What is Diabetes

Question 1

What are the types of Diabetes?

Answer 1

Type 1 (Insulin Dependant DM)
Type 2 - (Insulin Independant DM)

Maturity Onset Diabetes in the Young (MODY)
Secondary DM
Gestational Diabetes

Question 2

Pathophysiology of Type 1 Diabetes

Answer 2

Autoimmune destruction of B-Cells in pancreas

Reduction in insulin secretion

Question 3

Describe the genetic component of Type 1 Diabetes?

Answer 3

Human Leukocyte Antigen (HLA) genes

Question 4

How do we treat type 1 diabetes?

Answer 4

Daily insulin injections (as Peptide hormones don’t work orally)

Question 5

Pathophysiology of Type 2 diabetes?

Answer 5

Increased Central Adiposity -> High circulating FAs in blood -> Reduced insulin sensitivity

+ Genetic component

Question 6

How do you treat Type 2 Diabetes

Answer 6

1) If you can catch them in a pre-diabetic stage you can restore sensitivity through exercise and diet
2) Oral Hypoglycaemics e.g. Metformin
3) Sulphonylureas
4) Insulin injections

Question 7

Explain the OGTT:

Answer 7

Take fasting glucose level
Give glucose
Measure after 2 hrs
If raised= diabetes

Question 8

How do we diagnose childhood onset diabetes?

Answer 8

4Ts:

• Tired
• Thinner
• Thirsty
• Toileting more (incl return to day or bed wetting)

Then test with a finger prick glucose test

If suspected refer to a specialist for a same day review

Question 9

Why is it so important to diagnose diabetes as quickly as possible?

Answer 9

Undiagnosed children can very easily go into Diabetic Ketoacidosis -> Coma -> Death

Question 10

Many children present with diabetes in Diabetic Ketoacidosis, how do we spot this?

Answer 10

N&V
Sweet Ketotic breath
Drowsiness
Kussmaul breathing 
Coma

Question 11

Signs and Symptoms of Uncontrolled Diabetes

Answer 11

Thirst (polydipsia)
Tiredness
Polyuria/nocturia
Weight loss
Blurred Vision
Abdominal pain
Dehydration
Can develop into DKA or HHS

Question 12

What are the methods of testing for Diabetes?

Answer 12

Random Glucose tests
Fasting Glucose Tests
Oral Glucose tolerance Test
HbA1c blood test

Question 13

What are the diagnostic criteria for Diabetes?

Answer 13

Two Diagnostic tests without symptoms

Or 1 diagnostic tests with symptoms

Question 14

What values would make a diagnostic test +ve for diabetes?

Answer 14

Fasting glucose > 7mmol/l
Random glucose >11.1mmol/l
OGTT >11.1mmol/l after 2 hours
HbA1C >48mmol/mol

Question 15

When can we not use an HbA1c test?

Answer 15

Anything that effects the haemoglobin level e.g.:

• Pregnancy
• Acute illnesses
• Renal failure
• very recent pancreatic damage/removal
• HIV
• Meds that cause short term glucose spikes e.g. CCS
• Children

Question 16

A diagnostic test for people with diabetes require showing they are hyperglycaemic, but what is intermediate hyperglycaemia?

Answer 16

Intermediate hyperglycaemia is where glucose/HbA1c levels are raised but don’t meet the threshold for diabetes.

These people are considered high risk for diabetes, CVD and associated complications

Question 17

Acute complications of diabetes

Answer 17

Diabetic Ketoacidosis (DKA)

Hyperosmolar Hyperglycaemia State (HHS)

Question 18

Define Diabetic Ketoacidosis?

Answer 18

Low levels of insulin cause a high level of Fatty Acids in the blood.
They’re converted to Ketone bodies in the liver to be used for energy
Causes acidosis of the blood leading to:
- N&V
- Sweet Ketotic breath
- Drowsiness
- Rapid deep sighing respiration (hyperventilation)
- Weakness, confusion -> Coma
- Polyuria

Question 19

Define Hyperosmolar Hyperglycaemic State

Answer 19

High blood sugar levels resulting in a high osmolarity of blood without significant ketoacidosis.

More common in Type 2, it leads to:
- Dehydration
Weakness
- Leg cramps
- Visual problems
- Altered Consciousness

Question 20

What is MODY?

Answer 20

An autosomal dominant genetic syndrome making up 5% of diabetics, thus important to check for FH of diabetes.

Basically a single gene defect leads to impaired B-cell function.

It looks like Type 2 but presents in young people

Question 21

What are the sub-types of MODY?

Answer 21

Depends on the kind of mutation:

Glucokinase mutations
# Onset at Birth
# Stable hyperglycaemia
# Treated with diet
# Rare complications

Transcription Factor Mutations
# Adolescent onset
# Progressive Hyperglycaemia
# Treated with diet, oral hypoglycaemics and insulin
# Frequent complications

Question 22

What is Secondary Diabetes Mellitus?

Answer 22

DM brought on by:

• Drugs e.g. CCS
• Pancreatic destruction/removal
• Genetic syndromes
• Endocrine disorders e.g pheochromocytoma, cushings or acromegaly

Question 23

What is gestational diabetes?

Answer 23

Increased insulin resistance brought on by pregnancy

Associated with FH of type 2, being overwight and inactive. It also increases risk of Type 2.

Question 24

What does gestational diabetes cause regarding the baby?

Answer 24

• Foetal Macrosomia (big baby)
• Neonatal Respiratory arrest
• Neonatal Hypoglycaemia

Question 25

Presentation of DKA

Answer 25

• Ketotic breath
• N&V
• Hyperventilation
• Tachypnoea/tachycardia

Question 26

Diabetes presentation in children <5

Answer 26

Heavier/wetter nappies
blurred vision
Candidiasis (oral or vulval)
Constipation
Recurrent skin infections
Irritability or behavioural changes