Glucose regulation

Question 1

How many people worldwide had diabetes in 2015?

Answer 1

415 million

Question 2

How many people in the UK have diabetes

Answer 2

4.5 million

Question 3

Basic pathogen of T1DM

Answer 3

pancreatic islet beta-cell deficiency

Question 4

Basic pathogen of T2DM

Answer 4

insulin resistance

Question 5

What is MODY?

Answer 5

Maturity onset diabetes of the young

monogenic AD disease- genetic defect

Question 6

groups at risk of gestational diabetes

Answer 6

Overweight / obese
Previous gestational diabetes
Previous baby birthweight ≥4.5kg
FH of diabetes
South Asian, Black or African Caribbean or Middle Eastern ethnicity

Question 7

when should gestational diabetes be diagnosed?

Answer 7

a fasting plasma glucose level ≥5.6mmol/L

or

a 2-hour plasma glucose level ≥7.8mmol/L

Question 8

when to diagnose diabetes i.e. what results should be obtained

Answer 8

2 positive findings or 1 positive finding + symptom:

Fasting glucose ≥ 7.0 mmol/L
Random glucose ≥ 11.1 mmol/L
Oral glucose tolerance test (75g glucose)- Bloods taken at 0 and 120 mins

Question 9

BM fasting ranges

Answer 9

Normal: 3.5 - 5.4 mmol/L
Pre-Diabetic: 5.5 - 6.9 mmol/L
Diabetic: > 6.9 mmol/L

Question 10

Reference range for Hba1c

Answer 10

20-41

Question 11

HBa1c levels for:
pre-diabetes
diagnostic of diabetes

Answer 11

42-47 mmol/mol: Pre-diabetes

>47 mmol/mol: Diagnostic of diabetes

Question 12

5 factors that can affect Hba1c levels

Answer 12

Presence of abnormal haemoglobin 
Altered lifespan of the red cell
Recent blood transfusion
Anaemia (any cause) 
Ethnicity

Question 13

examples of situations when Hba1c is not appropriate for diagnosis of diabetes

Answer 13

ALL children and young people
When Type 1 diabetes suspected
Symptoms of diabetes for <2 months
Acutely ill (ie hosp admission) + high diabetes risk
Meds that may cause rapid glucose rise e.g. steroids, antipsychotics
Acute pancreatic damage, including pancreatic surgery
Pregnancy
Presence of genetic, haematologic and illness-related factors that influence HbA1c and its measurement

Question 14

Pathogenesis of DKA

Answer 14

insulin lack

increased gluconeogenesis, decreased glucose uptake

hyperglycaemia

glucosuria

osmotic diuresis

dehydration

lack of insulin

increased lipolysis

increased ketogenesis

ketonemia

ketonuria

acidosis

compensatory hyperventilation

Question 15

define DKA

Answer 15

Acute decompensation due to insulin deficiency and glucagon excess (counter-regulatory hormone)

Question 16

clinical features of DKA

Answer 16

vomiting, abdo pain, thirst and polyuria, hypotension, LOC, coma, hyperventilation

Question 17

diagnostic features of DKA

Answer 17

D –Diabetes - hyperglycaemia > 11.1mmol/L,

K – Ketonaemia

A - metabolic Acidosis (pH<7.3)

Question 18

5 causes of DKA

Answer 18

infection
non-complicance with meds
inappropriate insulin
new diagnosis 
MI

Question 19

clinical features of hyperosmolar hyperglycaemic state

Answer 19

insidious onset, vomiting, confusion, hypercoagulable state, venous thrombosis

Question 20

biochemical diagnosis of HHS

Answer 20

hyperglycaemia (often 30-70 mmol/l), high serum osmolality ( often > 350 mosmol), NO ACIDOSIS/KETONAEMIA

Question 21

causes of HHS

Answer 21

Ingestion of high sugar drinks
Inter-current infection
Myocardial infarction
Concomitant medication eg glucocorticoids

Question 22

5 ways to monitor diabetes

Answer 22

Hba1c
fructosamine
creatinine
lipid profile 
BM records

Question 23

what is fructosamine

Answer 23

glucose attached to albumin- can get an idea regarding glucose levels in the past 2-3 weeks

Question 24

3 potential microvascular complications of diabetes

Answer 24

nephropathy
retinopathy
neuropathy

Question 25

3 macrovascular complications of diabetes

Answer 25

IHD
stroke
peripheral vascular disease

Question 26

causes of hypoglycaemia

Answer 26

hyperinsulinaemia: endogenous e.g. islet cell tumour, sulphonyureas or exogenous e.g. iatrogenic or deliberate

endocrine deficiency
starvation
IGF2 secreting tumour

alcohol
galactosaemia

Question 27

2 tests to be done in hypoglycaemia

Answer 27

Insulin and C peptide measurement

Screening for sulphonylurea metabolites

patient has to be hypoglycaemia at time of test