Endocrine

Question 1

What is type 1 diabetes?

Answer 1

A state of absolute insulin deficiency

Question 2

Type 1 diabetes risk factors?

Answer 2

85% under 20's, peak 10-14 years
HLA class II antigen

Question 3

How many people with susceptible HLA antigens develop DM?

Answer 3

5%

Question 4

Triggers for developing DM with HLA?

Answer 4

Viral infection 
Maternal factors
Weight gain 
Vitamin D deficiency 
Environmental/nutritional factors

Question 5

What is normal glucose/insulin physiology?

Answer 5

Insulin is secreted at a low basal rate accounting 50% of insulin produced. Post prandial insulin is secreted in relation to post meal glucose

Question 6

Pathophysiology of type 1 diabetes?

Answer 6

Auto-immune destruction of insulin producing islet cells

Question 7

Pathophysiology of Type 2 diabetes?

Answer 7

Amyloid protein deposition and chronic destruction. Initial insulin resistance, then islet cell destruction and loss of B cell mass.

Question 8

What are the islet auto-antibodies?

Answer 8

IA-2
IAA
GAD65
ZnT8

Question 9

Type 1 diabetes diagnosis?

Answer 9

Fasting glucose >7.0mmol
Random >11.1 mmol
and symptoms

Question 10

Antibodies characterising T1DM?

Answer 10

anti-GAD/anti islet cell bodies

Question 11

T1DM clinical presentation?

Answer 11

Pre-school/peri-puberty 
Small peak in late 30's
Usually skinny 
Acute onset 
Severe urinary symptoms 
Severe weight loss 
Ketonuria +/
- metabolic acidosis

Question 12

T2DM clinical presentation?

Answer 12

Middle aged/elderly 
Insidious onset 
Usually obese
Ketonuria minimal or absent 
Evidence of micro-vascular disease

Question 13

What is Type 3 Diabetes?

Answer 13

Gestational diabetes

Question 14

What is Type 4 Diabetes?

Answer 14

Pancreatic disease endocrine disease, drug induced , abnormalities of insulin and its receptor, genetic diseases

Question 15

What to look out for to diagnose MODY?

Answer 15

Strong family history, young onset (<30), GAD negative, C peptide positive

Question 16

HbA1c in T2DM

Answer 16

48m/m

Question 17

Normal HbA1c

Answer 17

41m/m

Question 18

Presentation of diabetes mellitus

Answer 18

Thirst
Polyuria
Thrush
Fatigue
Blurred vision 
Infections

Question 19

Aims of therapy in Type 1 diabetes?

Answer 19

Prevent hyperglycaemia
Avoid hypoglycaemia
Reduce chronic complications

Question 20

signs of hypoglycaemia?

Answer 20

pallor, sweating, tremor, palpitations, confusion, nausea, hunger, coma

Question 21

name some microvascular complications of diabetes?

Answer 21

Retinopathy
Nephropathy
Neuropathy
Erectile dysfunction

Question 22

name some macrovascular complications of diabetes?

Answer 22

TIA and stroke
Angina
MI 
Cardiac failure
Peripheral vascular disease

Question 23

Where does metformin work?

Answer 23

liver and muscle

Question 24

where does insulin work?

Answer 24

liver and muscle

Question 25

where do glitazones work?

Answer 25

liver, muscle and adipose tissue

Question 26

where do incretins works?

Answer 26

pancreas and liver

Question 27

What is the 1st choice drug in T2DM?

Answer 27

Metformin