Intro to diabetes

Question 1

What is diabetes?

Answer 1

A group of metabolic diseases characterized by hyperlycaemia resulting from defects in insulin secretion, insulin action or both

Question 2

What type of diabetes is an absolute insulin deficiency?

Answer 2

Type 1 DM

Question 3

What type of diabetes is a relative insulin deficiency?

Answer 3

Type 2 DM

Question 4

What type of diabetes results from a failure of insulin synthesis, release or activity?

Answer 4

MODY

Question 5

What is the diagnostic criteria for diabetes?

Answer 5

HbA1c: 48mmol/mol and above
Fasting glucose: 7.0 mmol/L and above
2-hr glucose in OGTT: 11.1 mmol/L and above
Random glucose: 11.1 mmol/L

Question 6

What is the diagnostic criteria for imparied or pre-diabetes?

Answer 6

HbA1c: 42-47 mmol/mol
Fasting glucose: 6.1-6.9 mmol/L
2-hr glucose in OGTT: 7.8- 11.0 mmol/L

Question 7

What are normal values?

Answer 7

HbA1c: 41 mmol/mol and below
Fasting glucose: 6.0 mmol/L and below
2-hr glucose in OGTT: 7.7 mmol/L and below

Question 8

What defines fasting?

Answer 8

No caloric intake for at least 8 hours

Question 9

What are the different categories of diabetes?

Answer 9

Type 1 due to autoimmune beta cell destruction
Type 2 due to a progressive loss of beta cell insulin secretion and insulin resistance
Type 3 is gestational diabetes
Type 4 is miscellaneous

Question 10

What can cause type 4 diabetes?

Answer 10

Neonatal diabetes
Maturity-onset diabetes of the young (MODY) 
CF
Glucocorticoid use
Treatment of HIV/AIDS
Organ transplantation

Question 11

Waht is the pathogenesis of type 1 DM?

Answer 11

Innate immunce cells etner the panceratic islets and enter the pancreatic lymph nodes where the antigens trigger T cell
These T cells arrive from the lymph nodes and initiate destructive insulitis

Question 12

What is the clinical presentation of type 1 DM?

Answer 12

Acute onset
Severe weight loss
Ketonuria +/- metabolic acidosis
No evidence of microvascular disease at diagnosis

Question 13

What are the age peaks of prevalance in type 1 DM?

Answer 13

Pre-school and peri-puberty

Another peak in late 30s

Question 14

What are the age peaks of prevalance in type 2 DM?

Answer 14

Middle aged/elderly

Question 15

What is stage 1 type 1 DM?

Answer 15

Normoglycemia
Presymptomatic
Multiple autoantibodies
No IGT or IFG

Question 16

What is stage 2 type 1 DM?

Answer 16

Dysglycemic
Presymptomatic
Multiple autoantibodies
Fasting Plasma Glucose of 5.6-6.9
2hr fasting glucose of 7.8-11.0

Question 17

What is stage 3 type 1 DM?

Answer 17

New onset hyperglycaemia
Symptomatic
Clincal symptoms
Diabetes by clinical standard

Question 18

What are risk factors for diabetes?

Answer 18

First degree relative with diabetes
High risk race
History of CVD
Hypertension 
HDL cholesterol below 0.9mmol/l
Women with POS
Physicaly inactivity

Question 19

How will diabetes mellitus present?

Answer 19

Thirst
Polyuria
Thrush
Weakness/ fatigue
Blurred vision
Infections
Weight loss

Question 20

What are useful investigatory tests in type 1 DM?

Answer 20

Autoimmune markers; GAD65, insulin, tyrosine phosphatases
Ketones
C-peptide
HLA to DQA DQB genes

Question 21

What is gestational diabetes?

Answer 21

Any degree of glucose intolearnce arising or diagnosed during pregnancy

Question 22

What endocrine diseases can cause type 4 diabetes?

Answer 22

Cushings syndrome
Acromegaly
Phaeochromocytoma
Glucagonoma

Question 23

What drugs can induce diabetes?

Answer 23

Steroids
Bendroflumethiazide
Beta blockers
Atypical antiphychotics
Statins

Question 24

What genetic diseases can indude diabetes?

Answer 24

CF
Myotonic dystrophy
Turner’s syndrome

Question 25

What is HbA1c?

Answer 25

A measure of glucose control over the past 2/3 months

Question 26

What are the common macrovascualr complications of diabetes?

Answer 26

Heart disease

Stroke

Question 27

What are the common micro-vascular complications of diabetes?

Answer 27

Retinopathy
Nephropathy
Neuropathy
PVD