Types of Diabetes

Question 1

what type of cells what insulin

Answer 1

beta cells, islets of langerhans

Question 2

what type of diabetes has sweet smelling urine

Answer 2

mellitus (greek for honey)

Question 3

what do all types of diabetic share

Answer 3

an inability to maintain glucose homeostasis (due to either failure of insulin synthesis, release or activity)

Question 4

what diabetes is RELATIVE not absolute deficiency

Answer 4

type 2

Question 5

what is diabetes mellitus

Answer 5

group of metabolic diseases characterised by hyperglycemia resulting from defects in insulin secretion, action or both

Question 6

what is abnormal blood glucose

Answer 6

> 6.1 mmol/L but really more like >5.6 mmol/L

Question 7

what is the diagnostic criteria for diabetes

Answer 7

*impaired or pre diabetes

HbA1c >48 m/m (42-47m/m*)

fasting glucose >7 mmol/L (6.1-6.9mmol/L*)

2 hour glucose in OGTT >11.1 mmol/L (7.8-11.0 mmol/m)

random glucose >11.1mmol/L

Question 8

what is the normal ranges for blood glucose

Answer 8

3.3 - 5.8 mmol/L

Question 9

what is type 1 diabetes

Answer 9

autoimmune disease resulting in beta cell destruction, usually leading to absolute insulin deficiency

Question 10

what is type 2 diabetes

Answer 10

progressive loss of beta-cell insulin secretion (causing hyperinsulinaemia) frequently on the background of insulin resistance

Question 11

what is gestation diabetes mellitus

Answer 11

Any degree of glucose intolerance arising or diagnosed during pregnancy

Question 12

what is MODY

Answer 12

maturity onset diabetes of the young

Question 13

what antibodies re usually found in T1DM

Answer 13

anti-GAD/ anti- islet cell antibodies

Question 14

what might be seen histologically in T1DM

Answer 14

insulitis- lymphocytic infiltrate

Question 15

what is the typical presentation of type 1 diabetes

Answer 15

pre school and peri puberty 
small peak in late 30's
usually lean 
acute onset 
severe symptoms 
severe weight loss 
ketonuria +/- metabolic acidosis 
no evidence of microvascular disease at diagnosis 
immediate and permanent requirement for insulin

Question 16

what are the risk factors for type 2 diabetes

Answer 16

obesity (central)
familial 
race 
CVD
gestational diabetes
hypertension 
high cholesterol/ triglyceride 
polycystic ovary syndrome 
inactivity 
medications (antipyschotics)

Question 17

when should all patients get tested for diabetes

Answer 17

45 years

Question 18

how do you test for type 2 diabetes

Answer 18

fasting glucose, 2-hr plasma glucose during 75 g oral glucose tolerance test, A1C

Question 19

what are the symptoms of diabetes mellitus

Answer 19

thirst 
polyuria 
thrush 
weakness fatigue 
blurred vision
infections 
weight loss 
T2DM- complications- neuropathy, retinopathy

Question 20

what discriminatory tests can be used

Answer 20

autoimmune markers- anti-GAD, anti insulin, anti tyrosin phosphatases

ketones
C peptide

in type 1 there is a strong HLA association

Question 21

what is LADA and how do you distinguish it from T1DM

Answer 21

latent autoimmune diabetes of adults. type of diabetes mellitus with later onset than type 1

ketosis= type 1

Question 22

do people with idiopathic T1DM have B cell autoimmunity

Answer 22

no

Question 23

is idiopathic T1DM HLA associated

Answer 23

no, but strongly inherited

Question 24

what is type three diabetes

Answer 24

gestational

Question 25

what is type 4 diabetes

Answer 25

``` can arise from: drug induced abnormalities of insulin and its receptor genetic diseases pancreatic disease endocrine disease ```

Question 26

what pancreatic diseases can cause type 4 diabetes

Answer 26

chronic/ recurring pancreatitis (gall stones/ alcohol) haemochromatosis cystic fibrosis

Question 27

what endocrine diseases can cause type 4 diabetes

Answer 27

cushings syndrome acromegaly phaechromocytoma glucagonoma

Question 28

what drugs can cause type 4 diabetes

Answer 28

glucocorticoids diuretics b blockers

Question 29

what genetic diseases can cause type 4 diabetes

Answer 29

cystic fibrosis myotonic dystrophy turners syndrome

Question 30

what should you look out for which would suggest monogenic diabetes

Answer 30

``` Strong Family History Associated Features (renal cysts etc) Young Onset GAD-negative C-peptide positive ```

Question 31

what does HbA1c show

Answer 31

measure of glucose control over the past 2-3 months

Question 32

what are the complications of diabetes

Answer 32

macro-vascular: heart disease, storke, CVD, atheroma micro-Vascular: retinopathy (blindness), nephropathy (kidney failure), neuropathy- foot ulcers (charcots foot) psychiatry/ psychology

Question 33

which test is diagnostic of diabetes

Answer 33

fasting blood glucose