diabetes

Question 1

What is Type I diabetes?

Answer 1

The autoimmune destruction of insulin secreting β pancreatic cells

Question 2

What is the normal age of onset of Type I diabetes?

Answer 2

Normally adolescence but can happen at any age

Question 3

What are the two most likely complications of TI diabetes?

Answer 3

Ketoacidosis and weight loss

Question 4

What is Type II diabetes?

Answer 4

Decreased insulin secretion, increased insulin resistance

Question 5

When is the normal age of onset for Type II diabetes?

Answer 5

Normally in later age as it is due to lifestyle and diet rather than genetic factors

Question 6

In what demographic is the highest prevalence of TII diabetes?

Answer 6

Asians, the elderly, men

Question 7

What are factors that influence development of TII diabetes?

Answer 7

Obesity, lack of exercise, calorie excess, alcohol excess

Question 8

What is the preliminary phase of TII diabetes?

Answer 8

Impaired fasting glucose or impaired glucose tolerance

Question 9

What is MODY?

Answer 9

Maturity Onset Diabetes of the Young - rare autosomal dominant TII diabetes affecting young people

Question 10

What is normal range for impaired glucose tolerance?

Answer 10

Fasting plasma glucose < 7mmol/L

Oral glucose after 2hr 7.8 - 11.1mmol/L

Question 11

What is normal range for impaired fasting glucose?

Answer 11

Fasting plasma glucose 6.1 - 7mmol/L

Question 12

What is the management for impaired fasting glucose or glucose tolerance?

Answer 12

Lifestyle advice, OGTT to exclude diabetes mellitus

Question 13

Primary causes of diabetes mellitus

Answer 13

Steroids, anti-HIV drugs, new antipsychotics

Congenital lipodystrophy, glycogen storage diseases

Question 14

What are pancreatic causes of diabetes?

Answer 14

pancreatitis, pancreatectomy, trauma, destruction of pancreas, pancreatic Ca

Question 15

What are endocrine causes of diabetes?

Answer 15

Cushing’s, acromegaly, phaechromocytoma, hypERthyroidism, pregnancy

Question 16

What is metabolic syndrome?

Answer 16

Central obesity: BMI > 30 and

BP > 130/85 OR 3glycerides >1.7mmol/L OR HDL < 1.29mmol/L OR fasting glucose > 5.6mmol/L OR TII DM

Question 17

What are some risk factors for metabolic syndrome?

Answer 17

Weight, genetics, insulin resistance

Question 18

What is the management for metabolic syndrome?

Answer 18

Exercise, weight loss, treatment of individual components and symptoms

Question 19

What are the criteria to diagnose DM?

Answer 19

Symptoms of hyperglycaemia: polydipsia, polyuria, weight loss, visual blurring, genital thrush, lethargy AND
Raised venous glucose ONCE: fasting > 7mmol/L, random > 11.1mmol/L OR TWICE fasting, random or OGTT 2h > 11.1mmol/L
HbA1c > 48mmol/mol - not for pregnant, children, T1DM, haemoglobinopathies

Question 20

What are the characteristic features of T1 DM?

Answer 20

Unintentional weight loss, persistent hyperglycaemia despite diet, presence of autoantibodies - islet cell and GAD, ketonuria

Question 21

What is an epidemiological difference between T1 and T2 DM?

Answer 21

T1: often starts before puberty
T2: usually older patients

Question 22

What is a genetic difference between T1 and T2 DM?

Answer 22

T1: HLA D3, D4 linked
T2: no HLA association

Question 23

What is a causal difference between T1 and T2 DM?

Answer 23

T1: autoimmune β pancreatic cell destruction
T2: insulin resistance and β cell dysfunction

Question 24

What is a difference in presentation between T1 and T2 DM?

Answer 24

T1: polydipsia, polyuria, weight loss, ketosis
T2: asymptomatic or complications eg MI

Question 25

What are the long and short term blood test for glucose?

Answer 25

Short: random, fasting, venous Long: HbA1c - 8 weeks of glucose control

Question 26

What is general management for diabetes?

Answer 26

Education: exercise to increase insulin sensitivity Lifestyle: healthy eating - less sat fats, sugar, more starch carbohydrates, moderate proteins Set HbA1c targets for every 3-6 months Start high intensity statin eg atorvastatin Assess global vascular risk Give foot care DVLA for driving

Question 27

What is the management for T2 DM?

Answer 27

Lifestyle: diet, weight control, exercise Monotherapy: standard release metformin 1st line IF HbA1c rises > 58mmol/mol, ?dual therapy: Metformin + sitagliptin Metformin + pioglitazone (PG) Metformin + sulfonylurea (SU) Metformin + glifazon IF HbA1c rises > 58mmol/mol, ?triple therapy: Met + DPP4 inhibitor + SU Met + PG + SU Met + SU/PG + SLGT-2i Insulin-based therapy

Question 28

What are the complications of diabetes?

Answer 28

``` Injection site infection/lipohypertrophy Vascular disease, macro and microscopic Nephropathy Retinopathy - cataracts Rubeosis iridis Metabolic complications Diabetic feet Neuropathy ```

Question 29

What types of insulin are there?

Answer 29

Short, medium and fast acting, in strengths of 100 units/ml

Question 30

What are fast acting insulins and when are they used?

Answer 30

Humalog, Novorapid, ultra fast acting, injection at start of meal to match what is eaten/planned