Diabetes

Question 1

What is Diabetes mellitus ?

Answer 1

Disorder of metabolism characterised by hyperglycaemia

Question 2

What glucose levels are used for the cut off for the diagnosis of DM ? (3)

Answer 2

1. Fasting glucose levels > 7mmol/l
2. OGTT/Random glucose > 11.1mmol/l
3. HbA1c > 48mmol/l

Question 3

What is the normal value for the FF:

a) fasting glucose
b) OGTT/Random glucose

Answer 3

A) less than 6.1 mmol/l

B) less than 7.8 mmol/l

Question 4

What is impaired fasting glycaemia ?

Answer 4

Impaired fasting glycaemia is when an individual has fasting glucose levels above the normal range but below the diagnostic range for diabetes

Question 5

State the value for impaired fasting glycaemia

Answer 5

Greater than 6.1mmol/l but less than 7 mmol/l

Question 6

What is impaired glucose tolerance ?

😭

Answer 6

Impaired glucose tolerance is a stage of impaired glucose seen in any disorder of hyperglycaemia but it is not diabetes

Question 7

State the fasting glucose values for impaired glucose tolerance

Answer 7

Less than 7 mmol/l (6.1-7)

Question 8

State the random/OGTT values for impaired glucose tolerance

Answer 8

Greater than 7.8 mmol/l but Less than 11.1mmol/l (7.8-11.1mmol/l)

Question 9

What are the 4 main types of diabetes ?

Answer 9

1.T1DM 2.T2DM 3. Gestational diabetes 4.MODY

Question 10

When does T1DM occur ?

Answer 10

T1DM occurs when the pancreas fails to produce enough insulin,i.e, insulin deficiency. This is due to autoimmune destruction of the pancreatic islet B cells

Question 11

What does T2DM begin with and progress to ?

Answer 11

T2DM begins with insulin resistance and progresses to a decrease in insulin secretion

Question 12

What is insulin resistance ?

Answer 12

When cells fail to respond to insulin properly lead to IFG and IGT

Question 13

What is gestational diabetes ?

Answer 13

Gestational diabetes occurs during pregnancy with no previous history or diagnosis of diabetes

Question 14

What is MODY ?

Answer 14

Maturity onset diabetes in the young is a autosomal dominant form of type 2 diabetes that occur in young patients with a positive family history of diabetes

Question 15

State the 6 groups into which the secondary causes of diabetes can be grouped into ?

Answer 15

1.drugs 2.pancreatic 3.genetitic syndrome and defects 4. Endocrine causes 5. Wolfam’s. Syndrome 6. others

Question 16

State the secondary causes of diabetes for drugs ? (5)

Answer 16

CAB IT

1. Corticosteroids
2. Anti-HIVs (anti-retrovirals protease inhibitors
3. Anti-psychotics
4. Beta-blockers
5. Thiazides

Question 17

State the secondary causes of diabetes for pancreatic ? (4) 😭

Answer 17

1. Chronic pancreatitis
2. Surgical removal of the pancreas (pancreatomy)
3. Trauma and destruction (haemochromatomasis and CF)
4. Pancreatic cancer
   D+C can cause diabetes via inhibition of enzyme release

Question 18

State the secondary causes of diabetes for genetic syndromes (3) and defects

Answer 18

DKT: 1. Downs 2. Kleinfeiters 3.Turners

4. Genetic defects in B-cell and insulin function

Question 19

State the endocrine secondary causes of diabetes

Answer 19

PACT

1. Phaeochromocytoma
2. Acromegaly
3. Cushing’s
4. Thyrotoxicosis

Question 20

Wolfam’s syndrome

Answer 20

Secondary cause of diabetes

Question 21

State the other secondary causes of diabetes (4)

Answer 21

1. Obesity
2. Cirrhosis
3. Congenital dystrophy
4. Glycogen storage Diseases

Question 22

What must T1DM patients have ?

Answer 22

Insulin

Question 23

What are the 3 clinical presentations of T1DM ?

Answer 23

1. Mainly occurs in young patients, i.e, adolescents peak age 13, but can occur at any age
2. Associated with LADA
3. There may be a family history or concurrent autoimmune disease

Question 24

What are 3 signs and symptoms of T1DM and when do these all occur ?

Answer 24

1. Severe polyuria and polydysia due to PERSISTENT hyperglycaemia
2. Weight loss
3. Ketosis ( KETOACODOSIS and ketonuria on urine -dipstick)
   These all occur over weeks

Question 25

What are the 5 clinical presentations of T2DM ?

Answer 25

1. Asymptomatic but there my be a complication e.g MI 2. Increases with age (i.e older patients), obesity and lack of physical activity 3. Family history is more common 4. Occurs more frequently in patients with hypertension and dyslipidaemia 5. Fatigue

Question 26

State 2 differences between T1DM and T2DM ?

Answer 26

1. In T2DM, patients may present with complications FIRST 2. Ketoacidosis and osmotic symptoms such as polyuria and polydypsia Are less common patients with T2DM

Question 27

Describe the dietary treatment for diabetes including what they should do generally

Answer 27

1.Reduce fat intake, specifically saturated fats. Fat=35% of total intake with Sats + Trans < 10% 2. Protein: 1g/1kg 3. CHO: 40-60% of total intake 4. Salt: less than 6g a day. Diabetic hypertensive patients should have less than 3g/day Generally, pick foods with low GI, increase fruit fibre, veg. Some alcohol is allowed

Question 28

State the 4 ways in which diabetic control can be evaluated

Answer 28

1. Urine glucose testing 2. Self-monitored blood glucose testing 3. Measurement of HbA1c 4. Continuous blood glucose monitoring

Question 29

When is it best to do urine testing ?

Answer 29

In the morning

Question 30

What are the 3 things you need to know about Urine testing ?

Answer 30

1. Identifies high urine glucose and ketones. 2. However, does not give you an idea of current blood glucose levels (as urine glucose lags behind that of blood glucose 3. It Does not give you an idea about whether glucose is too low, i.e hypoglycaemia goes unmarked

Question 31

State 2 features of self monitored blood glucose testing

Answer 31

1. Best and immediate indication of blood glucose levels | 2. Monitors hypoglycaemia and hyperglycaemia

Question 32

State the target for Hb A1C

Answer 32

Less than 48mmol/l

Question 33

State the 2 features of Hb A1C

Answer 33

1. Gives indication of long-term glycaemic control | 2. Ideally than once a year

Question 34

What is the indication for continuous glucose monitoring ?

Answer 34

It is offered to people with poor-hypoglycaemic awareness

Question 35

State 2 features of continuous glucose monitoring

Answer 35

1. Measures glucose in ICF | 2. Gives a hundred readings a day