Diabetes Overview

Question 1

What are the two broad categories of diabetes?

Answer 1

1. Diabetes mellitus
2. Diabetes insipidus

Question 2

In which way are insulin molecules stored?

Answer 2

Hexamers

Question 3

Why does type 1 DM develop?

Answer 3

Complete destruction of pancreatic B cells

Question 4

Why does type 2 DM develop?

Answer 4

Relative insulin deficiency

Inadequate insulin production/secretion/insulin resistance

Question 5

MODY is usually due to what?

Answer 5

Failure of insulin synthesis, release or activity

Question 6

Diabetes mellitus is an umbrella term encompassing conditions which are characterised in which ways?

Answer 6

Metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action or both

Question 7

What is HbA1c?

Answer 7

Haemoglobin A1c

This is a glycated version of haemoglobin (Hb that joins with glucose)

Question 8

Why is measuring HbA1c levels useful?

Answer 8

It gives a measure of blood glucose levels

Question 9

Diabetes can be diagnosed at which levels of HbA1c?

Answer 9

48mmol/mol

Question 10

What are the normal levels of HbA1c?

Answer 10

< 41mmol/mol

Question 11

Diabetes can be diagnosed with a fasting glucose level of what?

Answer 11

7mmol/l

Question 12

What are normal fasting blood glucose levels according to the WHO?

Answer 12

< 6.1mmol/l

Question 13

What are truly normal fasting blood glucose levels?

Answer 13

< 5.6 mmol/l

(diabetes is not diagnosed above this level)

Question 14

What is an OGTT?

Answer 14

Oral glucose tolerance test

Question 15

Diabetes can be diagnosed at what glucose level after a 2hr OGTT?

Answer 15

11.1mmol/l

Question 16

A normal 2hr OGTT would be below which level of glucose in the blood?

Answer 16

7.7mmol/l

Question 17

A random glucose level may be able to diagnose diabetes at what level?

Answer 17

11.1mmol/l

Question 18

In any test for diabetes diagnosis what is required for confirmation?

Answer 18

A repeat test

Question 19

Type 1 diabetes is characterised by the presence of which antibodies?

Answer 19

1. Anti-GAD
2. Anti-islet cell

Question 20

Why is type 1 diabetes not diagnosed before the age of 1?

Answer 20

1. They may have MODY
2. It may be transient
3. Unlikely to be type 1

Question 21

How does type 1 diabetes manifest clinically?

Answer 21

1. In pre-school and peri-puberty (small peak in late 30s)
2. Usually lean individuals
3. Acute
4. Severe
5. Weight loss
6. Ketonuria +/- metabolic acidosis
7. Immediate and permanent insulin requirement

Question 22

How does type 2 diabetes manifest clinically?

Answer 22

1. Middle aged/elderly
2. Obese
3. Pre-diagnosis stage for around 10 years
4. Insidious onset over weeks to years
5. Evidence of microvascular disease at diagnosis in around 20%
6. Managed with diet, exercise and tablets

Question 23

What are the risk factors for type 2 diabetes?

Answer 23

1. Obesity
2. FH
3. Gestational diabetes
4. Age
5. Ethnicity (asian, african, afro-carribean)
6. PHx of MI/stroke

Question 24

What are the symptoms of DM?

Answer 24

1. Thirst
2. Polyuria (excessive drinking)
3. Thrush
4. Weakness and fatigue
5. Blurred vision
6. Infections
7. Weight loss
8. Neuropathy, retinopathy (T2DM)

Question 25

Name 3 useful discriminatory tests for DM

Answer 25

1. GAD/anti-islet cell antibodies 2. Ketones 3. C-peptide in the plasma

Question 26

Ketosis is most associated with which type of diabetes?

Answer 26

Type 1

Question 27

Type 4 DM may be due to which 4 main things?

Answer 27

1. Pancreatic disease 2. Endocrine disease 3. Drug induced 4. Genetic causes (abnormalities of insulin and its receptor)

Question 28

Which type of pancreatic disease may lead to type 4 diabetes?

Answer 28

1. Chronic or recurrent pancreatitis 2. Haemochromatosis 3. Cystic fibrosis

Question 29

Which types of endocrine disease can cause type 4 diabetes?

Answer 29

1. Cushing's syndrome 2. Acromegaly 3. Phaechromocytoma 4. Glucagonoma

Question 30

Which types of drugs can induce type 4 diabetes?

Answer 30

1. Glucocorticids 2. Diuretics 3. B-blockers

Question 31

Which genetic disease may lead to the development of type 4 diabetes?

Answer 31

1. Cystic fibrosis 2. Myotonic dystrophy 3. Turner's syndrome

Question 32

Monogenic diabetes usually has which tell-tale features?

Answer 32

1. Strong FH 2. Associated features e.g. renal cysts 3. Young onset 4. GAD negative 5. C-peptide positive

Question 33

Type 3 diabetes is also know by which other name?

Answer 33

Gestational diabetes | (diabetes during pregnancy)

Question 34

What are some macro-vascular complications of diabetes?

Answer 34

1. Heart disease 2. Stroke 3. Hypertension 4. PVD (these are the main causes of death)

Question 35

What are the microvascular complications of diabetes?

Answer 35

1. Retinopathy 2. Nephropathy 3. Neuropathy

Question 36

What does DAFNE stand for and what is it?

Answer 36

Dose Adjustment For Normal Eating An educational programme allowing those with type 1 diabetes to understand their condition better including how much carbohydrate is in each meal and when/how much insulin to inject