What is Diabetes?

Question 1

how is the incidence of each type of diabetes changing?

Answer 1

type 2 largely (obesity) increasing

type 1 slightly increasing (unknown reason)

Question 2

what are the 2 forms of diabetes?

Answer 2

mellitus = pancreas problem
insipidus = pituitary problem

Question 3

what is diabetes?

Answer 3

group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, action or both

Question 4

why does diabetes develop?

Answer 4

insufficient insulin to maintain glucose homeostasis either due to

• absolute insulin deficiency (type 1)
• relative insulin deficiency (type 2)
• failure of insulin synthesis, release or activity (MODY)

Question 5

what are the 4 classifications of diabetes?

Answer 5

type 1
type 2
gestational diabetes mellitus (only appears in pregnancy)
specific types of diabetes due to other causes (e.g MODY) - basically all other types

Question 6

WHO definition of type 1?

Answer 6

pancreatic beta cell destruction/insulin is required for survival
characterised by the presence of anti GAD/anti islet antibodies

Question 7

WHO definition of type 2?

Answer 7

diagnosis of exclusion

Question 8

histological features of type 1 diabetes?

Answer 8

insulitis - lymphocytic infiltrate

Question 9

type 1 vs type 2 pathogenesis?

Answer 9

1 = beta cell failure and absolute insulin deficiency
2 = hyperinsulinaemia + insulin resistance

Question 10

how does type 1 present?

Answer 10

pre-school and peri puberty peak incidence
small peak in 30s
usually lean
acute onset
severe symptoms
severe weight loss
ketonuria +/- metabolic acidosis
no evidence of microvascular disease at diagnosis
immediate and permanent requirement for insulin

Question 11

type 2 presentation?

Answer 11

middle aged/elderly
usually obese
pre-diagnosis duration of 6-10 years
insidious onset over weeks to years
ketonuria minimal or absent
evidence of microvascular disease at diagnosis in 20%
managed initially with diet tablets

Question 12

features of stage 1 of type 1 DM?

Answer 12

stage 1 = autoimmunity, normoglycaemia, presymptomatic

Question 13

features of stage 2 of type 1?

Answer 13

autoimmunity
dysglycaemia
presymptomatic

Question 14

type 2 risk factors?

Answer 14

central obesity
family history
gestational diabetes
age
ethnicity (Asian, African, afro-Caribbean)
MI/stroke history
medications - antipsychotics
IGT/IFG

Question 15

how does DM present?

Answer 15

thirst
polyuria
thrush
weakness/fatigue
blurred vision
infections
weight loss
Type 2 = signs of complications, neuropathy, retinopathy

Question 16

features of idiopathic type 1?

Answer 16

permanent insulinopenia
prone to DKA
no evidence of B cell autoimmunity
often African or Asian
strongly inherited but not HLA associated
episodic DKA with varying insulin deficiency between episodes

Question 17

causes of type 4?

Answer 17

pancreatic disease - pancreatitis, haemochomatosis, CF
endocrine disease - cushings, acromegaly, phaechromocytoma, glucagonoma
drug induced - glucocorticoids, diuretics, B blockers
abnormalities of insulin and its receptor
genetic disease - CF, myotonic dystrophy, turners syndrome

Question 18

features of monogenic diabetes?

Answer 18

strong family history
assoc features - renal cysts
young onset
GAD negative
C peptide positive

Question 19

types of diabetes complications?

Answer 19

macro-vascular - heart disease, stroke
micro-vascular - retinopathy, nephropathy, neuropathy
psychology/psychiatry

Question 20

deformity associated with charcots foot?

Answer 20

rocker bottom

Question 21

how can you diagnose diabetes?

Answer 21

random blood glucose
fasting glucose
NOT RANDOM FINGER PRICK

Question 22

which is diagnostic of diabetes

• fasting glucose of 7.8
• HbA1c of 6.1%
• 2 hr OGTT level of 10.1
• +++ glycosuria on dipstick
• random blood glucose (fingerprick) reading of 16.1

Answer 22

7.8

Question 23

neuropathy is macrovascular disease, true or false?

Answer 23

false

microvascular

Question 24

40% of diabetics die from CV events, true or false?

Answer 24

false

Question 25

DAFNE is what?

south Asians are more suscdeptible to diabetes than Caucasians, true or false?

Answer 25

DAFNE = education programme

false

Question 26

features of stage 3 type 1 diabetes?

Answer 26

new onset hyperglycaemia
symptomatic
diagnosis = clinical symptoms and standard criteria

Question 27

diabetes risk factors?

Answer 27

first degree relative with diabetes
high risk race/ethnicity
history of CVD
hypertension
HDL cholesterol <35 mg/dL and/or triglyceride level >250mg/dL
women with polycystic ovary syndrome
physical inactivity
other clinical conditions associated with insulin resistance (obesity, acanthosis nigricans etc)