Diabetes

Question 1

Is is important to think of diabetes as what type of disease?

Answer 1

Vascular

Question 2

What is insulin dependent diabetes?

Answer 2

Damage to beta cells is the cause

Question 3

What is insulin independent diabetes + give 2 examples?

Answer 3

Beta cells are functional so condition caused by other factors
Resistance
Channel mutations

Question 4

What is HbA1c and what + what is the normal level + what is the level diabetes is diagnosed at + target level for reducing microvascular complications?

Answer 4

Average blood glucose over 3 months
< 41 mmol/l
> 48 mmol/l
< 53 mmol/l

Question 5

Name 3 tests for diagnosing diabetes.

Answer 5

Fasting glucose
Random glucose
Oral glucose tolerance test

Question 6

How long is a fasting glucose + how long and how much glucose for an OGTT?

Answer 6

Fasting = 8 hours
OGTT = 75g and 2 hours

Question 7

How many venous glucose samples for symptomatic and non-symptomatic DM patients?

Answer 7

1 for symptomatic

2 for non-symptomatic

Question 8

Diagnosis of DM for symptomatic patients?

Answer 8

Presence of classic symptoms
Fasting glucose > 7
Random or OGTT > 11.1

Question 9

Diagnosis of DM for non-symptomatic patients?

Answer 9

2 separate findings of:
Fasting glucose > 7
Random or OGTT > 11.1
HbA1c > 48 mol/l

Question 10

What is T1DM?

Answer 10

Autoimmune beta cell loss causing insulin deficiency

Question 11

Is T1DM associated with other autoimmune conditions. If so, what is the genetic link?

Answer 11

Yes

DR3, DR4, DQ2 and DQ8 genes

Question 12

How can T1DM present?

Answer 12

Young
Weight loss
Fatigue
Polyuria/dipsia
DKA

Question 13

Name 3 islet cell autoantibodies associated with T1DM + do they appear before or after symptoms?.

Answer 13

GAD65
IA-2
ZnT8
Before symptoms

Question 13

What is the general treatment for T1DM?

Answer 13

MDI or insulin pump (CSI)

DAFNE education

Question 14

What 4 things can be tested in the blood for T1DM and will they be high/low/present/absent?

Answer 14

Autoantibodies = present
C-peptide = low
HbA1c = high
Blood glucose = high

Question 16

Name a complication of MDI.

Answer 16

Lipohypertrophy

Question 17

Name 2 common MDI regimes for T1DM.

Answer 17

BD - 2 x mixed insulin

QD - bedtime long acting + rapid acting before meals

Question 18

What is LADA?

Answer 18

T1DM subtype presenting later in life

Question 19

What are the SICK day rules + which 2 DM drugs need to be stopped + 3 other drugs which need to be stopped?

Answer 19

S (sugar) = check BG every 2-3 hours
I (insulin) = keep taking insulin
C (carbs) = keep eating and drinking
K (ketones) = check ketones every 4 hours
Metformin and SGLT2i
ACEi/ARB, NSAIDs, diuretics

Question 20

T1DM has a … concordance in twins and T2DM has a … concordance meaning … is more genetically influenced?

Answer 20

30%
80%
T2DM

Question 21

What is T2DM?

Answer 21

Reduced insulin sensitivity causing hyperinsulinemia

Question 22

How can T2DM present?

Answer 22

Older
Obese
Polydipsia/uria
Fatigue
Thrush/UTI
Visual blurring
Mental health issues
Erectile dysfunction

Question 23

Will C-peptide be high or low in T1DM + T2DM?

Answer 23

T1DM = low
T2DM = high

Question 24

Name a cutaneous sign of insulin resistant diabetes.

Answer 24

Acanthosis nigricans

Question 25

Name 7 risk factors for T2DM.

Answer 25

``` Smoking Obesity Alcohol Anti-psychotics Asian CVD POS ```

Question 26

How often should people with HbA1c > 39 or IGTT/IFG be screened?

Answer 26

Every year

Question 27

Name 3 tests that diagnosed diabetics should have every year.

Answer 27

Retinal screening Foot screening Kidney screening

Question 28

What is the stepwise treatment for T2DM?

Answer 28

``` Lifestyle changes Metformin (or SU) Metformin + 1 Metformin + 2 Insulin therapy ```

Question 29

What 2 other drugs should be considered in the treatment of T2DM to reduce CVD disease?

Answer 29

Statin if > 40 | Anti-hypertensives

Question 30

What is metabolic syndrome (syndrome X)?

Answer 30

Having a range of risk factors for stroke, CVD and diabetes

Question 31

Name the 5 features of metabolic syndrome.

Answer 31

``` Visceral obesity Insulin resistance Hypertension Hypertriglyceridemia Low HDL ```

Question 32

What is MODY + inheritance + age of onset?

Answer 32

AD monogenetic diabetes | < 25

Question 33

Which 2 features of T1DM does MODY lack?

Answer 33

Auto-antibdies | DKA

Question 34

Name the 3 types of MODY in order of prevalence + mutation.

Answer 34

MODY 1,3 and 5 = HNF TF MODY 2 = glucokinase MODY X = none

Question 35

Name the 3 differences between MODY 2 and MODY 1, 3 and 5.

Answer 35

MODY 2 = birth onset, complications rare, stable hyperglycaemia MODY 1, 3 and 5 = young adult onset, complications common and unstable hyperglycaemia

Question 36

What is the treatment and for MODY 2?

Answer 36

Diet modification

Question 37

What is the treatment for MODY 1, 3 and 5?

Answer 37

Diet + SU + insulin

Question 38

Name 2 conditions caused by Kir6.1 and SUR1 subunit mutations.

Answer 38

Congenital hyperinsulinism | Neonatal diabetes

Question 39

Name the 2 subtypes of neonatal diabetes and how they are treated.

Answer 39

``` Transient = periodic insulin Permanent = lifelong insulin + SU ```

Question 40

What is the target BG before a meal and 1-2 hours after?

Answer 40

``` Before = 3.9-7.2 mmol/l After = < 10 mmol/l ```