54 Diabetes

Question 1

What is the normal level of blood glucose?

Answer 1

5mmol/l.

Question 2

Simply, what does insulin do?

Answer 2

Stops release of glucose from liver by increasing glycogen formation.
Increases glucose uptake into the tissues.

Question 3

Define hypo and hyperglycaemia.

Answer 3

Hypo: less than 4mmol/l
Hyper: over 11mmol/l.

Question 4

Define a syndrome:

Answer 4

Collection of symptoms and signs due to more than one cause.

Question 5

What are the symptoms and signs of diabetes? (7).

Answer 5

Thirst.
Tiredness.
Polyuria.
Weight loss.
Dry mouth.
Glycosuria.
Hyperglycaemia.

Question 6

What are the diagnostic criteria for diabetes? (4)

Answer 6

Symptoms and:
Fasting blood glucose > 7mmol/l.
OGTT >11mmol/l.
HbA1c >48mmol/mol.

Question 7

How is a oral glucose tolerance test (OGTT) carried out?

Answer 7

Fasting.
75g oral glucose load.
Measure blood glucose 2hrs after.

Question 8

What are the diagnostic criteria for borderline diabetes? (2).

Answer 8

Impaired fasting glucose: 6-7mmol/l.

Impaired OGTT response: 7.8-11mmol/mol.

Question 9

What is type 1 diabetes due to?

Answer 9

Lymphocyte infiltration and autoimmune destruction of insulin producing beta islet cells of pancreas.

Question 10

Which autoantibodies are present in type 1 diabetes? (3).

Answer 10

ICA.
IA2.
GAD.

Question 11

What is latent autoimmune diabetes in adults (LADA)?

Who gets it?

Answer 11

Type 2 with islet destruction over time.

Older females.

Question 12

Which conditions are associated in the PMH/FH with LADA? (6).

Answer 12

Type 1 diabetes.
Thyroid.
Psoriatic arthritis.
Addison’s.
Coeliac.
Vitiligo.

Question 13

Which autoantibodies are seen in LADA? (4).

Answer 13

GAD.
ICA.
tTG.
TPO.

Question 14

What is the typical presentation of type 2 diabetes? (5).

Answer 14

Insulin resistant.
Strong family history.
Obese.
Hypertensive + hyperlipidaemic.

Question 15

What is ketosis prone type 2 diabetes?

Answer 15

Temporary ketosis when stressed with illness.

Temporarily requires insulin.

Question 16

Which pancreatic disorders may diabetes be secondary to? (5).

Answer 16

Pancreatitis (acute or chronic).
Pancreatectomy.
Pancreatic cancer.
Cystic fibrosis.
Haemochromatosis.

Question 17

Which drugs may induce diabetes? (4).

Answer 17

Diuretics.
Steroids.
Anti-psychotics: olanzapine.

Question 18

Which endocrine disorders may cause diabetes? (3).

Answer 18

Acromegaly (too much IGF-1).
Cushing’s (cortisol increases glucose levels).
Pheochromocytoma (less insulin).

Question 19

What is MRDM?

Answer 19

Malnutrition related diabetes.

Question 20

What is J type/Flatbrush diabetes? (3).

Answer 20

Ketosis prone.
On and off insulin therapy.
Not particularly obese.

Question 21

Which genetic syndromes can cause diabetes? (2).

Answer 21

Friedrich’s ataxia.

Dystrophia myotonica.

Question 22

Describe the diagnostic criteria for gestational diabetes: (2).

Answer 22

Appears during pregnancy.

Resolves after pregnancy.

Question 23

Are women with gestational diabetes at increased risk of diabetes in the future?

Answer 23

Yes.

Question 24

Describe mature onset diabetes in the young: (3).

Answer 24

Autosomal dominant.
Starts under 25y/o.
Insulin not required initially.

Question 25

Name the genes implicated in mature onset diabetes in the young: (3).

Answer 25

Glucokinase.
HNF 1A.
HNF 4A.