What is Diabetes Mellitus? (including Epidemiology of Diabetes)

Question 1

How does the body make/get glucose?

Answer 1

Oral intake - Glucose absorbed from the gut

Hepatic - Gluconeogenesis and Glycogen breakdown

Question 2

what uses glucose in the body?

Answer 2

brain

muscle

adipose tissue

Question 3

A continuous supply of glucose is essential for what?

Answer 3

the brain

Question 4

Levels of glucose and other nutrients entering the blood ____ _________ during the day

But, between a complete carbohydrate blow-out and NO food ingested, blood glucose concentrations are ____________ ____ _ _____ _____

Answer 4

Levels of glucose and other nutrients entering the blood vary markedly during the day

But, between a complete carbohydrate blow-out and NO food ingested, blood glucose concentrations are maintained over a fairly tight range

Question 5

Insulin dominates the _________ state; it is the only hormone which ______ blood glucose levels

Answer 5

Insulin dominates the absorptive state; it is the only hormone which lowers blood glucose levels

Question 6

study this image carefully and think about it

Answer 6

Question 7

affect of insulin on A

Answer 7

Reduced lipolysis

Question 8

affect of insulin on B

Answer 8

Reduced glucose production

Question 9

affect of insulin on C?

Answer 9

Increased glucose uptake

Question 10

what is the definition of diabetes?

Answer 10

“a group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both”

Question 11

what symptoms does hyperglycaemia cause?

Answer 11

polydipsia - excessive thirst or excess drinking

polyuria - excessive or an abnormally large production or passage of urine

blurred vision - Eye balls change shape leading to blurred vision

weight loss

infections

Question 12

what does metabolic decompensation caused by hyperglycaemia cause?

Answer 12

DKA/HHS

(Hyperosmolar Hyperglycaemic State)

Question 13

what are long term complications of hyperglycaemia?

Answer 13

microvascular (retinopathy, neuropathy, nephropathy)

macrovascular (stroke, MI, PVD)

(Retinopathy is any damage to the retina of the eyes, which may cause vision impairment)

(neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord from and to the rest of the body are damaged or diseased)

(Nephropathy is a general term for the deterioration of proper functioning in the kidneys)

Question 14

name A?

All values are for venous plasma samples and units are mmol/L

Answer 14

Question 15

name B

All values are for venous plasma samples and units are mmol/L

Answer 15

Question 16

name C?

All values are for venous plasma samples and units are mmol/L

Answer 16

Question 17

How can HbA1c levels diagnose diabetes?

Answer 17

Diagnostic HbA1c ≥ 48 mmol/mol

Question 18

what is intermediate hyperglycaemia?

Answer 18

Increased risk of diabetes but don’t yet have it

Close eye of them, may get a yearly check up

a state of raised glycaemic levels in a person without diabetes

It is an independent risk-factor for type 2 diabetes and cardiovascular disease

The primary aim of management of intermediate hyperglycaemia is to prevent progression to diabetes

Question 19

How do you diagnose diabetes

Answer 19

measure blood glucose or HbA1c

ONE diagnostic lab glucose plus symptoms

TWO diagnostic lab glucose or HbA1c levels without symptoms

Question 20

What levels are rquired for someone to have intermediate hyperglycaemia?

Answer 20

Impaired fasting glucose 6.1-7 mmol/l

Impaired glucose tolerance 2h glucose ≥7.8 and <11mmol/l

HbA1c 42-47mmol/mol

Question 21

why the criteria for diabetes?

Answer 21

Diabetes diagnostic criteria identify a group with significantly increased premature mortality and increased risk of microvascular and cardiovascular complications

Question 22

What is normoglycaemia?

Answer 22

‘normoglycaemia’ is used for glucose levels associated with low risk of developing diabetes or cardiovascular disease

Question 23

What is intermediate hyperglycaemia?

Answer 23

Intermediate hyperglycaemia (IGT and IFG) identifies a group at higher risk of future diabetes and adverse outcomes such as cardiovascular disease

Question 24

What does diabetes diagnostic criteria say about a person?

Answer 24

Diabetes diagnostic criteria identify a group with significantly increased premature mortality and increased risk of microvascular and cardiovascular complications

Question 25

how can HbA1c be used in diagnosing diabetes?

Answer 25

Glucose in the blood binds irreversibly to a specific part of haemoglobin in red blood cells, forming HbA1c The higher the glucose, the higher the HbA1c HbA1c circulates for the lifespan of the red blood cell, so reflects the prevailing blood glucose levels over the preceding 2-3 months American Diabetes Association have recommended that HBA1c can be used to diagnose diabetes (HbA1c \>/= 48)

Question 26

what are the advantages of using glucose as a diagnostic tool?

Answer 26

established method smaller variation between labratories more feasible in developing countries directly measures molecule thought to cause diabetic complications

Question 27

what are the disadvantages of using glucose as a diagnostic tool?

Answer 27

requies a fasting state may require OGTT higher variability within individuals

Question 28

what are the advantages of using HbA1c as a diagnostic tool?

Answer 28

No need for a fasting sample More stable after collection Marker of glycaemic control Lower variability within individuals

Question 29

what are the disadvantages of using HbA1c as a diagnostic tool?

Answer 29

Measurement can be misleading with haemoglobinopathies, anaemia or renal failure May differ with age & ethnicity More costly Surrogate marker of hyperglycaemia

Question 30

When can HbA1c not be used for diagnosis?

Answer 30

All children and young people Pregnancy—current or recent (\< 2 months) Short duration of diabetes symptoms Patients at high risk of diabetes who are acutely ill (HbA1c ≥ 48 mmol⁄ mol confirms pre-existing diabetes, but a value \< 48 mmol ⁄ mol does not exclude it and such patients must be retested once the acute episode has resolved) Patients taking medication that may cause rapid glucose rise; for example, corticosteroids, antipsychotic drugs (2 months or less). HbA1c can be used in patients taking such medication long term (i.e. over 2 months) who are not clinically unwell Acute pancreatic damage or pancreatic surgery Renal failure Human immunodeficiency virus (HIV) infection

Question 31

what are the types of diabetes?

Answer 31

Maturity Onset Diabetes of the Young (MODY) is an inherited form of diabetes mellitus

Question 32

what is the most common type of diabetes?

Answer 32

Question 33

is diabete sincreasing or decreasing around the world?

Answer 33

increasing

Question 34

is the numbers of diabetes increasing in scotland?

Answer 34

yes 5.5% of the population now have it

Question 35

what is the cause of type 1 diabetes?

Answer 35

Many different antibodies you can use to look for Looking for antibodies that are attacking part of the pancreas attacking B cells leading to a lack of insulin Anti GAD main ones

Question 36

what is the genetic risk of type 1 diabetes?

Answer 36

if father has type 1 = 6% risk if mother has type 1 = 1% risk if both parents have type 1 = 30% risk if sibling has type 1 = 8% risk Monozygotic twins = 30-50% concordance If non-identical twin has Type 1 = 10% risk

Question 37

Development of Type 1 Diabetes Mellitus requires what?

Answer 37

Genetic pre-disposition plus: Trigger e.g.? Viral infection Auto immunity People can be diagnosed at all different ages and it is unknown why people develop it at certain points Struggled to find the underlying thing that starts the process Patient with type 1 diabetes more likely to have other autoimmune conditions like coeliac disease and thyroid disease

Question 38

T1DM is characterised by what?

Answer 38

insulin deficiency

Question 39

flow chart showing type 1 diabetes summary

Answer 39

Question 40

What is the clinical presentation of type 1 diabetes mellitus on the short term?

Answer 40

* Thirst * Tiredness * Polyuria/nocturia * Weight loss * Blurred vision * Abdominal pain Key message – essential to make this diagnosis. Don’t ignore these symptoms at any age

Question 41

What is the clinical presentation of type 1 diabetes mellitus on examination?

Answer 41

* Ketones on breath * Dehydration * May have increased respiratory rate, tachycardia, hypotension * Low grade infections, thrush/balanitis

Question 42

how did the survival time of T1DM change after the discovery of insulin

Answer 42

it greatly increased

Question 43

describe the evolution of type 2 diabetes

Answer 43

Pancreas becomes tired trying to overcome the increasing insulin resistance then glucose levels rise

Question 44

what is the genetics of type 2 diabetes?

Answer 44

* Identical twin = 90-100% risk * One parent = 15% risk * Both parents = 75% risk * Sibling = 10% risk * Non-identical twin = 10% risk

Question 45

study this image as previously seen

Answer 45

Insulin has a key role in cellular metabolism

Question 46

A

Answer 46

altered lipolysis

Question 47

B

Answer 47

increased glucose production

Question 48

C

Answer 48

reduced glucose uptake

Question 49

Body not bale to produce enough insulin to keep up =

Answer 49

hyperglycaemia

Question 50

what are the symptoms of type 2 diabetes?

Answer 50

May have no symptoms * Thirst * Tiredness * Polyuria/nocturia * Sometimes weight loss * Blurred vision * Symptoms of complications e.g. CVD

Question 51

what are the signs of type 2 diabetes?

Answer 51

* Not ketotic * Usually overweight but not always * Low grade infections, thrush/balanitis * In type 2 DM may have micro vascular or macrovascular complications at Dx

Question 52

Screening for diabetes in asymptomatic populations: Who would you encourage to have a risk assessment?

Answer 52

All eligible adults aged 40 and above, except pregnant women People aged 25–39 of South Asian, Chinese, African- Caribbean, black African and other high-risk black and minority ethnic groups, except pregnant women Adults with conditions that increase the risk of type 2 diabetes

Question 53

What are particular conditions can increase the risk of type 2 diabetes?

Answer 53

cardiovascular disease hypertension obesity stroke polycystic ovary syndrome a history of gestational diabetes mental health problems

Question 54

what are other types of diabetes?

Answer 54

* Recognised genetic syndromes: MODY - genetic cause of diabetes * Gestational diabetes - occurring in pregnancy * Secondary diabetes - occurring due to pancreatic insult

Question 55

Describe the features of MODY: Maturity Onset Diabetes in the Young

Answer 55

* Autosomal dominant * ? 5% of people with diabetes * Impaired beta-cell function * Single gene defect

Question 56

what is important in people with new onset diabetes?

Answer 56

take a history

Question 57

what are the 2 ways MODY is caused?

Answer 57

Glucokinase mutations: - Onset at birth - Stable hyperglycaemia - Diet treatment - Complications rare Transcription factor mutations (HNF-1a, HNF-1b, HNF-4a): - Adolescence/young adult onset - Progressive hyperglycaemia - 1/3 diet, 1/3 OHA, 1/3 Insulin - Complications frequent

Question 58

What is Gestational diabetes - hyperglycaemia of pregnancy?

Answer 58

Increasing insulin resistance in pregnancy Associated with FH of Type 2 diabetes Increased risk of Type 2 diabetes later in life Develops 2nd/3rd trimester More common if overweight and inactive Neonatal problems – macrosomia/respiratory distress/neonatal hypoglycaemia

Question 59

what is secondary diabetes?

Answer 59

Any major disease of the exocrine pancreas can be associated with development of diabetes e.g. Chronic pancreatitis, Haemochromatosis, Cystic fibrosis Endocrinopathies e.g. Acromegaly, Cushing’s syndrome, Glucagonoma, Phaeochromocytoma Drug or chemical induced diabetes e.g. steroids