Diabetes Mellitus

Question 1

what does diabetes mellitus mean?

Answer 1

abnormality of glucose regulation

Question 2

what does diabetes insipidus mean?

Answer 2

abnormality of renal function

Question 3

what is the most common type of diabetes mellitus?

Answer 3

type 2

Question 4

what does the exposure to chronic hyperglycaemia do?

Answer 4

increases the risk of microvascular complications and long-term macrovascular disease

Question 5

what tests are used for diabates?

Answer 5

random sugar, fasting sugar, glucose tolerance test, HbA1C

Question 6

what results come back from a random plasma glucose test indicating diabetes?

Answer 6

> 11.1mmol/L on 2 occasions

Question 7

what does a glucose tolerance test indicate?

Answer 7

if fasting sample indicates impaired fasting glucose

Question 8

what result from the HbA1C indicates that the patient is diabetic?

Answer 8

> 48mmol/mol (6.5%)

Question 9

how do you do a glucose tolerance test?

Answer 9

measure the glucose level in blood before giving 75g of glucose and then measure afterwards

Question 10

what are the ranges of values of normal to diabetic BEFORE giving glucose in the glucose tolerance test?

Answer 10

<6.1 = normal 
6.1-7.0 = impaired fasting glucose 
>7 = diabetes

Question 11

what are the ranges of values of normal to diabetic AFTER giving glucose in glucose tolerance test

Answer 11

<7.8 = normal 
7.8-11.1 = impaired glucose tolerance 
>11.1 = diabetes

Question 12

what is type 1 diabetes?

Answer 12

insulin deficiency, the autoimmune destruction of pancreatic B cells

Question 13

what causes type 1 diabetes?

Answer 13

interplay between genetic and environmental factors

Question 14

in type 1 diabetes what determines the clinical presentation?

Answer 14

rate of destruction

Question 15

what is caused by the immune mediated pancreatic B cell destruction?

Answer 15

hyperglycaemia and ketoacidosis

Question 16

what do low c-peptide levels indicate?

Answer 16

low insulin secretion

Question 17

what circulating antibodies are present in type 1

Answer 17

GAD, ICA, IAA

Question 18

what is ketoacidosis?

Answer 18

body cells cannot access glucose for metabolism so they start to metabolise fat which results in ketones as end product

Question 19

what is the peak incidence of type 1

Answer 19

10-14yrs

Question 20

what antibodies do type 1 diabetic children have?

Answer 20

higher ICC and IAA

Question 21

what antibodies do type 1 diabetic adults have?

Answer 21

lower GAD

Question 22

what are the symptoms of diabetes?

Answer 22

polyuria, polydipsia and tiredness

Question 23

what is seen with acute presentation of diabetes?

Answer 23

hyperglycaemia with diabetic symptoms and ketoacidosis

Question 24

what is the stage between normoglycaemia and diabetes?

Answer 24

impaired glucose tolerance

Question 25

what age group does type 2 diabetes present in?

Answer 25

over 40s

Question 26

what is type 2 diabetes associated with?

Answer 26

obesity and inactivity, also strong family history

Question 27

what is type 2 diabetes characterised by?

Answer 27

defective and delayed insulin secretion and abnormal postprandial suppression of glucagon

Question 28

what is the pathogenesis of type 2 diabetes complicated with?

Answer 28

varying degrees of insulin deficiency, insulin action and genetic and environmental factors

Question 29

what is type 2 diabetes?

Answer 29

insulin resistance

Question 30

what factors add to insulin resistance?

Answer 30

defect in insulin synthesis, secretion and action defect in pulsatile insulin secretion visceral fat

Question 31

what are the contributing factors to the defects in insulin synthesis, secretion and action?

Answer 31

B cell response to hyperglycaemia is inadequate, elevated basal insulin levels, failure of gluconeogenesis suppression, insulin stimulated glucose uptake reduced

Question 32

what metabolic changes occur in type 2

Answer 32

inadequate release of incretins or response to incretins, increased absorption of glucose from GI tract due to increased transporter

Question 33

what are the multisystem effects of type 2

Answer 33

impaired glucose tolerance, hyperinsulinaemia, hypertension, obesity with abdominal distribution, dyslipidaemia, procoagulant epithelial markers, early and accelerated atherosclerosis

Question 34

what happens with insulin over time with type 2

Answer 34

the ability to secrete insulin falls

Question 35

what is the presentation of type 2 diabetes?

Answer 35

polyuria, polydipsia, tiredness, unusual infections, CVS complications (atherosclerosis)

Question 36

what is important in slowing the decline from IGT?

Answer 36

strict diet and exercise

Question 37

what medicines induce diabetes?

Answer 37

corticosteroids, immune suppressants, cancer medication, antipsychotics, antivirals

Question 38

what types of medication induces diabetes?

Answer 38

medicine that interferes with the secretion of insulin or glucagon, medicine which alters tissue uptake of glucose

Question 39

what other conditions is diabetes related to?

Answer 39

``` endocrine disease (cushing's, phaeochromocytoma (adrenaline tumour), acromegaly) pregnancy ```

Question 40

summarise type 1

Answer 40

younger, thinner, potential family history, diabetic symptoms, ketoacidosis common

Question 41

summarise type 2

Answer 41

older, obese, strong family history, multisystem complications, rarely get ketoacidosis