Diabetes Mellitus-diagnosis and monitoring

Question 1

What are the WHO criteria for diagnosing DM?

Answer 1

• hyperglyceamic symptoms AND a fasting glucose of 7+ mmol or 11.1+ non-fasting glucose
• raised venous glucose on two separate occasions (fasting, non-fasting, OGTT 2hr value of 11.1+
• HbA1c of 48 or greater (6.5%)

Question 2

When does type 1DM present?

Answer 2

Typically presents in adolescence but can occur at any age

Question 3

What causes ty1DM?

Answer 3

Autoimmune destruction of beta cells in the islets of langerhans in the pancreas resulting in a lack of insulin production

Question 4

What is ty1DM associated with and what genetic feature carried by 90% of those affected with ty1DM?

Answer 4

Autoimmune diseases

HLA DR3 +/- DR4

Question 5

What is the significance of the HLA DR3/4 alleles?

Answer 5

They are frequently associated with multiple autoimmune conditions…
DR3 = myasthenia gravis, PSC and Hashimoto’s thyroiditis
DR4 = RA, SLE, HOCM, IgA nephropathy

(Human leukocyte antigen D related) involved in self recog

Question 6

Is the concordance of type 1 or type 2 higher for identical twins, what does this suggest?

Answer 6

80% in ty2 compared to 30% in ty 1 suggesting that there is a much stronger environmental impact in ty 1 and a higher genetic component in ty 2

Question 7

What gene is responsible for islet sensitivity to damage?

Answer 7

6q

Question 8

What form of type 1 DM results in a slower progression to diabetes later in life?

Answer 8

Latent autoimmune diabetes of adults (LADA)

Question 9

What non-adjustable factors increase the chance of getting ty2DM?

Answer 9

Being Asian, male or elderly

Question 10

What causes type 2 DM?

Answer 10

Reduced insulin secretion and/or reduced insulin sensitivity

Question 11

What adjustable risk factors are associated with ty2DM?

Answer 11

Obesity, calorie intake excess, lack of exercise

Question 12

What is diabetes mellitus?

Answer 12

It is he lack of or reduced effectiveness of endogenous insulin.

Question 13

Define impaired glucose tolerance (IGT)…

Answer 13

OGTT 2hrs of greater than 7.8mmol but less than 11.1mmol

And a fasting plasma glucose of less than 7mmol

Question 14

Define impaired fasting glucose (IFG)…

Answer 14

A fasting glucose of 6.1 or higher but less than 7mmol (WHO)

Question 15

Between IFG and IGT, which one if diagnosed, are more likely to progress to DM?

Answer 15

IGT

Question 16

How do you manage IFG and IGT?

Answer 16

Lifestyle advice and annual review

Question 17

Secondary causes of DM include… (Name 5)

Answer 17

Steroids, newer anti-psychotics, anti-HIV medication, thiazides, pancreatitis, pancreatic resection (90% removed), cystic fibrosis, haemachromatosis (destroys pancreas), pancreatic Cr, cushings, pregnancy, glycogen storage diseases

Question 18

What percentage of pregnancies are complicated by DM, either existing or developed during pregnancy?

Answer 18

4% (3.5% of which is gestational diabetes)

Question 19

What are the risk factors for mothers developing gestational diabetes?

Answer 19

Older than 25, FMH, overweight, non-Caucasian, HIV +ve, previous GDM

Question 20

If a potential mother has one of the risk factors what should be done?

Answer 20

Screened with OGTT at the 16-18 week mark. On top of lifestyle advice

Question 21

If diagnosed with GDM or already a diabetic, what treatments should be discontinued?

Answer 21

All oral hypoglyceamics bar metformin

Question 22

6 weeks post partum mothers affected with GDM are screened for DM, what percentage go on to develop DM even if -ve result is achieved?

Answer 22

50%!

Question 23

What conservative measures should be offered to any diabetic?

Answer 23

Stop smoking!, Increase exercise, reduce calorie intake, loose weight, MDT involvement (dietitians, help groups, specialist nurses and doctors), set a HbA1c goal (6.5% or less) (pre meal of 4-7mmol blood glucose), start a station and control BP!

Question 24

What specifically should change in a diabetics diet?

Answer 24

Reduce saturated fats and sugars, increase complex carbohydrates and starches instead, moderate protein

Question 25

What are the pre/post prandial bms recommended for ty1/ty2 diabetics?

Answer 25

4-7 mmol for ty1+2 pre prandial
Less than 8.5 mmol in type 2 diabetes post prandial
Less than 9.0 mmol in type 1 diabetes post prandial

Question 26

What are the healthy values for pre/post prandial blood glucose?

Answer 26

Pre = 4-5.9 mmol
Post= less than 7.8 mmol

Question 27

How effective is the ketogenic diet?

Answer 27

95% no longer required or reduced their medication. Diet is the most important determinant of blood glucose.

Question 28

How should diabetes be monitored for ty 1 and ty 2?

Answer 28

Finger prick glucose for ty1s and ty2s on insulin

HbA1c for ty2 diabetics every 2-6 months

Question 29

What time period does the HbA1c test look at?

Answer 29

The past 8 weeks (roughly the half life of RBCs)