DM

Question 1

Def of dm?

Question 2

Insulin structure?

Answer 2

Prepro insulin
Pro insulin (endoplasmic reticulum)
Insulin + C peptide (golgi apparatus of beta cells)

Question 3

Insulin secretion?

Answer 3

5

Question 4

Insulin receptor structure?

Answer 4

3

Question 5

Mechanism of insulin transport glucose into the cells?

Answer 5

5
Then
Metabolism (glycolysis,lipogenesis)
Storage (glycogenesis)

Question 6

Funtions of incretine?

Answer 6

Glucose dependent ,

• Increase insulin from beta cells (GLP-1 N GIP)
• reduce glucagon from alpha cells (GLP-1)

Question 7

Diagnosis of dm?

Answer 7

4

Question 8

Pre diabetic values?

Answer 8

Impaired fasting glycaemia
FPG- 5.6-7 (6.9) mmol/l
2HR PG during OGTT -7.8-11(10.9)

Question 9

Factors interfere with HBA1C measurement?

Answer 9

1. genetic varients (Hbs,Hbc)
2. elevated Fhb n checmically modified derivatives of hb (carbamethylated hb in RF)
3. And condition that shortens erythrocyte lifestyle (recover from blood loss,hemolytic anemia)
4. IDA (high)
5. ^ red cell turnover
6. transfusion
7. iron replacement therapy (lowers)
8. late preg (high)
9. in CKD, renal anemia,erythropoietin intake etc
10. Dialysis (low)

Question 10

Type 1 n type 2 differences?

Answer 10

Deficiency 
Age
Presentation 
Complications at diagnosis- not in 1,25% in 2
Fhx
Fasting C peptides
Ab- HLA DR3 n DR4 in >90% , anti GDA (glutamic acid decarboxylase)  in type 1
Genetic (1-HLA DQB1,DR3,DR4 2-TCF7L2)
Association 
Tx

Question 11

Type 1 dm features?

Answer 11

• Presence of 2 or more ab
• Rate of progression dependent on, age at first detection og ab,no.of ab, ab specificity,ab titer
• tupe qA had ab where as 1B has no ab
• 3stages

Question 12

3 stages of type 1 dm?

Answer 12

Stage 1-
Autoimmunity 
Normoglycemia
Presymptomatic
Multiple ab (dx)

Stage 2-
Autoimmunity 
Dysglycemia(pre dm)
Presymptomatic
Multiple ab,dysglycemia (dx)

Stage 3-
New onset hyperglycemia
Symptomatic
Clinical symptoms,dm usual criteria (dx)

Question 13

Causes of insulin resistance?

Answer 13

13

Question 14

Types of dm?

Answer 14

Monogenic

• neonatal diabetes
• MODY (maturity onset diabetes of the young)

LADA (latent autoimmune diabetes in adults)

Gestational dm

Secondary causes

Post transplant dm

Question 15

Neonatal diabetes?

Answer 15

<6 months of age

80-85% hv am underlying monogenic cause

Question 16

MODY?

Answer 16

Monogenic dm (1-2%)
<25 yrs
AD (>2generations)
Ab -
C peptide + (ar dx and even after potential honeymoon period of 5yrs)
Low insulin requirement
4 types (1,2,3 most common,5)

Question 17

When to suspect monogenic dm?

Answer 17

In a setting of T1 DM,

• absent ab at presentation
• normal C peptide (even after 5yrs
• Fhx of parent having normal c peptide levels

In the settings of T2Dm,
Absence of obesity,acanthosis nigricans,PCOS
-N or high HDL (suggest 3, hdl low in mody 1)
-elevated high sensitive CRP favours T2DM over MODY

Stab,e mild fasting hyperglycemia,stable A1c netween 5.6-7.6%

Question 18

LADA?

Answer 18

• Adult onset diabetes
• Auto ab +
• Treatable with oral hypoglycemics at onset
• need insulin within 6 months-few years (in type 1 need from beginning)
• higher titers predict earlier need for insulin

Question 19

GDM?

Answer 19

Lifelong screening at least every 3 yrs

Use metformin/intensive lifestyle interventions in pre diabetic

Question 20

Secondary causes of dm?

Answer 20

1. Pancreatic- chronic pancreatitis,CF, hereditary hemachromatosis
2. endocrine- cushings, thyrotoxicosis, phaechromocyyoma, glucanoma, acromegaly
3. drugs- thiazide, beta blockers steroids
4. Genetic - friedrich’s ataxia,dystropia mytonica

Question 21

Criteria of testing dm?

Answer 21

1. obese adults who have 1 or more risk factors (8)
2. prediabetic-yearly
3. gdm -3 yearly
4. 45 yrs
5. If normal should repeat min 3 yr interval

Question 22

Pre diabetic mx? 3 places of prediabetic where metformin is used?

Answer 22

Lifestyle interventions

• 7% loss of body weight
• moderate intensity physical activity (150min/week)

1. BMI:35 kg/mw
2. > 60yrs
3. prior GDM

long term metformin-periodic measurement of vit B12

Question 23

HbA1c goals?

Answer 23

1. diagnosis->6.5%
2. diabetic <7%
3. <8% if hx of hypoglycemia,elderly,complications etc

Question 24

Glycemic recommendation in diabetics?

Answer 24

Hba1c <7
Preprandial capillary plasma glucose- 80-130 mg/dl
Peak postprandial capillary plasma glucose <180 mg/dl

Question 25

Levels of hypoglycemia and tx?

Answer 25

Level 1- <70 - 15-20g glucose Level 2 - <54 - glucogan(intranasal ,autoinjector also available) Level 3 - altered mental status or physical status requiring assistance for tx if hypoglycemia

Question 26

Presentation of dm?

Answer 26

6

Question 27

Complications of DM?

Answer 27

Macrovascular 1. cvs- CAD,PVD 2. CNS- TIA n stroke ``` Micro vascular 1.diabetic nephropathy 2.diabetic retinopathy 3.diabetic neuropathy (Sensory poluneuropathy, diabetic amyotrophy,mononeuropathy,autonomic neuropathy) ``` Other- foot complications,recurrent infections Acute- hypo and hyper

Question 28

Indications to take insulin?

Answer 28

1. evidence of ongoing catabolism 2. symptoms of hyperglycemia 3. A1c >10 or blood glucose levels very high (>300)

Question 29

Diabetic drugs and mechanism and SEs?

Answer 29

1. biguanides- metformin 2. sulphonylureas- tolbutamide, gliclazide, glipizide.glibenclamide,glimipiride 3. meglitinides- repaginide,nateglinide 4. thiazolidenadiones (glitazones)- pioglitazone,rosiglitazone 5. alpha glucosidase inhibitors- acarbose 6. GLP1 analogoues- exenatide,liraglutide 7. DPP4 inhibitors- sitagliptin,vidagliptin 8. SGLT2 inhibitors- gliflozins

Question 30

Mx of complications?

Answer 30

Tute