucokinase enzyme (MODY2) or in Hepatocyte Nuclear Factors 1 & 4 (MODY3 and MODY1).

Question 3

pancreatic causes of secobdary diabetes

Answer 3

Pancreatitis, Haemochromatosis, Pancreatic surgery/trauma, Cystic Fibrosis

Question 4

endocrine causes for 2ndary diabetes

Answer 4

Acromegaly, Cushing Syndrome, Pheochromocytoma

Question 5

drug induced causes of diabetes

Answer 5

Glucocorticoids (steroids), thiazide diuretics, ẞ Blockers

Question 6

infectious causes od diabetes

Answer 6

Congenital Rubella, Cytomegalovirus, Mumps

Question 7

what should you check in all cases of hy[erglycaemia

Answer 7

ketones as shouldnt assume t2dm

Question 8

features of t1d

Answer 8

occurs young
weight loss common 
osmotic symptoms common dye to rapid onset
ketosis v likely
insulin absent or low

Question 9

features od t2d

Answer 9

more likely in the obese 
weight loss less common
Less common to have osmotic symptoms but cano occur if severe hyperglycaemia 
Ketosis less likely 
Insulin levels low or normal

Question 10

How is glucose uptake into cels

Answer 10

Insulin is released by the β cells when glucose levels rise after a meal. Insulin acts upon glucose transporters (GLUTs) which are responsible for sensing and taking up glucose into the cells; GLUT2 is important for sensing glucose in βcells and GLUT4 is involved in insulin mediated glucose uptake in skeletal muscle and adipose tissue.

Question 11

Function of insulin

Answer 11

Insulin anabolic effects result in glucose being converted to glycogen in muscle, glycogen and triglycerides in the liver and triglycerides in adipose tissue. Insulin also promotes glycolysis (breakdown of glucose to produce ATP) and inhibits gluconeogenesis (synthesis of glucose from stored substrates).

Question 12

What happens during a fasted state

Answer 12

During a fasted state insulin production is down regulated and glucose stores are released through glucagon mediated gluconeogenesis therefore preventing a hypoglycaemic state in the body during periods of fasting.

Question 13

What processes does body go through in absence of insulin due to t1d

Answer 13

In the absence of insulin (due to Type 1 diabetes) the glucose cannot be taken up into the cells effectively starving the cells of its most effective substrate to make energy. This signals gluconeogenesis, glycogenolysis and lipolysis as the body can no longer make use of the glucose that is available

Question 14

What is DKA

Answer 14

hypeglucaemia in presence of acidosis and ketosis

Question 15

What can precipitate e DKA

Answer 15

first diagnosis, infection or poor compliance, or MI/infarct

Question 16

Why does diuresis occur

-consequences

Answer 16

Due to hyperglycaemia resulting in polyuria and polydipsia

-Can result in AKI with electrolyte disturbances (hypokalaemia and hyponatraemia)

Question 17

Role of glucagon in DKA

Answer 17

its effects result in production of ketone Bodies from the conversion of FFA to acetoacetate and conversion of glycerol and amino acid to glucose leading to worsening hyperglycaemia

Question 18

Why does breathlessness occur in DKA

What kind of breathing occurs

Answer 18

Acidosis nobody tries to remove co2

First rapid, then Kussmaul’s which is deep, labour breathing

Question 19

What will blood gases in DKA show and why

Lactate?

Other signs of DKA

Answer 19

Acidosis due to bicarbonate consumption by acidic ketone bodies

LActate rasied

Sweet pear drop smell on breath, confusion, drowsiness, blurred vision and coma possibly

Question 20

treatment for dka

Answer 20

Iv insulin and fluids with electrolyte replacement

Question 21

What is hyperosmolar hy[erglycaemic state

Answer 21

Associated with t2dm

is characterised by severe hyperglycaemia leading to diuresis leading to volume depletion, dehydration and haemoconcentration.

Question 22

Why is Hyperosmolar hyperglycaemic state less often associated with katonaemia and acidosis

Answer 22

due to Presence of insulin which is enough to suppress lipolysis

Question 23

What osmolality determines a state of HHS

Answer 23

> 320mmol/kg

Question 24

Criteria to diagnose HHS

Answer 24

Hypovolaemia (due to osmotic diuresis)
Marked Hyperglycaemia (serum glucose>30mmol/L)
No significant ketonaemia/ketonuria (serum ketone <3mmol/L)
No significant acidosis (pH>7.3, bicarb >15mmol/L)
Osmolality >320mmol/kg

Question 25

Why does diabetes lead to arterial occlusion and macrovascular complications

Answer 25

diabetes hyperglycaemia leads to formation of advanced glycation end products (AGE) on arterial endothelial cells and activation of inflammatory pathways, resulting in formation of foam cells from macrophages in the intimal layer of arteries. This exacerbates the process of atheroma formation, leading to artery occlusion and subsequent macrovascular complications

Question 26

Why does diabetes lead to microvascular complications

Answer 26

occur via AGE activated biochemical pathways resulting in cellular damage caused by abnormal extracellular protein matrix accumulation and reactive oxygen species production. Cytokine and growth factor production leads to increased vascular permeability and angiogenesis (which is attributed to causing retinopathy).

Question 27

Why do diabetic foot complications arise

Answer 27

Result from interplay between both macro and microvascular pathophysiology leading to peripheral neuropathy and subsequent complications (rocker-bottom foot and ulcers)

Question 28

microvascular complications

Answer 28

Retinopathy
Nephropathy
Neuropathy (e.g. vagus nerve leading to gastroparesis. IN men ED can occur)

Question 29

Bedside tests to investigate diabetes

Answer 29

Urine dipstick- identify glycosuria and ketonuria.

Blood sugar testing - random (significant if >3)

Question 30

What should you always check for in hyperglycaemia

Answer 30

ketones

Question 31

What does protein in urine dipstick suggest

Answer 31

Diabetic nephropaty related to Kidney disease

Question 32

Biochemical testing for diabetes

Answer 32

Fasting blood glucose
Oral glucose tolerance test
HBA1c

Question 33

When to not use hba1c

Answer 33

can’t be used to diagnose type1 diabetes
Recent onset of symptoms <2 months
Children
pregnancy
In situations where glucose is temporarily raised like infections or steroids
Haemolytic anaemias, sickle cell, recent blood transfusion, liver disease, CKD, iron deficiency, b12/filate deficiency

Question 34

Diagnosis of diabetes

Answer 34

Fasting plasma glucose values of ≥ 7.0 mmol/L (normal <6.0 mmol/L)
Oral Glucose tolerance test (OGTT) resulting in a 2 hour plasma glucose ≥ 11.1 mmol/L (normal <7.8mmol/L). Ensure a fasting glucose is taken and the levels must be normal to inteprete an OGTT
HbA1c ≥ 48 mmol/mol (normal <42 mmol/mol)
Random blood glucose ≥ 11.1 mmol/L