What is Diabetes Mellitus?

Question 1

Define diabetes mellitus (massive long one from Jane)

Answer 1

‘a group of metabolic diseases of multiple aetiologies characterised by hyperglycaemia together with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both’

Question 2

Give symptoms of hyperglycaemia

Answer 2

Polydipsia
Polyuria
Blurred vision 
Weight loss
Infections

Question 3

What can result from metabolic decompensation as a result of DM?

Answer 3

DKA/HHS

Question 4

Give the long term microvascular complications of DM

Answer 4

Retinopathy
Neuropathy
Nephropathy

Question 5

Give the long term macrovascular complications of DM

Answer 5

Stroke
MI
PVD

Question 6

What is the diagnostic fasting glucose level in DM?

Answer 6

> 7 mmol/l

Question 7

What is the diagnostic random glucose level in DM?

Answer 7

> 11 mmol/l

Question 8

What is the diagnostic HbA1c level in DM?

Answer 8

> 48 mmol/mol

Question 9

What is the expected OGTT (oral glucose tolerance test) measurement after 75g CHO (carbs) in DM?

Answer 9

> 11 mmol/l

Question 10

What does intermediate hyperglycaemia indicate?

Answer 10

A person at higher risk of future diabetes and adverse outcomes such as CV disease

Question 11

What is the expected intermediate hyperglycaemia fasting glucose level?

Answer 11

6.1 - 7 mmol/l

Question 12

What is the expected intermediate hyperglycaemia OGTT level?

Answer 12

> 7.8 and <11 mmol/k

Question 13

What is the expected intermediate hyperglycaemia HbA1c level?

Answer 13

42-47mmol/mol

Question 14

What is the diagnostic criteria guideline for DM?

Answer 14

One diagnostic lab glucose plus symptoms

Two diagnostic lab glucose without symptoms

Question 15

What does HbA1c (glycated haemoglobin) indicate?

Answer 15

Blood glucose levels over last 8-12 weeks

Question 16

Try to name the patients in which HbA1c cannot be used for diagnosis

Answer 16

All children + young people
Pregnant women
Short duration symptoms
Patients at high risk of DM who are acutely ill
Patients taking meds that may cause rapid glucose rise
Acute pancreatic damage/surgery 
Renal failure 
HIV infection

Question 17

Give the 3 factors required in the development of type 1 DM

Answer 17

Genetic pre-disposition
Trigger e.g. viral infection
Autoimmunity

Question 18

What cells are destroyed in Type 1 DM?

Answer 18

Beta cells

Question 19

At what age will most people with type 1 have presented?

Answer 19

30 yrs

Question 20

Give 3 features of insulin deficiency related to the main functions of insulin

Answer 20

Increased lipolysis
Raised glucose production
Reduced muscle glucose uptake
(hyperglycaemia/ketonaemia = DKA)

Question 21

Again, give the clinical presentation of type 1 DM (symptoms)

Answer 21

SHORT duration of
Thirst
Tiredness
Polyuria/nocturia
Weight loss
Blurred vision 
Abdominal pain

Question 22

Give the clinical presentation of type 1 DM on examination (signs)

Answer 22

Ketones on breath
Dehydration
May have increased RR, tachycardia, hypotension
Low grade infections, thrush/balantis

Question 23

Briefly describe the mechanism of type 2 diabetes

Answer 23

Initial hyperinsulinaemia then progressive decrease in insulin production; increased cellular insulin resistance; occurs when insulin production cant overcome insulin receptor resistance

Question 24

Give the clinical presentation of type 2 DM (symptoms)

Answer 24

May have NO symptoms
Thirst
Tiredness
Polyuria/nocturia
Sometimes weight loss
Blurred vision 
Symptoms of complications e.g. CVD

Question 25

Give the clinical presentation of type 2 DM on examination (signs)

Answer 25

Not ketotic Usually overweight but not always Low grade infections, thrush/balanitis In type 2 DM may have macro/micro vascular complications at Dx

Question 26

What is more genetically determined type 1 or type 2?

Answer 26

Type 2

Question 27

Give some risk factors for type 2 DM

Answer 27

``` Overweight Fam history Over 30 yrs (if indian subcontient/pacific island descent) Over 40 yrs (if european) Prev history of gestational diabetes Had a LGA baby Inactive lifestyle Prev high BG/impaired glucose tolerance ```

Question 28

Give three other types of DM

Answer 28

MODY Gestational diabetes Secondary diabetes

Question 29

What is MODY?

Answer 29

Maturity Onset Diabetes in the Young Single gene defect Autosomal dominant

Question 30

What 2 types of mutations cause MODY?

Answer 30

Glucokinase mutations | Transcription factor mutations

Question 31

What can cause secondary DM?

Answer 31

- drug therapy e.g. corticosteroids - pancreatic destruction - recognised genetic syndormes - DIDMOAD - rare endocrine disorders

Question 32

Give examples of pancreatic destruction causes

Answer 32

Haemochromatosis CF Chronic pancreatitis Pancreatectomy

Question 33

Give examples of rare endocrine disorders

Answer 33

Cushings Acromegaly Pheochromocytoma

Question 34

What is gestational diabetes?

Answer 34

Increasing insulin resistance in pregnancy

Question 35

What does gestational diabetes increase the risk of?

Answer 35

Type 2 DM later in life

Question 36

When does gestational diabetes develop?

Answer 36

2nd/3rd trimester

Question 37

Who is gestational diabetes more common in?

Answer 37

Overweight and inactive individuals

Question 38

What neonatal problems can gestational diabetes cause?

Answer 38

Macrosomia Resp distress Neonatal hypoglycaemia