1- diabetes basic principles

Question 1

what is diagnostic threshold for glucose for diabetes diagnosis?

Answer 1

7mM (threshold was made based on risk of retinopathy)

Question 2

what is
(a) normal glucose & diabetic diagnosis glucose?
(b) normal HbA1c & diabetic HbA1c?

Answer 2

a) normal 6mM and 7mM diabetic
b) 41mmol/mole normal and 48 mmol/mole

Question 3

what is glucose level for diagnosis for gestational diabetes?

Answer 3

fasting = 5.6 mmol/l
2hr = 7.8 mmol/l

Question 4

what is C-peptide?

Answer 4

connecting peptide that cleaved off when pro-insulin cleaved to insulin = it’s measure to know if pancreas working

Question 5

what are some disorders of insulin secretion?

Answer 5

• type 1 diabetes
• pancreatic diseases (pancreatitis, pancreatectomy, pancreatic cancer)

Question 6

what are some disorders of insulin action?

Answer 6

• pure disorders (genetic ones like donohue & rabson mendenhall) -more in other lectures
• insulin resistance like obesity or type 2 diabetes
• endocrinopathies = cushings, acromegaly
• steroid induced

Question 7

what is type 1 diabetes?

Answer 7

= autoimmune destruction of pancreatic beta-cells resulting in beta-cell deficiency

→antibodies are marker of this destruction (95% of people have them in blood)

*note that not only children, now older people also can get type 1

Question 8

what is type 2 diabetes?

Answer 8

• diagnosis of exclusion (not type 1, not unusual syndrome.. then type 2)
• mostly don’t need insulin to survive but can later in disease

Question 9

what is presentation of diabetes?

Answer 9

= often asymptomatic

• polyuria (pee a lot)
• thirst & polydipsia (drink a lot because pee a lot)
• blurred vision (sugar in eyeball, messing up fluid)
• genital thrush (since pee out glucose)
• fatigue
• weight loss (when out of control diabetes)

*can also present with signs of complications like in optician

Question 10

what are some micro and macrovascular complications of diabetes?

Answer 10

• microvascular = retinopathy, neuropathy, nephropathy
• macrovascular = MI, stroke, PVD

Question 11

what is HbA1c?

Answer 11

• when haemoglobin exposed to glucose = it becomes glycated (this is HbA1c)

= this means that amount of glycation of RBC is proportional to amount of glucose the red blood cell has been exposed to in it’s life (90 days)

Question 12

what is the 1 caution for HbA1c?

Answer 12

not effective in conditions of increased or reduced red cell turnover

e.g. haemolytic anaemia; Haemoglobinopathies may give spurious results

Question 13

what is main action of insulin about glucose?

Answer 13

tells liver to stop producing glucose & tells skeletal muscle to take up glucose (by anabolic pathway)

Question 14

in type 2 diabetes - what are the main dysfunctions of insulin & glucagon?

Answer 14

1. insulin = impaired secretion or sensitivity
2. glucagon = signal stays on (bad as telling liver to keep making glucose)