4: What is diabetes?

Question 1

The number of people with diabetes in Scotland is (increasing / decreasing).

Answer 1

increasing

Question 2

Which types of diabetes involve

a) an absolute
b) a relative

insulin deficiency?

Answer 2

a) Type 1 diabetes - absolute insulin deficiency

b) Type 2 diabetes - relative insulin deficiency

Question 3

What is the definition of diabetes mellitus?

Answer 3

Group of diseases featuring hyperglycaemia

caused by probs with insulin secretion, insulin action or both

Question 4

What is the normal range for glycated haemoglobin (HbA1c)?

Answer 4

41 mmol/L or less

Question 5

What concentration of HbA1c is diagnostic of diabetes?

Answer 5

48 mmol/L or above

Question 6

What is the upper limit of normal fasting glucose concentration?

Answer 6

6.0 mmol/L

Normal is around 5.5 mmol/L

Question 7

What fasting glucose concentration is diagnostic of diabetes?

Answer 7

7.0 mmol/L or above

Question 8

What is the upper limit of normal glucose concentration 2 hours after an oral glucose tolerance test?

Answer 8

7.7 mmol/L

Question 9

What 2-hr OGTT glucose concentration is diagnostic of diabetes?

Answer 9

11.1 mmol/L or more

Question 10

If you were to take a random glucose measurement and it was more than __._ mmol/L, that would be diagnostic of diabetes.

Answer 10

11.1 mmol/L

Question 11

Type _ diabetes is characterised by autoimmune beta cell destruction.

Type 2 diabetes is a diagnosis of ___.

Answer 11

Type 1 diabetes is autoimmune

Type 2 is a diagnosis of exclusion

Question 12

What is the name for the inflammation seen in beta cells in Type 1 diabetes?

Answer 12

Insulitis

Question 13

Insulitis in Type 1 diabetes eventually causes total ___ of beta cells.

Answer 13

destruction

Question 14

What follows hyperglycaemia in Type 2 diabetes, creating a vicious cycle of disease?

Answer 14

Hyperglycaemia > Hyperinsulinaemia > Insulin resistance > Hyperglycaemia…

Question 15

Which type of diabetes is associated with ketoacidosis?

Answer 15

Type 1 diabetes

Question 16

Which patients does Type 1 diabetes tend to present in?

Answer 16

Young patients

Question 17

Type 1 diabetics tend to be (lean / overweight).

Answer 17

lean

Weight loss is a symptom

Question 18

Type 1 diabetics immediately require which treatment upon diagnosis?

Answer 18

Insulin

Question 19

What are the classical symptoms of Type 1 diabetes?

Answer 19

Increased urination frequency (polyuria, often smells sugary)

Increased thirst (polydipsia)

Fatigue

Weight loss

TOILET, THIRSTY, TIRED, THIN

Question 20

What four Ts describe the presentation of Type 1 diabetes?

Answer 20

Toilet

Thirsty

Tired

Thin

Question 21

What age are patients who present with Type 2 diabetes?

Answer 21

Older (mid 30s and up)

Question 22

Type 2 diabetics tend to be (lean / overweight).

Answer 22

overweight

Question 23

The pre-diabetic period before Type 2 diabetes starts in earnest lasts how long?

Answer 23

6 - 10 years

so by the time they’re diagnosed, complications have usually occurred :(

Question 24

Type 1 diabetes has a (rapid / insidious) onset.

Answer 24

Type 1 diabetes - rapid onset

Type 2 diabetes - insidious, over 6-10 years

Question 25

Do Type 2 diabetics tend to have smelly urine?

Answer 25

**No**, but you would know if it was Type 1/2 based off the history (older, overweight etc.)

Question 26

Is Type 2 diabetes managed with insulin injections?

Answer 26

**Not the first line therapy** but many go on to need injections when they get older

Question 27

What kind of diabetes occurs temporarily in pregnant mothers and increases their risk of developing Type 2 diabetes in the future?

Answer 27

**Gestational diabetes**

Question 28

Patients with a ___ history of diabetes are more likely to develop it.

Answer 28

**family history** it likely has a genetic component

Question 29

Patients with a history of ___ disease are more likely to develop Type 2 diabetes.

Answer 29

**cardiovascular disease**

Question 30

People with diabetes tend to get what fungal infection? Where?

Answer 30

**Candida** **spp.** i.e yeast infection - **THRUSH** ## Footnote **Groin**

Question 31

What early vision problem can Type 2 diabetics present with?

Answer 31

**Blurred vision**

Question 32

What are the general names for the complications of poorly controlled diabetes?

Answer 32

**Neuropathy** **Retinopathy** **Cardiovascular disease** - atherosclerosis, diabetic foot etc. **Nephropathy**

Question 33

In which type of diabetes do you get a positive anti-Islet antibody test?

Answer 33

**Type 1 diabetes** autoimmune basis

Question 34

If a person's ketones are elevated they likely have which type of diabetes?

Answer 34

**Type 1** ketoacidosis

Question 35

C-peptide is a component of proinsulin that is cleaved off during insulin production. It is used as a marker to distinguish Type 1 and Type 2 diabetes? How?

Answer 35

**Type 1 diabetics** have little / no insulin production (because their beta cells are destroyed), so they will have **little / no C-peptide** **Type 2 diabetics** still produce some insulin so they will have **greater levels of C-peptide** (once the disease has advanced to the point they can't produce insulin either, the test isn't any good)

Question 36

What are the four types of diabetes?

Answer 36

**Type 1** **Type 2** **Type "3"** - other diseases like pancreatitis, endocrine syndromes, drug-induced and MODY **Gestational diabetes**

Question 37

What is **LADA**?

Answer 37

**Late onset Type 1 diabetes**

Question 38

What is **MODY**?

Answer 38

**Mature onset diabetes of the young** caused by a **genetic mutation** - a Type "3" diabetes

Question 39

Apart from cardiovascular disease causing nephropathy, neuropathy and retinopathy, what is another complication of diabetes diagnosis?

Answer 39

**Psychological illness** depression, anxiety etc.