Diabetes

Question 1

What other conditions are associated with diabetes?

Answer 1

• High BP

- High cholesterol

Question 2

What is the normal blood glucose level? What can go wrong?

Answer 2

• Normal: 5mmol/l

- Low: 11mmol/l hyperglycaemia

Question 3

What are signs & symptoms of diabetes?

Answer 3

• Thirst
• Polyuria
• Weight loss
• Fatigue
• Dry mouth
• Glycosuria
• Hyperglycaemia

Question 4

How is diabetes diagnosed?

Answer 4

• Diabetic symptoms
• Random high blood glucose >11.1
• Fasting blood/plasma glucose >7mmol/l
• 75g OGTT (glucose tolerance test) with 2 plasma readings >11.1
• HbA1c 48mmol/mol

Question 5

What investigations can be done for suspected diabetes?

Answer 5

• HbA1c (glycated Hb)
• Renal function
• Liver function
• Lipids
• Thyroid function

Question 6

What types of diabetes are there?

Answer 6

• Type 1: insulin dependant
• Type 2
• LADA (autoimmune)
• Pancreatic disorders
• Drug induced
• Endocrine disorders
• Ethnic variants of diabetes
• Genetic syndromes

Question 7

How does type 1 diabetes occur? How is it diagnosed?

Answer 7

• Autoimmune destruction of insulin producing beta cells
• Lymphocytic infiltration of islets of langerhans (insulitis)
• Autoantibody tests: GAD, IA2, ICA

Question 8

Describe LADA

Answer 8

• Older patients
• Usually female
• Autoantibodies GAD, TPO, ICA, tTG
• Presents as type 2
• Medical or family related
• Progressive deterioration in control-increasing therapy
• Related conditions: thyroid, Addison’s, vitiligo, coeliac

Question 9

What is the diagnostic criteria for type 2 diabetes?

Answer 9

• Insulin resistant/deficient
• Family history
• Often obese/overweight
• Hypertensive & hyperlipidaemic

Question 10

Describe type 2 diabetes variant: ketosis- prone type 2

Answer 10

• Obese ethnic minority
• Ketosis when stressed with intercurrent illness
• Temporarily requites insulin
• Not insulin dependant

Question 11

Name some pancreatic disorders that cause secondary diabetes

Answer 11

• Chronic/acute pancreatitis
• Calcific tropical pancreatitis
• Pancreatectomy
• CF
• Haemochromatosis (hereditary iron overload storage disorder)
• Pancreatic cancer

Question 12

What drugs cause drug induced diabetes?

Answer 12

• Diuretics
• Steroids
• Antipsychotics (olanzapine)
• Psychiatric drugs= weight gain

Question 13

What endocrine disorders can cause diabetes?

Answer 13

• Acromegaly (high growth hormone levels)
• Cushing’s syndrome (high cortisol levels)
• Phaeochromocytoma

Question 14

What are the ethnic variants of diabetes?

Answer 14

• J type
• Flatbush
• MRDM (malnutrition)
• Z type
• Chronuc calcific pancreatitis

Question 15

Describe J type diabetes

Answer 15

• Jamaican/flatbush
• Ketosis prone
• On & off insulin therapy

Question 16

What is the diagnostic criteria for gestational diabetes?

Answer 16

• Appears during pregnancy
• Disappears after pregnancy
• Risk of diabetes later in life/ other pregnancies
• fasting plasma glucose >5.6mmol/l or
• 2hr plasma glucose >7.8mmol/l