Diabetes

Question 1

What is the definition of diabetes?

Answer 1

Disorder of the metabolism causing excessive thirst and the production of large amounts of urine
Metabolic disease characterised by hyperglycaemia resulting from defect in insulin secretion, production or both

Question 2

5 types of diabetes?

Answer 2

Type 1
Type 2 
MODY
Gestational 
Other - caused by steroids

Question 3

What is type 1?

Answer 3

Auto immune - Pancreatic beta cells destruction

Insulin dependant

Question 4

What is type 1 characterised by?

Answer 4

Presence of anti GAD / anti islet cell antibodies

Question 5

When is a person thought to have type 2 diabetes?

Answer 5

When they don’t have the 1, monogenic diabetes or other medical conditions or Tx suggestive of secondary diabetes

Question 6

What is MODY?

Answer 6

Monogenic Diabetes (genetic)

Question 7

Secondary causes of diabetes?

Answer 7

Drugs
Pancreatic pathology
Endocrine causes

Question 8

Who discovered insulin in the treatment of diabetes and when?

Answer 8

Banting
Best
MacLeod 
Collio 
1922

Question 9

How did they figure out it helped in diabetes?

Answer 9

Dog pancreas removed and treated with insulin injections

Question 10

Who was the first person to receive insulin to treat their diabetes?

Answer 10

Leonard Thompson

Question 11

When is type one usually diagnosed?

Answer 11

Childhood

Question 12

What do people wit type 1 have high levels of in their blood?

Answer 12

Anti islet cell antibodies

Question 13

What is an insulin pump?

Answer 13

It administers short acting insulin through out the day
The rate can vary depending on the demand
Amount of insulin depends on carbohydrate intake

Question 14

What is a continuous glucose monitor?

Answer 14

Takes subcutaneous measurements and sends them to the pump

Question 15

What does the patient still have to decide on if they have a continuous glucose monitor?

Answer 15

How much insulin to take

Question 16

When is type 2 usually diagnosed?

Answer 16

> 40

Question 17

What is type 2?

Answer 17

Insulin resistant

Question 18

What is the underlying physiology of type 2?

Answer 18

Insulin resistance

Beta cell dysfunction

Question 19

What happens if you are insulin resistant?

Answer 19

Problem with downstream signalling from insulin receptors so the glucose can’t get into the cells and the blood sugar rises

Question 20

What do people have before developing type 2?

Answer 20

Impaired glucose tolerance

Question 21

What are the causes of insulin resistance?

Answer 21

Ectopic fat accumulation
Increase inflammatory mediators
Reduction in insulin

Question 22

What is insulin resistance associated with?

Answer 22

Intra abdominal obesity
Medication 
Smoking
Genetics
Inactivity 
Fetal malnutrition 
Endothelial disease
Polycystic ovaries 
Ageing 
Hypertension

Question 23

How are you tested for diabetes? (type 2)

Answer 23

Fasting glucose level >7

Given a high sugar drink and tested 2 hours later and if level >11.1 = diabetes

Question 24

Treatment for type 2?

Answer 24

Life style changed - can stop need for meds
Oral mono therapy 
Oral combination 
Injectable and oral therapy 
Drugs - metformin / sulphonylurea

Question 25

What is the reference range when monitoring glucose ?

Answer 25

~4-6%

Question 26

What is the target range when monitoring glucose levels in diabetics?

Answer 26

6.5 - 7.5%

Question 27

What is the target glucose level pre meals and post meals?

Answer 27

Pre meal = 4-7 | Post meal =

Question 28

What are the aims of therapy in diabetes?

Answer 28

Prevent hyperglycaemia Avoid hypoglycaemia Reduce chronic complication

Question 29

What are some macrovascular complications?

Answer 29

IHD | Stroke

Question 30

What are some microvascular complication ?

Answer 30

Neuropathy Nephoropathy Retinopathy

Question 31

What is diabetes the leading cause of in the UK?

Answer 31

Blindness Dialysis Amputation

Question 32

What is done when screening for microvascular complications?

Answer 32

Annual urinary albumin creatinine ratio to screen for kidney disease Annual retinal photograph Annual foot screening

Question 33

What do the CVR guidelines state about statins?

Answer 33

Give them to diabetics >40 regardless of baseline cholesterol

Question 34

What happens when glucose falls?

Answer 34

Release of counter regulatory hormones | Stimulate glycogenolysis

Question 35

What is reduced hypoglycaemia awareness?

Answer 35

Repeated exposure to hypo reduced warning signs

Question 36

Precipitating factors of hypoglycaemia?

Answer 36

``` Dosage of insulin Error in does administered Timing of meds Alcohol Exercise Renal, adrenal, pituitary insufficiency ```

Question 37

What is DKA?

Answer 37

Diabetic Ketoacidosis

Question 38

What is HNC/HONK?

Answer 38

Hyperosmolar non ketotic coma

Question 39

What type of diabetes do DKA and HNC/HONK occur?

Answer 39

``` DKA = type 1 HNC/HONK = type 2 ```

Question 40

Precipitating factors of DKA

Answer 40

``` Acute illness Injury or infection Medications Poor compliance or error in compliance with tx Psychological / social issues ```

Question 41

What other conditions does diabetes make people at risk to?

Answer 41

Stroke Visual impairment Renal disease Cardiovascular disease

Question 42

Why is there an increased risk of a hyper/hypo in patients with tooth ache

Answer 42

Poor oral intake Sepsis Sleep deprivation All resulting in pt modifying their normal drug regime