Diabetes

Question 1

What are the 2 types of type 1 diabetes based on pathophysiology? Which is most common?

Answer 1

Type 1 A which is immune mediated and type 1B which isn’t. Type 1A is most common.

Question 2

What is the peak age of presentation of type 1 diabetes?

Answer 2

Around the age of puberty

Question 3

What id the name given to the variant of T1DM that presents later in life?

Answer 3

Latent autoimmune diabetes in adults (LADA)

Question 4

Is T1DM genetically predetermined or is it a matter of genetic susceptibility?

Answer 4

Genetic susceptibility

Question 5

How strong is the heritability of type 2 diabetes mellitus?

Answer 5

Strong

Question 6

How does diabetes affect inflammatory factors?

Answer 6

Subclinical inflammatory changes like raised CRP, pro-inflammatory cytokines and raised clotting factors. These kinds of changes are also seen as a result of obesity.

Question 7

At diagnosis of T2DM how high are circulating insulin levels relative to normal? Why?

Answer 7

High. Due to insulin resistance.

Question 8

What happens to insulin levels in T2DM patients after diagnosis? Why?

Answer 8

A rise due to worsening insulin resistance followed by a decrease due to secretory failure.

Question 9

Does diabetes have a significant effect on life expectancy?

Answer 9

Yes, a man diagnosed between the ages of 40 and 59 has a decrease in lifespan on average of 5 to 10 years.

Question 10

How does diabetes present acutely?

Answer 10

Usually a young patient with a 2-6 week history of polyuria, polydipsia and weight loss

Question 11

How does diabetes present subacutely?

Answer 11

Often in older patients the onset is over months or years with the typical triad of polydipsia, polyuria and weight loss as well as potential complaints of lack of energy, visual blurring and/or symptoms of a yeast infection.

Question 12

What complications can be the presenting features in diabetes patients?

Answer 12

Staphylococcal skin infections
Optician noticing retinopathy
Tingling and numbness in the feet
Erectile dysfunction
Arterial disease resulting in MI or peripheral gangrene

Question 13

How might diabetes present asymptomatically?

Answer 13

Raised blood glucose or glycosuria in a routine test in an asymptomatic patient

Question 14

How might a diabetic patient present on examination?

Answer 14

Evidence of weight loss and dehydration, breath smelling of ketones

Question 15

What tests can be used to diagnose diabetes?

Answer 15

Random blood glucose, oral glucose tolerance test , fasting blood glucose and HbA1c

Question 16

Are impaired glucose tolerance or impaired fasting glucose diagnostic of diabetes?

Answer 16

No but they are risk factors for development of future diabetes

Question 17

What other investigations are appropriate other than ones relating to glucose metabolism?

Answer 17

Urine dip for protein, FBC, U&E, liver biochemistry and random lipids (for associated hyperlipidaemia)