Other types of diabetes

Question 1

What is MODY?

Answer 1

Monogenic diabetes of the young

Question 2

What is the pathogenesis of MODY?

Answer 2

autosomal dominant inheritance

Glucokinase mutation or SUR1 mutation

Question 3

What age does glucokinase mutation MODY present?

Answer 3

presents at birth

Question 4

What is the glycaemic profile of a glucokinase mutation MODY?

Answer 4

stable hyperglycaemia

Question 5

How is glucokinase MODY treated?

Answer 5

dietry controlled

Question 6

What transcription factors are affected in TF MODY mutations?

Answer 6

HNF1 alpha
HNF1 beta
HNF4 alpha

Question 7

What age to transcription factor MODY present?

Answer 7

adolescence

Question 8

What is the glycaemic profile of a transcription factor MODY?

Answer 8

preogressive hyperglycaemia

Question 9

How are transcription factor MODYs treated?

Answer 9

diet
Oral hypoglycaemic agents
insulin

Question 10

what transcription factor MODY can be managed with sulphonylureas?

Answer 10

HNF1 alpha

Question 11

What is the aetiology of MODY?

Answer 11

Young onset
strong FHx
associated renal cysts
GAD negative
C peptide positive

Question 12

What is the cause of neonatal diabetes?

Answer 12

Mutation in K+ channel gene
ATP does not close Katp channel
Hyperpolarisation
no Ca2+ influx
no insulin released

Question 13

When is transient neonatal diabetes a) diagnosed b) resolved?

Answer 13

a) less than 1 week

b) median 12 weeks

Question 14

When is permanent neonatal diabetes diagnosed?

Answer 14

0-6 weeks

Question 15

What is the treatment for neonatal diabetes?

Answer 15

insulin in first 3 months

may need lifelong treatment

Question 16

What are the genetic causes of Type 3 diabetes?

Answer 16

Cystic fibrosis
Myotonic dystrophy
Turner’s syndrome

Question 17

What are the endocrine causes of Type 3 diabetes?

Answer 17

Cushing’s
Acromegaly
Phaeochromocytoma
Glucagonoma

Question 18

What are the drug induced causes of Type 3 diabetes?

Answer 18

Glucocorticoids
Diuretics
Beta blockers

Question 19

What are the oancreatic causes of type 3 diabetes?

Answer 19

chronic/recurrant pancreatitis
Haemochromatosis
Cystic fibrosis

Question 20

What is type 4 diabetes and how is it characterised?

Answer 20

Gestational diabetes

Any degree of glucose intolerance in pregnancy

Question 21

What happens in diabetes insipidus?

Answer 21

ADH disturbances
Not registered in kidney
Higher volume, less concentrated urine
Symptoms of thirst

Question 22

What happens in diabetes insipidus?

Answer 22

ADH disturbances in ant pit
Not registered in kidney
Higher volume, less concentrated urine
Symptoms of thirst

Question 23

How does gestational diabetes occur?

Answer 23

Progesterones and hPL cause insulin resistance

if already predisposed rise in blood glucose

Question 24

What are the foetal complications of gestatoinal diabetes?

Answer 24

congenital malformation
prematurity
intrauterine growth retardation
macrosomia (>90th centile size)
polyhydramnios
stillbirth

Question 25

What are the complications of gestational diabetes in neonates?

Answer 25

respiratory distress

hypo/hyperglycaemia

Question 26

How is gestational diabetes managed?

Answer 26

pre pregnancy counselling
folic acid 5mg
change from tablets to insulin
regular eye checks
Avoid ACEI (use labetalol, nifedipine, methy dopa)

Question 27

how do you ensure resolution of gestational diabetes?

Answer 27

6 weeks post natal GTT

Question 28

What %age of gestational diabetics go on to have in next 10 years

a) type 1
b) type 2?

Answer 28

a)

Question 29

How do you prevent post gestational diabetes from becoming permenant?

Answer 29

low weight
healthy diet
aerobic exercise
annual fasting glucose

Question 30

When does gestational diabetes present?

Answer 30

3rd trimester