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Gen Med (Endocrine) > Diabetes - Classification & Diagnosis > Flashcards

Diabetes - Classification & Diagnosis Flashcards

1
Q

If a patient is symptomatic of hyperglycaemia, how many abnormal blood glucose or HbA1c results must be obtained for them to be diagnosed with diabetes?

A

One

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2
Q

If a patient is asymptomatic, how many abnormal blood glucose or HbA1c results must be obtained for them to be diagnosed with diabetes?

A

Two (on two separate occasions)

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3
Q

What are the major symptoms of hyperglycaemia?

A

Polyuria, polydipsia, weight loss, fatigue

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4
Q

A fasting blood glucose of greater than or equal to what value is suggestive of a diagnosis of diabetes mellitus?

A

7mmol/L

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5
Q

A random blood glucose of greater than or equal to what value is suggestive of a diagnosis of diabetes mellitus?

A

11.1mmol/L

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6
Q

A blood glucose level of greater than or equal to what two hours after an oral glucose tolerance test is suggestive of a diagnosis of diabetes mellitus?

A

11.1mmol/L

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7
Q

An HbA1c value of greater than or equal to what is suggestive of a diagnosis of diabetes mellitus?

A

48mmol/mol (6.5%)

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8
Q

Does having an HbA1c value of < 48mmol/mol rule out a diagnosis of diabetes mellitus?

A

No

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9
Q

HbA1c provides a measure of glycaemic control over what time period?

A

The previous 2-3 months

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10
Q

An HbA1c value of greater than what is suggestive of poor diabetic control?

A

75mmol/mol

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11
Q

An HbA1c or blood glucose value which falls between the normal value and the value which is diagnostic of diabetes mellitus can be defined as what?

A

Pre-diabetes

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12
Q

A normal HbA1c value is what value or less?

A

41mmol/mol

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13
Q

A normal fasting blood glucose level is what value or less?

A

6mmol/L

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14
Q

A normal random blood glucose level is less than what value?

A

11.1mmol/L

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15
Q

A normal blood glucose level 2 hours after an oral glucose tolerance test is what value or less?

A

7.7mmol/L

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16
Q

Type 1 diabetes is usually adolescent in onset, but has a secondary peak when?

A

Late 30s

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17
Q

Type 1 diabetes is a state of absolute insulin deficiency as a result of what?

A

Autoimmune destruction of pancreatic beta cells

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18
Q

Type 1 diabetes has strong associations with other autoimmune conditions because > 90% of those affected by it carry at least one of which two genes?

A

HLA-DR3 and/or HLA-DR4

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19
Q

Type 1 diabetes has a most significant overlap with which other autoimmune condition? If you are testing for type 1 diabetes autoantibodies, you should test for which other ones at the same time?

A

Coeliac disease - also test for anti-TTG antibodies

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20
Q

What is the concordance rate of type 1 diabetes in identical twins?

A

30%

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21
Q

What is a rare form of type 1 diabetes which involves a slower progression to insulin dependence in later life?

A

Latent autoimmune diabetes of adults (LADA)

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22
Q

Polyuria associated with type 1 diabetes may present as what in children?

A

Enuresis

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23
Q

What is the concordance rate of type 2 diabetes in identical twins?

A

> 80%

24
Q

What is a rare form of type 2 diabetes which affects young people with a strong family history?

A

Maturity onset diabetes of the young (MODY)

25
Q

What are some pancreatic conditions which may cause secondary diabetes mellitus?

A

Chronic pancreatitis, haemochromatosis, CF

26
Q

What are some examples of drugs which may cause secondary diabetes mellitus?

A

Glucocorticoids, thiazide diuretics, beta blockers

27
Q

What are the 4 main features of metabolic syndrome (syndrome X)?

A

Central obesity, hypertension, hyperlipidaemia, insulin resistance

28
Q

The presence of ketones on urinalysis is most suggestive of which type of diabetes mellitus?

A

Type 1

29
Q

What are 3 useful tests for ruling out type 1 diabetes?

A

GAD/islet cell autoantibodies, C-peptide, ketones

30
Q

Blood ketones of greater than what value would be considered significant?

A

1.5mmol/L

31
Q

Blood ketones of greater than what value would be suggestive of DKA?

A

3mmol/L

32
Q

What is important to be aware of when testing C-peptide levels for type 1 diabetes?

A

Some people with type 1 diabetes may retain C-peptide for a few years after they stop producing insulin

33
Q

What diagnosis should be suspected in individuals aged around 25-40 who present with symptoms of diabetes, are non-obese and may have other autoimmune conditions?

A

LADA

34
Q

Permanent neonatal diabetes usually occurs within what timeframe?

A

The first 6 months of life

35
Q

Children who are diagnosed with neonatal diabetes are most likely to have what underlying type of the condition?

A

MODY

36
Q

What is the target HbA1c value for all type 1 diabetic patients and type 2 diabetic patients on lifestyle or lifestyle + metformin management?

A

48mmol/mol

37
Q

How is MODY inherited?

A

Autosomal dominant

38
Q

Which subtype of MODY is caused by a defect in the glucokinase enzyme on chromosome 7?

A

MODY2

39
Q

Which subtype of MODY involves mild, asymptomatic and stable hyperglycaemia which is present from birth?

A

MODY2

40
Q

How is MODY2 usually managed?

A

Lifestyle management only

41
Q

What is the most common type of MODY?

A

MODY3

42
Q

Which subtype of MODY involves severe hyperglycaemia after puberty which is progressive?

A

MODY3

43
Q

How is MODY3 usually managed?

A

Sulfonylureas

44
Q

Which subtype of MODY is associated with pancreatic atrophy, renal abnormalities and genital tract malformations?

A

MODY5

45
Q

What is a useful test for distinguishing between type 1 diabetes and MODY?

A

C-peptide

46
Q

Gestational diabetes can be diagnosed if there is a blood glucose of what or more after an OGTT?

A

7.8mmol/L

47
Q

What is the screening test used to detect gestational diabetes?

A

Oral glucose tolerance test

48
Q

How should patients who have had gestational diabetes be followed up for their risk of developing type 2 diabetes?

A

Fasting blood glucose 6 weeks post-partum and annual review

49
Q

Pregnant (and pre-conception for planned pregnancy) diabetic patients should aim for an HbA1c of what value or less?

A

43mmol/mol

50
Q

Pregnancy should be avoided if HbA1c is greater than what value?

A

85mmol/mol

51
Q

What supplement should be given to diabetic patients pre-conception?

A

5mg folic acid

52
Q

What are some drugs, commonly taken by diabetic patients, which must be stopped in pregnancy?

A

Most oral hypoglycaemic agents (except metformin), ACE inhibitors/ARBs, statins

53
Q

How should foetal growth be monitored in babies of diabetic mothers?

A

4 weekly growth scans from 28 weeks onwards

54
Q

What happens to the insulin requirement in pregnancy?

A

Increases by 50-100%

55
Q

NICE recommends delivery at what gestation for a) pre-existing and b) gestational diabetes?

A

a) 38 weeks b) 40 weeks

56
Q

What may cause an individual to have a falsely high HbA1c result?

A

Splenectomy

57
Q

Conditions such as sickle cell anaemia, G6PD deficiency and hereditary spherocytosis, along with blood donation, have what effect on HbA1c results?

A

Falsely low

Gen Med (Endocrine) (12 decks)

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