Diabetes Overview

Question 1

what is diabetes

Answer 1

a group of metabolic disorders characterised by hypoglycaemia from defects in insulin resistance

Question 2

what is the normal range for fasting blood glucose

Answer 2

4.4-6.1 mmol/L

Question 3

what two tests can be carried out to determine if someone has diabetes

Answer 3

fasting overnight glucose

2 hour glucose tolerance test - check blood glucose 2 hours after 75g of glucose

Question 4

what is HbA1C

Answer 4

a measurement of glucose attached to red blood cells, measures over 3 months

Question 5

list HbA1C levels for a normal individual and someone with diabetes

Answer 5

normal <41

diabetes >48

Question 6

list fasting glucose levels for a normal individual and someone with diabetes

Answer 6

normal <6

diabetes >7

Question 7

list levels of glucose after OGTT for normal individual and someone with diabetes

Answer 7

normal <7.7

diabetes >11.1

Question 8

what is the target HbA1C range for any diabetic

Answer 8

48-59

Question 9

what causes T1DM to arise

Answer 9

absolute insulin deficiency due to autoimmune destruction of beta cells from the pancreatic islet cells

Question 10

what increases someones risk of developing T1DM

Answer 10

polymorphic genetic risk combined with environmental triggers such as infection and diet

Question 11

list the auto-antibodies associated with T1DM

Answer 11

anti-GAD and anti-islet cell

Question 12

state the typical presentation of type 1 diabetes

Answer 12

onset in early childhood 
fatigue 
weight loss 
polydipsia and polyuria 
present with DKA

Question 13

what investigations are carried out for suspected T1DM

Answer 13

glucose testing
check urine for ketones if suspect DKA
auto-antibodies

Question 14

what is the mainstay management for T1DM

Answer 14

control of blood glucose through insulin

Question 15

outline the insulin regime a type 1 diabetic would follow

Answer 15

2 daily injections of mixed release insulin

basal bolus to take overnight and then a short acting one to take before a meal

Question 16

list the macrovascular complications of diabetes

Answer 16

stroke
MI
PVD
heart failure

Question 17

list the microvascular complications of diabetes

Answer 17

neuropathy
nephropathy
retinopathy

Question 18

what are the specific complications for type 1 diabetes

Answer 18

hypoglycaemia

lipohypertrophy - fatty lumps appear at the injection site if too regularly injected into

Question 19

list the high risk individuals that will receive testing for T2DM

Answer 19

first degree relative with diabetes 
ethnically high risk 
history of CVD 
poorly controlled hypertension 
HDL >35
women with PCOS 
physical inactivity 
any condition associated with insulin resistance 
history of gestational diabetes

Question 20

how often are women with a history of gestational diabetes tested

Answer 20

tested every 3 years as risk increases risk time

Question 21

how does type 2 diabetes present

Answer 21

usually asymptomatic

if symptomatic can be with hyperglycaemia eg polyuria etc or present with the complications such as neuropathy

Question 22

what associated symptoms increase risk of cardio complications in diabetes

Answer 22

hypertension
central obesity
dyslipidaemia
micro-albuminaemia

Question 23

what is the pathophysiology of T2DM

Answer 23

insulin is still being produced but the liver no longer responds to it and resistance has developed

Question 24

what is the first line management of T2DM

Answer 24

metformin

Question 25

what is the second line management of T2DM

Answer 25

variable depending on patients age and risk factors, usually combination with metformin once all methods have been exhausted, commence insulin

Question 26

describe the presentation of peripheral neuropathy

Answer 26

ulcers, deformities, infections, ischaemia and gangrene

Question 27

describe the presentation of autonomic neuropathy

Answer 27

postural hypotension, bladder and erectile dysfunction, diarrhoea and gastroparesis