What are the two broad categories of diabetes?
- Diabetes mellitus
- Diabetes insipidus
In which way are insulin molecules stored?
Why does type 1 DM develop?
Complete destruction of pancreatic B cells
Why does type 2 DM develop?
Relative insulin deficiency
Inadequate insulin production/secretion/insulin resistance
MODY is usually due to what?
Failure of insulin synthesis, release or activity
Diabetes mellitus is an umbrella term encompassing conditions which are characterised in which ways?
Metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both
What is HbA1c?
This is a glycated version of haemoglobin (Hb that joins with glucose)
Why is measuring HbA1c levels useful?
It gives a measure of blood glucose levels
Diabetes can be diagnosed at which levels of HbA1c?
What are the normal levels of HbA1c?
Diabetes can be diagnosed with a fasting glucose level of what?
What are normal fasting blood glucose levels according to the WHO?
What are truly normal fasting blood glucose levels?
< 5.6 mmol/l
(diabetes is not diagnosed above this level)
What is an OGTT?
Oral glucose tolerance test
Diabetes can be diagnosed at what glucose level after a 2hr OGTT?
A normal 2hr OGTT would be below which level of glucose in the blood?
A random glucose level may be able to diagnose diabetes at what level?
In any test for diabetes diagnosis what is required for confirmation?
A repeat test
Type 1 diabetes is characterised by the presence of which antibodies?
- Anti-islet cell
Why is type 1 diabetes not diagnosed before the age of 1?
- They may have MODY
- It may be transient
- Unlikely to be type 1
How does type 1 diabetes manifest clinically?
- In pre-school and peri-puberty (small peak in late 30s)
- Usually lean individuals
- Weight loss
- Ketonuria +/- metabolic acidosis
- Immediate and permanent insulin requirement
How does type 2 diabetes manifest clinically?
- Middle aged/elderly
- Pre-diagnosis stage for around 10 years
- Insidious onset over weeks to years
- Evidence of microvascular disease at diagnosis in around 20%
- Managed with diet, exercise and tablets
What are the risk factors for type 2 diabetes?
- Gestational diabetes
- Ethnicity (asian, african, afro-carribean)
- PHx of MI/stroke
What are the symptoms of DM?
- Polyuria (excessive drinking)
- Weakness and fatigue
- Blurred vision
- Weight loss
- Neuropathy, retinopathy (T2DM)
Name 3 useful discriminatory tests for DM
- GAD/anti-islet cell antibodies
- C-peptide in the plasma
Ketosis is most associated with which type of diabetes?
Type 4 DM may be due to which 4 main things?
- Pancreatic disease
- Endocrine disease
- Drug induced
- Genetic causes (abnormalities of insulin and its receptor)
Which type of pancreatic disease may lead to type 4 diabetes?
- Chronic or recurrent pancreatitis
- Cystic fibrosis
Which types of endocrine disease can cause type 4 diabetes?
- Cushing's syndrome
Which types of drugs can induce type 4 diabetes?