epidemiology of diabetes

Question 1

3 ways of making GLC?

Answer 1

oral intake - absorbed in gut
gluconeogensis in liver
glycogen breakdown in liver

Question 2

how does glycogenolysis/gluconeogenesis occur?

Answer 2

alpha cells promote the action of glucagon, promoting glycogenolysis/gluconeogenesis

Question 3

describe 3 results of insulin secretion?

Answer 3

reduced lipolysis (adipose)
reduced GLC production (liver)
increased GLC uptake (muscle)

Question 4

definition of diabetes mellitus?

Answer 4

Group of metabolic diseases characterized by hyperglycaemia together with disturbances of metabolism resulting from defects in insulin secretion +/ action

Question 5

symptoms of hyperglycaemia? (THINK: type 1 diabetes)

Answer 5

polydipsia
polyuria
blurred vision
weight loss
infections

Question 6

metabolic decompensation of hyperglycaemia?

Answer 6

DKA/HHS

Question 7

microvascular long term complications of hyperglycaemia?

Answer 7

retinopathy
neuropathy
nephropathy

Question 8

macrovascular long term complications of hyperglycaemia?

Answer 8

stroke
MI
PVD

Question 9

OGTT?

Answer 9

oral GLC tolerance test

Question 10

normal values v.s. diabetes for OGTT?

Answer 10

fasting: <6 v >7
random: <11.1 v >11.1
2hr: <7.7 v >11.1

Question 11

requirements for diagnosis of diabetes?

Answer 11

either -
symptoms + 1 abnormal GLCs
OR….
2 abnormal GLCs/HbA1c (if asymptomatic)

Question 12

diagnostic HbA1c value?

Answer 12

> 48 mol/mol

Question 13

what is intermediate diabetes and what management is provided?

Answer 13

people in-between normal and diabetic values - i.e those to watch -
management:
yearly check ups for BP, weight management, regular eye tests

Question 14

intermediate values for diagnosis?

Answer 14

values between that of normal and diabetics:
fasting glucose 6.1-7 mmol/l
glucose tolerance 2h glucose ≥7.8 and <11mmol/l
HbA1c 42-47mmol/mol

Question 15

why is the Fasting BG level set at 7 for diabetics?

Answer 15

this is the level where complications begin to arise

Question 16

adv & disadv. of GLC as a diagnostic tool?

Answer 16

adv:
feasible in developing world
more established
directly measures molecule that causes diabetes

disadv:
fasting state needed
may need OGTT
varies between individuals

Question 17

adv & disadv. of HbA1c as a diagnostic tool?

Answer 17

adv:
don’t fast
marker of glycemic control
low variability between people

disadv:
differs with age and ethnicity
costly
surrogate marker of hyperglycaemia

Question 18

examples of when HbA1c CANNOT be used?

Answer 18

young people and children 
pregnancy
medications acute pancreatic damage/post pancreas related surgery 
renal failure 
HIV patients

Question 19

how many people in Scotland have diabetes?

Answer 19

~300,000 - ~5% population

Question 20

which antibodies are found to attack islets in type 1?

Answer 20

anti-GAD antibodies

Question 21

what is the greatest risk of developing type 1 diabetes from genes?

Answer 21

identical twin - 30-50% risk
both parents - 30% 
non-identical twin - 10%
sibling - 8%
father - 6%
mother - 1%

Question 22

what are type 1 diabetics more likely to develop?

Answer 22

another autoimmune disease?

e.g. coeliac

Question 23

defence mechanisms against hypoglycaemia?

Answer 23

increase in - 
glucagon
cortisol
catecholamines 
GH

Question 24

what can increase in glucagon be due to when not diabetes?

Answer 24

stress

Question 25

symptoms of type 1?

Answer 25

``` Thirst Tiredness Polyuria / nocturia Weight loss Blurred vision Abdominal pain – children ```

Question 26

examination findings in type 1?

Answer 26

Ketones on breath (+in blood) Dehydration May have increased respiratory rate, tachycardia, hypotension Low grade infections, thrush / balanitis

Question 27

development of type 2 diabetes?

Answer 27

over course of years: insulin resistance increases ->insulin release increases ->pancreas cannot keep up secretion to overcome resistance

Question 28

genetics of type 2 diabetes?

Answer 28

``` Identical twin: 90-100% One parent: 15% Both parents: 75% Sibling: 10% Non-identical twin: 10% ```

Question 29

describe 3 results of insulin and type 2?

Answer 29

altered lipolysis (adipose) increased GLC production (liver) reduced GLC uptake (muscle)

Question 30

symptoms type 2?

Answer 30

often asymptomatic ``` Thirst Tiredness Polyuria / nocturia Sometimes weight loss Blurred vision ```

Question 31

signs of type 2?

Answer 31

NOT ketotic Usually overweight but not always Low grade infections, thrush / balanitis

Question 32

screening for diabetes in asymptomatic populations?

Answer 32

``` aged 25-39 people of non-white ethnicities NOT pregnant women of the following conditions: CVD hypertension obesity stroke polycystic ovary syndrome a history of gestational diabetes mental health problems ```

Question 33

MODY?

Answer 33

monogenetic diabetes, an autosomal dominant condition - will appear in FAMILY history single geen defect impaired beta-cell function

Question 34

MODY - types of mutations?

Answer 34

1) glucokinase mutations | 2) transcription factor mutations

Question 35

glucokinase mutations - presentation?

Answer 35

Onset at birth | Stable hyperglycaemia Diet treatment Complications rare

Question 36

transcription factor mutations - presentation?

Answer 36

(HNF-1a HNF-1B HNF-4a Adolescence/young adult onset Progressive hyperglycaemia 1/3 diet, 1/3 OHA, 1/3 Insulin Complications frequent

Question 37

gestational diabetes?

Answer 37

Increasing insulin resistance in pregnancy | mothers don't have diabetes @ start of pregnancy, but do so @ the end

Question 38

when is gestational diabetes most common?

Answer 38

if mother is inactive and overweight

Question 39

when does gestational diabetes develop?

Answer 39

2nd/3rd trimester

Question 40

what neonatal problems arise due to gestational diabetes?

Answer 40

macrosomia/ resp. distress/ HYPOglycaemia

Question 41

causes of 2y diabetes?

Answer 41

Alcohol and Gallstones are v common causes, also - 1) diseases of exocrine pancreas - Chronic pancreatitis Haemochromatosis Cystic fibrosis 2) endocrine disorders - Acromegaly Cushing’s syndrome 3) drug-induced - steroids