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

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.