Lec 1 Diabetes mellitus

Question 1

What is the normal range for blood glucose in healthy people?

Answer 1

70-140 mg/dl

Question 2

What happens to blood glucose levels in the fed state?

Answer 2

Blood glucose starts to rise

Question 3

What hormone is released by the β cells of the pancreas after a meal?

Answer 3

Insulin

Question 4

What effect does insulin have on glucose uptake?

Answer 4

Stimulates glucose uptake by muscles and fat cells

Question 5

What process does insulin stimulate in the liver?

Answer 5

Glycogenesis

Question 6

What process does insulin inhibit in the liver?

Answer 6

Gluconeogenesis

Question 7

Fill in the blank: Insulin inhibits _______ in the liver.

Answer 7

gluconeogenesis

Question 8

What is the role of insulin in maintaining blood glucose levels?

Answer 8

Keeps blood glucose in normal range

Question 9

True or False: Insulin promotes the breakdown of glycogen.

Answer 9

False

Question 10

What is glycogenesis?

Answer 10

Building up glycogen from glucose

Question 11

DM could cause short term, acute complications:
like what?

Answer 11

Diabetic Ketoacidosis (DKA)
Hyperosmolar Hyperglycemic State (HHS)
Hypoglycemia

Question 12

DM also could cause long term, chronic complications that are mainly vascular and divided into:

Answer 12

Microvascular Complications
Retinopathy
Nephropathy
Neuropathy

Macrovascular Complications
Ischemic Heart Disease
Cerebrovascular Disease
Peripheral Arterial Disease

Question 13

DM is a biochemical diagnosis based on:

Answer 13

fasting plasma glucose (FPG)

postprandial (2 hour) glucose level during a 75 gm oral glucose tolerance test (OGTT)

Glycosylated Hemoglobin (HbA1c).

Question 14

what is HbA1c?

Answer 14

a non enzymatic condensation between glucose and an amino group of the beta chain of Hb A. the red cells had a life span _90-120 days, so HbA1c can reflect blood glucose in the preceding 3 months

Question 15

Most patients have antibodies to specific β-cell antigen like?

Answer 15

Glutamic Acid Decarboxylase (GAD), tyrosine phosphatase (IA-2), and zinc transporter 8 (ZnT8)

Question 16

What condition is most commonly presented in Type 1 DM?

Answer 16

DKA

DKA stands for Diabetic Ketoacidosis.

Question 16

What is the primary treatment for Type 1 DM?

Answer 16

Insulin from the start

Question 17

What does LADA stand for?

Answer 17

Latent autoimmune diabetes of adults

Question 18

What is the ‘honeymoon period’ in Type 1 DM?

Answer 18

A phase after diagnosis where insulin requirements reduce dramatically

Question 19

What percentage of diabetes cases does Type 2 DM account for?

Answer 19

90%

Question 20

What are the main pathogenesis factors of Type 2 DM?

Answer 20

• Insulin resistance
• Reduced insulin secretion
• Incretin defect
• Increased glucose reabsorption from the kidney

Question 21

What is the typical age at presentation for Type 2 DM?

Answer 21

Usually older, with peak at 60

Question 22

What is acanthosis nigricans?

Answer 22

A dark velvety skin condition associated with insulin resistance

Question 23

What does HOMA-IR estimate?

Answer 23

Insulin resistance

Question 24

What does metabolic syndrome represent?

Answer 24

Clusters of CVD risk factors associated with insulin resistance

Question 25

What is the role of C-peptide in diabetes management?

Answer 25

Used to represent B-cell reserve and should be measured in correlation to plasma glucose

Question 26

What is the concordance rate for Type 2 DM among monozygotic twins?

Answer 26

60–100%

Question 27

What is the common initial presentation of Type 1 DM?

Answer 27

Polyuria, polydipsia, weight loss, ketoacidosis

Question 28

What is the common initial presentation of Type 2 DM?

Answer 28

Hyperglycaemic symptoms, often with complications

Question 29

What is the genetic association for Type 1 DM?

Answer 29

HLA D3 and D4 linked

Question 30

Is DKA common in Type 2 DM?

Answer 30

No, it is rare

Question 31

What is Gestational DM?

Answer 31

Diabetes diagnosed in the second or third trimester of pregnancy

Question 32

What is MODY?

Answer 32

Maturity-onset diabetes of the young

Question 33

What is the primary aim of diabetes management?

Answer 33

To control hyperglycemia and reduce complications

Question 34

What are the components of a healthy lifestyle for diabetes management?

Answer 34

* Healthy balanced diet * Calorie restriction * Weight management * Increased physical activity

Question 35

What are the two types of insulin used in Type 1 DM management?

Answer 35

* Basal (Background) insulin * Bolus (meal time/quick acting) insulin

Question 36

What is the total daily dose (TDD) calculation for insulin?

Answer 36

TDD = 0.5-1 unit × body weight (Kg)

Question 37

What are the common insulin regimens for Type 1 DM?

Answer 37

* Basal bolus regimen * Twice-daily fixed mixtures

Question 38

What is a common complication of insulin therapy?

Answer 38

* Hypoglycemia * Lipohypertrophy * Lipoatrophy * Injection site reaction

Question 39

What is the dawn phenomenon?

Answer 39

Fasting hyperglycemia due to rise in growth hormone and cortisol at dawn

Question 40

What are the management recommendations for Type 2 DM?

Answer 40

* Non-insulin glucose lowering medications ± insulin * Assess and optimize cardiovascular risk * Screen for complications

Question 41

What is the initial glucose lowering medication for most Type 2 DM patients?

Answer 41

Metformin

Question 42

What are the side effects of Metformin?

Answer 42

* Gastrointestinal issues * Vitamin B12 deficiency

Question 43

What do Sulphonylureas do?

Answer 43

Stimulate insulin secretion from β-cells

Question 44

What are the side effects of Pioglitazone?

Answer 44

* Edema * Risk of bone fracture * Risk of bladder cancer

Question 45

What is the mechanism of action for DPP IV inhibitors?

Answer 45

Inhibit Dipeptidyl Peptidase IV enzyme to increase endogenous GLP1 and GIP

Question 46

What is the benefit of GLP1 Receptor Agonists?

Answer 46

Established cardiovascular and renal benefits

Question 47

What do SGLT2 inhibitors do?

Answer 47

Inhibit glucose reabsorption in the kidney and induce glycosuria

Question 48

What is the target HbA1c level in diabetes management?

Answer 48

HbA1c < 7%

Question 49

Which of the following defines normal glucose tolerance? Fill in the blank: Fasting plasma glucose below _______.

Answer 49

100 mg/dL

Question 50

What is the most appropriate first test in evaluating a patient for diabetes mellitus?

Answer 50

Hemoglobin A1C

Question 51

Which of the following is NOT a risk factor for Type 2 DM?

Answer 51

BMI below 25 kg/m2

Question 52

What BMI value indicates mild obesity?

Answer 52

BMI below 25 kg/m2 ## Footnote BMI is a measure used to classify individuals based on their body weight relative to their height.

Question 53

What condition is characterized by the presence of multiple cysts in the ovaries?

Answer 53

Polycystic ovary syndrome ## Footnote This syndrome often affects women's hormone levels and can lead to various health issues.

Question 54

What HDL cholesterol level is considered low?

Answer 54

HDL level below 35 mg/dL ## Footnote Low HDL levels are associated with an increased risk of cardiovascular disease.

Question 55

What hemoglobin A1C range indicates prediabetes?

Answer 55

Hemoglobin A1C 5.7–6.4% ## Footnote A1C levels are used to diagnose diabetes and prediabetes.

Question 56

What condition is characterized by consistently high blood pressure?

Answer 56

Systemic hypertension ## Footnote Hypertension can lead to serious health complications if left untreated.

Question 57

What random plasma glucose level confirms the diagnosis of diabetes mellitus?

Answer 57

Random plasma glucose of 211 mg/dL ## Footnote A glucose level of 200 mg/dL or higher is indicative of diabetes.

Question 58

Which antibody test is used to strongly indicate type 1 diabetes mellitus?

Answer 58

Anti–GAD-65 antibody ## Footnote This test helps differentiate between type 1 and type 2 diabetes.

Question 59

What is the onset and duration of action for NPH insulin?

Answer 59

4 hours, 14 hours ## Footnote NPH is an intermediate-acting insulin often used in combination with rapid-acting insulins.

Question 60

What is the onset and duration of action for Regular insulin?

Answer 60

0.25 hour, 6 hours ## Footnote Regular insulin is a short-acting insulin used to manage blood glucose levels.

Question 61

What is the most appropriate first-line therapy for a patient with type 2 diabetes and mild systemic hypertension?

Answer 61

Metformin ## Footnote Metformin is usually the first-line treatment for type 2 diabetes due to its effectiveness and safety profile.

Question 62

True or False: Glyburide is the first-line therapy for type 2 diabetes mellitus.

Answer 62

False ## Footnote Metformin is the preferred first-line treatment for type 2 diabetes.

Question 63

Fill in the blank: The hemoglobin A1C level of 7.6% indicates _______ diabetes mellitus.

Answer 63

type 2 ## Footnote An A1C level above 6.5% is diagnostic for diabetes.