What is Diabetes Mellitus?

Question 1

What are the symptoms of hyperglycemia?

Answer 1

Polydipsisa
Polyuria
Blurred vision
Weight loss
Recurrent infections

Question 2

What are the short and long term complications of hyperglycaemia?

Answer 2

Short term- DKA
Long term:
-microvascular- nephropathy, retinopathy, neuropathy
-macrovascular- stroke. MI, PVD

Question 3

What are the diagnostic levels of blood glucose, HbA1c and OGTT for diabetes?

Answer 3

Blood glucose- random >11.1mmol/L or fasted >7.0mmol/L
OGTT 2hrs after 75g CHO > 11.1mmol/L
HbA1c>48mmol/L

Question 4

What levels of blood glucose, OGTT and HbA1c indicate intermediate hyperglycaemia?

Answer 4

Fasting glucose- 6.1-7.0mmol/L
OGTT- 7.8-11.1mmol/L
HbA1c- 42-47mmol/L

Question 5

How is diabetes diagnosed clinically?

Answer 5

One diagnostic lab glucose plus symptoms

Two diagnostic lab glucose or HbA1c if asymptomatic

Question 6

What is HbA1c and why is it useful?

Answer 6

Glycated haemoglobin, useful as it gives an idea of the blood glucose levels over the last 8-12 weeks

Question 7

When can HbA1c not be used for diagnosis?

Answer 7

In children
In pregnancy (or recent pregnancy < 2 months)
Short duration of diabetic symptoms
Patients at high risk of diabetes who are acutely ill
Patients taking corticosteroids or anti-psychotics for less than 2 months
Acute pancreatic damage/surgery
Renal failure
in HIV+ patients

Question 8

How does type 1 diabetes usually present?

Answer 8

Symptoms:
-polyuria
-polydipsia
-tiredness
-weight loss
-blurred vision
-abdominal pain
On examination:
-ketones on breath
-dehydration
-may have increased resp/heart rate or BP 
-low grade infections (ie thrush)

Question 9

What are the symptoms of type 2 diabetes?

Answer 9

May be asymptomatic, but symptoms can include:

• Thirst
• Tiredness
• Polyuria/nocturia
• Weight loss (rare)
• Blurred vision
• Symptoms of complications

Question 10

What are the signs of type 2 diabetes?

Answer 10

Not ketotic
Usually but not always overweight
Low grade infections
Micro or macrovascular complications

Question 11

What are the risk factors for type 2 diabetes?

Answer 11

Overweight
Family history
Age (over 30 if Maori/Asian, over 40 if European)
History of gestational diabetes
Had a big baby
Inactive lifestyle
Previous high blood glucose

Question 12

What is MODY?

Answer 12

Maturity onset diabetes in the young

Autosomal dominant condition

Question 13

What are the two possible mutations that result in MODY and how does each present/

Answer 13

Glucokinase mutations- presents at birth, stable hyperglycaemia, controlled with diet treatment and complications are rare
Transcription factor mutations- presents in adolescence/young adulthood, progressive hyperglycaemia, controlled with diet, insulin and oral hypoglycaemic agents, complications are frequent

Question 14

What are the causes of secondary diabetes mellitus?

Answer 14

Drug therapy
Pancreatic destruction
Recognised genetic syndromes
Rare endocrine disorders

Question 15

What causes gestational diabetes, when does it develop and what are the risk factors?

Answer 15

An increased resistance to insulin during pregnancy
Develops in the 2nd/3rd trimester
Risk factors include and inactive lifestyle and a family history of type 2 diabetes