Diabetes Mellitus

Question 1

Diabetes

Answer 1

Chronic metabolic disease characterised by elevated levels of blood glucose which leads over time to serious heart, blood vessel, eye, kidney, and nerve damage

Question 2

Which type of diabetes is autoimmune

Answer 2

Type 1

Question 3

What cell disruption causes type 1 diabetes

Answer 3

Disruption of pancreatic beta cells in islets of langerhans

Question 4

What causes type 1 diabetes

Answer 4

Autoantibodies attack islets of langerhans

Question 5

Insulitis

Answer 5

Inflammation of islets of langerhans

Question 6

What causes type 2 diabetes

Answer 6

Abnormal insulin action and beta cell dysfunction

Question 7

Type 2 diabetes risk factors

Answer 7

Family history
Ethnicity
Overweight
Diet
Inactivity
Older age
Hypertension
Impaired glucose tolerance
History of gestational diabetes
Poor nutrition in pregnancy

Question 8

How does obesity cause insulin resistance

Answer 8

Accumulation of lipids and their metabolites
Incr circulating conc of FFAs
Chronic inflammation
Altered adipokine levels
Mitochondrial dysfunction
Oxidative stress
ER stress

Question 9

How does hyperinsulinaemia lead to type 2 diabetes

Answer 9

Increases lipid synthesis and exacerbates insulin resistance

Question 10

Do most genetic susceptibility genes for type 2 diabetes impair insulin secretion or impact insulin action

Answer 10

Impair insulin secretion

Question 11

What environmental components can damage beta cells

Answer 11

Lipotoxicity
Glucotoxicity
Glucolipotoxicity
Hyperinsulinaemia

Question 12

What is the most common type of monogenic diabetes

Answer 12

Maturity onset diabetes of the young MODY

Question 13

What causes maturity onset diabetes of the young MODY

Answer 13

Impairment of insulin secretion/beta cell dysfunction due to mutation of single MODY gene

Question 14

What pregnancy complications are associated with gestational diabetes

Answer 14

Hypertension
Large birth weight babies
Obstructed labour

Question 15

Why are children of mothers with gestational diabetes predisposed to becoming overweight

Answer 15

Exposure to hyperglycaemia in the womb

Question 16

What are possible mechanisms of gestational diabetes

Answer 16

Excessive proinsulin may induce beta cell stress
High hormone concentrations may affect beta cell function and peripheral insulin sensitivity

Question 17

What type of diabetes has features of type 1 and type 2 diabetes

Answer 17

Latent autoimmune diabetes of adults LADA

Question 18

How is diabetes diagnosed

Answer 18

Symptoms
Plasma glucose
Oral glucose tolerance test
HbA1c

Question 19

What plasma glucose results indicate diabetes

Answer 19

Random - >11.1mmol/L
Fasting - >7mmol/L

Question 20

What test is recommended for gestational diabetes diagnosis

Answer 20

Oral glucose tolerance test

Question 21

What plasma glucose levels indicate gestational diabetes

Answer 21

Fasting - >5.6mmol/L
2 hrs - >7.8mmol/L

Question 22

What is HbA1c

Answer 22

Hb with glucose attached

Question 23

What does HbA1c test show

Answer 23

Average plasma glucose over previous 8-12 wks

Question 24

What HbA1c indicated diabetes

Answer 24

48mmol/L - 6.5%

Question 25

What is indicated by a HbA1c level of 42-47 mmol/L

Answer 25

Prediabetes

Question 26

How is type 1 diabetes treated

Answer 26

Insulin and analogues

Question 27

What drugs are used in type 2 diabetes

Answer 27

Biguanides Sulfonylureas Thiazolidinediones GLP1R agonists and DPP-4 inhibitors SGLT2 inhibitors Meglitinides Alpha glucosidase inhibitors Bile acid sequestrants

Question 28

What drug type is metformin

Answer 28

Biguanide

Question 29

How do biguanides help diabetes

Answer 29

Inhibit Gluconeogenesis Enhance insulin sensitivity

Question 30

How do thiazolidinediones help diabetes

Answer 30

Increase insulin sensitivity by promoting adipogenesis

Question 31

What is the main issue with thiazolidinediones in type 2 diabetes treatment

Answer 31

Cause weight gain

Question 32

How do solfonylureas and prandial glucose regulators help type 2 diabetes

Answer 32

Stimulate insulin secretion

Question 33

Why are DPP-4 inhibitors given with GLP-1 receptor agonists

Answer 33

DDP4 cleaves GLP-1

Question 34

How do SGLT2 inhibitors help diabetes

Answer 34

Reduce glucose reabsorption and increase urinary glucose secretion

Question 35

How is DKA treated

Answer 35

Fluids Electrolytes esp K+ Insulin

Question 36

What causes Kussmaul’s respiration in DKA

Answer 36

incr breathing to counteract metabolic acidosis

Question 37

What can reduced insulin and excess glucagon cause in diabetics

Answer 37

DKA

Question 38

Chronic complications of diabetes

Answer 38

Hyperglycaemia Atherosclerosis CV events Nephropathy Neuropathy Retinopathy Amputation Dislipidaemia

Question 39

Diabetic retinopathy mechanisms

Answer 39

Dilation of retina veins Microaneurisms of retina veins Internal haemorrhaging and oedema in retina Formation of fragile new blood vessels which bleed, reduce vision, and cause separation and detachment of areas of the retina Decr retinal blood flow Diabetic macular oedema Apoptosis of retinal pericytes

Question 40

What is diabetic nephropathy

Answer 40

Disease of the kidney involving damage to the blood vessels in the glomerulus

Question 41

Characteristics of diabetic nephropathy

Answer 41

Proteinuria Glomerular hypertrophy Decr GFR Renal fibrosis

Question 42

Types of diabetic neuropathy

Answer 42

Peripheral Autonomic Proximal Focal

Question 43

What type of diabetic neuropathy causes pain or feeling loss in the hands arm feet and legs

Answer 43

Peripheral

Question 44

What type of diabetic neuropathy causes changes in digestion, bowel and bladder problems, erectile dysfunction, and heart problems

Answer 44

Autonomic

Question 45

What type of diabetic neuropathy causes pain in the thighs and hips and weakness in legs

Answer 45

Proximal

Question 46

What type of diabetes can affect any nerve in the body causing pain or weakness

Answer 46

Focal

Question 47

What are complications of diabetic neuropathy in the feet

Answer 47

Foot ulcers Infection Limb amputation

Question 48

Why does diabetes increase risk of athersclerosis

Answer 48

Hyperglycaemia Dislipidaemia AGE modification of oxidised LDL and their receptor Glycation of apolipoprotein, LDL, or LDL receptor

Question 49

How do hyperglycaemia and Dislipidaemia cause atherosclerosis

Answer 49

Causes Endothelial cell dysfunction which increases adhesion of monocytes and platelets

Question 50

How doe sAGE modification of oxidised LDLs and their receptor cause atherosclerosis

Answer 50

Incr LDL uptake into atherosclerotic plaques Pro inflammatory cytokines production

Question 51

How does glycation of apolipoprotein, LDL, and LDL receptors cause atherosclerosis

Answer 51

Impairs cholesterol effluent from atherosclerotic plaques and cholesterol clearance

Question 52

What are vascular complications of diabetes

Answer 52

Compromised nutrient and oxygen supply to tissues Stroke Heart disease Peripheral artery disease

Question 53

Why is COVID morbidity higher in diabetics

Answer 53

Impaired immune response Expression and activity of ACE Inflammation Atherothrombotic state