Endocrine: Diabetes Mellitus

Question 1

what is type 1 diabetes?

Answer 1

absolute insulin deficiency resulting from destruction of insulin-producing beta-cells in the pancreatic islets of Langerhans (most commonly an autoimmune disease)

Question 2

what is Idiopathic type 1 diabetes

Answer 2

no evidence of autoimmune destruction of pancreatic beta cells

Question 3

which type of diabetes requires lifelong insulin therapy?

Answer 3

type 1

Question 4

what is type 1 diabetes?

Answer 4

a combination of insulin resistance (where the body is unable to respond to normal levels of insulin) and insulin deficiency (where the pancreas is unable to secrete enough insulin to compensate for this resistance)

Question 5

what is the most common type of diabetes?

Answer 5

type 2 (85%)

Question 6

what is gestational diabetes?

Answer 6

Defined as any degree of glucose intolerance with onset or first recognition occurring during pregnancy.

• uncommon to present with symptoms.

Question 7

what is Mature onset diabetes of the young (MODY)?

Answer 7

Several forms of diabetes with mono-genetic defects of beta cell function.

Question 8

what is meant by secondary diabetes?

Answer 8

Caused by underlying pathology such as pancreatitis or Cushing’s syndrome.

Question 9

what are the risk factors for type 2 diabetes?

Answer 9

• obesity
• inactivity
• family history
• ethnicity
• history of gestational diabetes
• poor diet
• drugs
• Polycystic ovarian syndrome.
• Metabolic syndrome.
• Low birthweight for gestational age.

Question 10

which drugs can increase the risk of developing hyperglycaemia and type 2 diabetes?

Answer 10

statins, corticosteroids, and combined treatment with a thiazide diuretic plus a beta-blocker

Question 11

what are some clinical features of diabetes?

Answer 11

Polyuria.
Polydipsia.
Weight loss.
Young age. 
Blurred vision. 
Nausea and vomiting. 
Abdominal pain. 
Tachypnoea. 
Lethargy.

NB: Type 2 can be asymptomatic or present with candida infections/skin infections, UTIs and the above.

Question 12

what is Polydipsia?

Answer 12

excessive thirst or excess drinking

Question 13

what is Tachypnoea?

Answer 13

abnormally rapid breathing.

Question 14

what investigations would you conduct to confirm a diagnosis of diabetes?

Answer 14

• random plasma glucose
• fasting plasma glucose
• 2-hour plasma or urine ketones
• HbA1c

Question 15

what is HbA1c?

Answer 15

Hemoglobin A1C

Glycated hemoglobin is a form of hemoglobin that is chemically linked to a sugar. Reflects degree of hyperglycaemia over the preceding 3 months, result ≥48 mmol/mol (≥6.5%).

Question 16

what is the treatment for type 1 diabetes?

Answer 16

basal-bolus insulin

insulin injected subcutaneously daily (insulin glargine, insulin isophane human (NPH), insulin detemir, insulin degludec)

and before meals (insulin neutral, insulin lispro, insulin aspart, insulin glulisine)

Question 17

what is the treatment for type 2 diabetes?

Answer 17

lifestyle changes, glycemic management and lipid management

Question 18

what are some complications of diabetes?

Answer 18

Microvascular - retinopathy, nephropathy, and neuropathy.

Macrovascular - cardiovascular disease (CVD), cerebrovascular disease, and peripheral arterial disease.
Metabolic conditions - diabetic ketoacidosis (DKA) and dyslipidaemia.

• reduced quality of life and reduced life expectancy.