Endocrine - Diabetes

Question 1

Diabetes

Answer 1

High blood glucose level (high BP and cholesterol)

Question 2

Insulin

Answer 2

Hormone produced by pancreas, control the release of glucose from liver and promotes glucose uptake

Question 3

Normal glucose range

Answer 3

4mmol/l - 11mmol/l

Question 4

Symptoms

Answer 4

Thirst, polyuria, weight, loss tiredness

Question 5

Signs

Answer 5

Dry mouth, weight loss, glycosuria, hyperglycaemia

Question 6

Diagnosis of Diabetes

Answer 6

High random blood glucose, fasting blood glucose >7mmol/l, OGTT 75g, HbA1c 48 mmol/mol

Question 7

Glucose tolerance test

Answer 7

Oral OGTT/IV, fasting then 75g OGTT, 2 hour post-glucose load diabetic >11 mmol/l

Question 8

Borderline diabetes

Answer 8

Impaired fasting glucose 6-7mmol/l

Question 9

Investigations

Answer 9

HbA1c, renal function, liver function, lipids, thyroid function

Question 10

HbA1c

Answer 10

Glycated haemoglobin, assessing degree of glycemic control

Question 11

Type 1 diabetes

Answer 11

LADA latent autoimmune diabetes in adults, autoimmune destruction of the insulin producing islet beta cells, lymphocytic infiltration of islets of Langerhans

Question 12

Type 2 diabetes

Answer 12

Pancreatic disorders, drug induced (steroids), endocrine disorders, ethnic variants (J-type Afro-Caribbean), genetic syndromes

Question 13

Who does type 1 diabetes effect?

Answer 13

Usually young, any age

Question 14

Autoantibody tests for Type 1 diabetes

Answer 14

ICA, IA2, GAD

Question 15

Professor Willy Gepts

Answer 15

Discovered insulitis

Question 16

LADA

Answer 16

Latent autoimmune diabetes in adults, older patients often female, medical/family history of related conditions (type 1 diabetes, thyroid, PA, Addison’s, coeliac, vitiligo), presents as ‘type 2’ diabetes, progressive deterioration in control increasing therapy

Question 17

LADA autoantibodies

Answer 17

GAD, ICA, tTG, TPO

Question 18

Type 2 diabetes

Answer 18

Insulin resistant/deficient, not insulin dependent, family history, overweight, hypertensive and hyperlipidaemic

Question 19

Ketosis-prone type 2

Answer 19

Often obese, ethnic minority, ketosis when physically stressed with intercurrent illness, temporarily requires insulin

Question 20

Diabetes secondary to pancreatic disorders

Answer 20

Chronic/acute pancreatitis, calcific, tropical pancreatitis, pancreatectomy, pancreatic cancer, cystic fibrosis, haemochromatosis (hereditary iron overload storage disorder)

Question 21

Drug induced diabetes

Answer 21

Diuretics, steroids, antipsychotics (olanzapine), psychiatric drugs (weight gain)

Question 22

endocrine disorders

Answer 22

Acromegaly (high GH), Cushing’s syndrome (high cortisol), Phaeochromocytoma

Question 23

Ethnic variants

Answer 23

J type diabetes (Jamaican), Flatbush Afro-Americans, MRDM (tropical), chronic calcific pancreatitis, secondary to diabetes, Z type diabetes

Question 24

J type Jamaican diabetes

Answer 24

Ketosis prone, not obese, on/off insulin therapy, variable insulin requirements, also called flatbush

Question 25

Genetic syndromes cause diabetes

Answer 25

Friedreich's ataxia, dystrophia myotonica (genetic diabetes syndrome)

Question 26

Gestational diabetes

Answer 26

During pregnancy and resolves after, risk of diabetes in future,

Question 27

Maturity onset diabetes in the young (MODY)

Answer 27

Autosomal dominant pattern, 1-2% diabetes cases, onset under 25, insulin not required initially, glucokinase, HNF 1A, HNF 4A