diabetes- basic principles

Question 1

what is diabetes?

Answer 1

-an elevation of blood glucose above a diagnostic threshold

Question 2

what is the fasting plasma glucose threshold for diagnosis of diabetes?

Answer 2

126mg/dl= 7mmol/L

Question 3

what is the 2 hr plasma OGTT glucose threshold for diagnosis of diabetes?

Answer 3

200mg/dl= 11.1 mmol/L

Question 4

what is the HbA1c threshold for diagnosis of diabetes?

Answer 4

48mmol/mol

Question 5

what is the fasting glucose level for impaired or ‘pre-diabetes’?

Answer 5

6.1 to 6.9 mmol/L impaired fasting glucpse

Question 6

what is the glucose level for impaired or ‘pre-diabetes’ in 2hr glucose in OGTT?

Answer 6

7.8-11.0 mmol/L impaired glucose tolerence

Question 7

what is thr HbA1c level in impaired or ‘pre diabetes’

Answer 7

42-47mmol/ mol

Question 8

what is gestational diabetes?

Answer 8

diabetes that comes on during pregnancy

Question 9

what is the gestational diabetes criteria?

Answer 9

threshold levels are not set by retinopathy risk but rather by risk to the foetys/neonate

Question 10

where is insulin secreted from?

Answer 10

from beta cells in the pancreatic islet

Question 11

when is insulin produced?

Answer 11

when there is high blood glucose

Question 12

where is glucagon produced from?

Answer 12

alpha cells in pancreatic islet

Question 13

when is glucagon secreted?

Answer 13

when there is low glucose (glucose is gone)

Question 14

how is insulin cleaved and secreted from pancreatic B cells?

Answer 14

• pro insulin is in pancreatic beta cell
• pro insulin is cleaved into insulin and C peptide
• When insulin is secreted so is C peptide

Question 15

why is C peptide important?

Answer 15

• because if they just measure insulin then they will just be measuring how much insulin is injected into the blood
• if you measure C-peptide then you can measure how much insulin the individual is actually producing

Question 16

what are some examples of disorders of insulin secretion?

Answer 16

most common- type 1 diabetes

Genetic:

• MODY (rare form of diabetes different from both type 1 and type 2 caused by gene mutation)
• neonatal diabetes

Pancreatic disease:

• alcohol and chronic pancreatitis
• acute pancreatitis
• pancreatectomy
• cystic fibrosis (genetic)
• heamochromatosis (genetic)

Question 17

is type 2 diabetes a disorder of insulin secretion or a disorder of insulin action?

Answer 17

mixed- ranging from predominant beta cell deficiency to predominant insulin resistence

Question 18

what are some examples of disorders of insulin action?

Answer 18

• Donohue syndrome
• Rabson Mendenhall syndrome
• Familial Partial lipodystrophy
• Congenital lipoartrophy
• Aquired lipoartophy

Question 19

what is type 1 diabetes?

Answer 19

-autoimmune destruction of pancreatic beta cells resulting in beta cell deficiency

Question 20

what age does type 1 diabetes affect?

Answer 20

occurs at similar rate in all ages

Question 21

what autoantibodies do most type 1 diabetics have in their blood at diagnoses?

Answer 21

up to 95% have pancreatic autoantibodies

Question 22

what is type 2 diabetes?

Answer 22

type 2 diabetes is a condition ranging from predominantly insulin resistence with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance

Question 23

is type 1 or type 2 diabetes autoimmune?

Answer 23

type 1

Question 24

‘patients do not have any other known cause for their diabetes’

is this referring to type 1 or type 2 diabetes?

Answer 24

type 2- this is a diagnoses of exclusion

Question 25

how does diabetes present?

Answer 25

often asymptomatic- especially type 2 symptoms of high blood glucose: - polyuria - thirst and polydipsia - blurred vision - genital thrush - fatigue - weight loss symptoms/signs of complications (rarely) -loss of vision/retinal bleed or retinal changes found by optician

Question 26

what are some microvascular complications of untreated diabetes?

Answer 26

chronic hyperglycaemia from untreated diabetes can cause: - retinopathy - neuropathy - nephropathy

Question 27

what are some macrovascular complications that may occur in untreated diabetes?

Answer 27

- MI/ACS - Stroke - Peripheral vascular disease

Question 28

what is HbA1c?

Answer 28

-it's your average blood glucose levels over a certain period of time

Question 29

How is HbA1C measure?

Answer 29

using continuous glucose monitoring

Question 30

what mmol/mol rise is there in ebery 1% of Hba1c?

Answer 30

11mmol/mol increase

Question 31

if HbA1c goes from 8% at 64mmol/mol to 9% what would the mmol/mol of the HbA1c be?

Answer 31

75mmol/mol