Diabetes

Question 1

What is diabetes?

Answer 1

• A medical condition with high blood glucose levels
• Diabetic people also often have high BP and high cholesterol levels.
• a condition in which the blood glucose level drifts up: chronic hyperglycaemia

Question 2

Where are the breakdown products of food and drink refined to glucose?

Answer 2

In the Liver

Question 3

Where is ‘fuel’ stored?

Answer 3

In the liver and muscles as glucose and in fat cells.

Question 4

Using the analogy of a car, what are the issues with to little or too much fuel?

Answer 4

To little - stalling

Too much - uneven engine performance

Question 5

What is a normal blood glucose level?

Answer 5

5 mmol/l

Question 6

Glucose is released from where in response to insulin?

Answer 6

The liver

Question 7

Glucose is taken up to where in response to insulin?

Answer 7

Muscle tissue

Question 8

What are the signs are symptoms of diabetes?

Answer 8

• Symptoms: thirst, polyuria, weight loss, tiredness

- Signs: dry mouth, weight loss, glycosuria, hyperglycaemia

Question 9

How common is diabetes?

Answer 9

• Leeds 4% population
• Rising fast
• Associated with the rise in obesity and a reduction in physical activity
• High prevalence in certain ethnic groups: Asians, Afro-Caribbeans

Question 10

How is diabetes diagnosed?

Answer 10

• Typical symptoms and high RANDOM blood glucose
• Fasting blood glucose >7mmol/l
• 75g OGTT
• HbA1c; 48 mmol/mol (6.5%)

Question 11

What is the oral glucose tolerance test?

Answer 11

• Fasting, then 75g oral glucose load
• Blood glucose: fasting and at intervals
• Fasting: normal 7mmol/l
• 2-hour post-glucose load: diabetic >11 mmol/l

Question 12

What is ‘borderline’ diabetes?

Answer 12

• Impaired fasting glucose: 6-7mmol/l

- Impaired glucose tolerance: two-hour glucose levels of 7.8 -11.0mmol/l, 140 to 199mg/dl on the 75-g oral GTT

Question 13

What investigations are neccessary in diabetes?

Answer 13

• HbA1c
• Renal function
• Liver function
• Lipids
• Thyroid function

Question 14

What are the features of type 1 diabetes?

Answer 14

• Autoimmune destruction of the insulin producing islet beta cells
• Insulin deficient: insulin dependent
• Usually young, but can be ANY age.

Question 15

What autoantibodies may be present in TiDM?

Answer 15

• ICA
• IA2
• GAD

Question 16

What is latent autoimmune diabetes in adults(LADA)?

Answer 16

• Older patients, often female
• Medical or family history of related conditions: type 1 diabetes, thyroid, PA, Addison’s, coeliac, vitiligo
• Presents often as ‘type 2’ diabetes
• Progressive deterioration in control, increasing therapy

Question 17

What autoantibodies may be present in LADA?

Answer 17

• GAD
• ICA
• tTG
• TPO

Question 18

What are the features of type 2 diabetes?

Answer 18

• Insulin resistant/deficient
• Not absolutely insulin dependent
• Strong family history
• Often obese or overweight
• Usually hypertensive and hyperlipidaemic

Question 19

What are the features of TIIDM variant ‘ketosis-prone type 2’?

Answer 19

• Often obese, ethnic minority
• Ketosis when physically stressed with intercurrent illness
• Temporarily requites insulin
• Not insulin dependent

Question 20

Which pancreatic disorders can cause secondary diabetes?

Answer 20

• Chronic or acute pancreatitis
• Calcific, tropical pancreatitis
• Pancreatectomy
• Pancreatic cancer
• Cystic fibrosis
• Haemochromatosis

Question 21

Which drugs can induce diabetes?

Answer 21

• Diuretics
• Steroids
• Antipsychotics e.g. Olanzapine
• Psychiatric drugs: weight gain

Question 22

Diabetes may be comorbid in which endocrine disorders?

Answer 22

• Acromegaly: high growth hormone levels cause diabetes
• Cushing’s syndrome: high cortisol levels cause diabetes
• Phaeochromocytoma

Question 23

What are the ethnic variants of diabetes?

Answer 23

• J type diabetes: ‘Jamaican’ diabetes, Afro-Caribbeans
• Flatbush diabetes: US Afro-Americans
• MRDM: malnutrition- related diabetes, tropical diabetes
• Chronic calcific pancreatitis: secondary diabetes
• Z type diabetes

Question 24

What are the features if J typr Jamaican diabetes?

Answer 24

• Ketosis prone
• Not particularly obese
• On and off insulin therapy
• Variable insulin requirements
• Also called Flatbush diabetes

Question 25

Which genetic syndromes are associated with genetic syndromes?

Answer 25

- Friedreich’s ataxia | - Dystrophia myotonica: a genetic diabetes syndrome

Question 26

What is gestational diabetes?

Answer 26

- Diabetes appears during pregnancy - Diabetes resolves after pregnancy - At risk of diabetes in later pregnancy - At risk of diabetes in future - Pregnancy in the known diabetic case - Diabetes arising or diagnosed in pregnancy

Question 27

What is maturity onset diabetes in the young?

Answer 27

- Autosomal dominant pattern - 1-2% of diabetic cases - Onset under 25 - Insulin not required initially - Glucokinase, HNF 1A, HNF 4A