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Questions and Answers
Which of the following statements is true regarding Type 2 diabetes?
Which of the following statements is true regarding Type 2 diabetes?
What primary characteristic differentiates Type 1 diabetes from Type 2 diabetes?
What primary characteristic differentiates Type 1 diabetes from Type 2 diabetes?
What is a common symptom of hyperglycemia in diabetes mellitus?
What is a common symptom of hyperglycemia in diabetes mellitus?
Which diagnostic test is most commonly used to assess glucose levels in individuals suspected of having diabetes?
Which diagnostic test is most commonly used to assess glucose levels in individuals suspected of having diabetes?
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What is an essential management strategy for individuals with Type 2 diabetes?
What is an essential management strategy for individuals with Type 2 diabetes?
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What body weight is typically associated with Type 1 diabetes?
What body weight is typically associated with Type 1 diabetes?
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At what age does Type 2 diabetes commonly onset?
At what age does Type 2 diabetes commonly onset?
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Which of the following symptoms is particularly seen in Type 1 diabetes?
Which of the following symptoms is particularly seen in Type 1 diabetes?
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What is a common diagnostic test used to determine if someone has overt diabetes?
What is a common diagnostic test used to determine if someone has overt diabetes?
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What is the stability condition generally observed in Type 2 diabetes?
What is the stability condition generally observed in Type 2 diabetes?
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Which treatment is typically necessary for Type 1 diabetes?
Which treatment is typically necessary for Type 1 diabetes?
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What glycosylated hemoglobin (HbA1c) level is considered normal?
What glycosylated hemoglobin (HbA1c) level is considered normal?
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Which of the following is an ineffective treatment option at the onset of Type 2 diabetes?
Which of the following is an ineffective treatment option at the onset of Type 2 diabetes?
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What is the primary method of managing type 1 diabetes?
What is the primary method of managing type 1 diabetes?
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Which strategy is NOT typically part of the initial treatment for type 2 diabetes?
Which strategy is NOT typically part of the initial treatment for type 2 diabetes?
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What is the average glucose level considered acceptable for type 1 diabetes management?
What is the average glucose level considered acceptable for type 1 diabetes management?
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What is a common treatment option for type 1 diabetes?
What is a common treatment option for type 1 diabetes?
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Which of the following is a lifestyle modification recommended for managing diabetes-related risks?
Which of the following is a lifestyle modification recommended for managing diabetes-related risks?
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Why might insulin therapy become necessary in type 2 diabetes?
Why might insulin therapy become necessary in type 2 diabetes?
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What role does self-monitoring of blood glucose play in diabetes management?
What role does self-monitoring of blood glucose play in diabetes management?
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Which insulin types are commonly combined in type 1 diabetes treatment?
Which insulin types are commonly combined in type 1 diabetes treatment?
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What is the primary underlying cause of hyperglycemia in diabetes mellitus?
What is the primary underlying cause of hyperglycemia in diabetes mellitus?
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Which factor is a significant predisposing factor for insulin resistance in Type 2 diabetes?
Which factor is a significant predisposing factor for insulin resistance in Type 2 diabetes?
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What percentage of diabetes cases is classified as primary diabetes?
What percentage of diabetes cases is classified as primary diabetes?
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What is a common contributing factor associated with the development of Type 2 diabetes?
What is a common contributing factor associated with the development of Type 2 diabetes?
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What condition is generally observed as a secondary disturbance in diabetes mellitus?
What condition is generally observed as a secondary disturbance in diabetes mellitus?
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What is the typical age of onset for Type 1 diabetes?
What is the typical age of onset for Type 1 diabetes?
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Which of the following is a classic symptom of diabetes?
Which of the following is a classic symptom of diabetes?
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What characteristic is true regarding Type 2 diabetes in comparison to Type 1 diabetes?
What characteristic is true regarding Type 2 diabetes in comparison to Type 1 diabetes?
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Which of the following glucose levels indicates overt diabetes during fasting?
Which of the following glucose levels indicates overt diabetes during fasting?
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How does the stability of Type 1 diabetes generally compare to Type 2 diabetes?
How does the stability of Type 1 diabetes generally compare to Type 2 diabetes?
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Which method is typically NOT effective for controlling Type 1 diabetes?
Which method is typically NOT effective for controlling Type 1 diabetes?
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What is the significance of measuring glycosylated hemoglobin (HbA1c) in diabetes management?
What is the significance of measuring glycosylated hemoglobin (HbA1c) in diabetes management?
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Which of the following urine tests is primarily used for ketone bodies?
Which of the following urine tests is primarily used for ketone bodies?
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What is the primary cause of diabetic ketoacidosis (DKA)?
What is the primary cause of diabetic ketoacidosis (DKA)?
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Which of the following symptoms is characteristic of diabetic ketoacidosis?
Which of the following symptoms is characteristic of diabetic ketoacidosis?
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What blood glucose level is generally considered indicative of hyperglycemia hyperosmolar state?
What blood glucose level is generally considered indicative of hyperglycemia hyperosmolar state?
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Which complication is more commonly associated with type 2 diabetes?
Which complication is more commonly associated with type 2 diabetes?
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What is the typical treatment for hypoglycemia?
What is the typical treatment for hypoglycemia?
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Which of the following might lead to hypoglycemia in diabetes patients?
Which of the following might lead to hypoglycemia in diabetes patients?
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What is the primary goal of patient education and self-monitoring in diabetes management?
What is the primary goal of patient education and self-monitoring in diabetes management?
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Which of the following actions is typically recommended as the first treatment step for type 2 diabetes?
Which of the following actions is typically recommended as the first treatment step for type 2 diabetes?
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What is a potential consequence of untreated hypoglycemia?
What is a potential consequence of untreated hypoglycemia?
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What happens to insulin production in type 2 diabetes over time?
What happens to insulin production in type 2 diabetes over time?
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What physiological effect does high blood glucose have on the cells?
What physiological effect does high blood glucose have on the cells?
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In the management of type 1 diabetes, what is the significance of combining regular and NPH insulin?
In the management of type 1 diabetes, what is the significance of combining regular and NPH insulin?
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What is a common outcome if oral medications fail in type 2 diabetes management?
What is a common outcome if oral medications fail in type 2 diabetes management?
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Which blood glucose level range is suggested for type 1 diabetes management?
Which blood glucose level range is suggested for type 1 diabetes management?
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What lifestyle modifications can help control the risk of cardiovascular diseases in diabetes patients?
What lifestyle modifications can help control the risk of cardiovascular diseases in diabetes patients?
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When should insulin therapy be considered in type 2 diabetes management?
When should insulin therapy be considered in type 2 diabetes management?
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Study Notes
Diabetes Mellitus
- A disturbance of carbohydrate metabolism caused by insulin deficiency, resistance, or both, leading to hyperglycemia and possibly glucosuria.
- The most common endocrine disease with a 1-2% prevalence.
- Primarily caused by insulin deficiency or resistance.
- Type 1: Insulin-dependent diabetes mellitus (IDDM), previously known as juvenile-onset.
- Insulin deficiency caused by damage to the beta cells, resulting in hyperglycemia.
- Type 2: Non-insulin-dependent diabetes mellitus (NIDDM), previously known as maturity-onset.
- Insulin resistance &/or abnormal insulin structure, which in some cases becomes absolute, combined with relatively reduced insulin secretion.
- Type 1: Insulin-dependent diabetes mellitus (IDDM), previously known as juvenile-onset.
- Numerous theories about cause and mechanism of Type 2 Diabetes:
- Central obesity (fat concentrated around the waist) predisposes individuals to insulin resistance.
- It secretes adipokines that may affect glucose tolerance.
- Obesity is found in about 55% of patients diagnosed with Type 2 Diabetes.
- Family history: Type 2 Diabetes is more common in those with relatives who have had it.
- Central obesity (fat concentrated around the waist) predisposes individuals to insulin resistance.
Diabetes Mellitus
- A condition characterized by a disturbance in carbohydrate metabolism due to insulin deficiency, resistance, or both, leading to hyperglycemia and glucosuria. This also causes secondary disturbances in protein and fat metabolism
- Diabetes mellitus is the most common endocrine disease with a prevalence of 1-2%
- There are two main types of diabetes: type 1 and type 2.
Type 1 Diabetes
- Previously referred to as Insulin-Dependent Diabetes Mellitus (IDDM) or Juvenile-Onset Diabetes
- Caused by insulin deficiency due to the destruction of beta cells in the pancreas.
- Affects around 10% of all diabetic patients.
- Typically diagnosed before the age of 30, with the most common age of onset being between 12 and 14 years
- More prevalent in males.
- Individuals are often underweight.
- Characterized by severe and unstable diabetes.
- Insulin is essential for treatment.
- Oral hypoglycemic agents are ineffective.
Type 2 Diabetes
- Previously referred to as Non-Insulin-Dependent Diabetes Mellitus (NIDDM) or Maturity-Onset Diabetes
- Caused by a combination of factors including:
- Insulin resistance
- Abnormal insulin structure
- Reduced insulin secretion
- Accounts for 90% of all diabetic patients
- Typically diagnosed after the age of 40.
- More prevalent in females.
- Individuals are usually overweight.
- Characterized by mild or moderate, and stable diabetes.
- Initially may not require insulin.
- Oral hypoglycemic agents can be effective at least initially.
Theories Regarding Type 2 Diabetes
- Central obesity is considered a major risk factor for insulin resistance
- Abdominal fat is more hormonally active than subcutaneous fat.
- Abdominal fat secretes adipokines, which may impair glucose tolerance.
- Approximately 55% of patients diagnosed with type 2 diabetes are obese.
- Family history strongly influences the likelihood of developing type 2 diabetes.
Clinical Presentations
- Often asymptomatic and discovered accidentally.
- Classic symptoms include:
- Polyuria (excessive urination)
- Polydipsia (excessive thirst)
- Polyphagia (excessive hunger, with weight loss especially in type 1)
- Pruritis (itching, especially of the vulva and anal region)
- Parathesia (numbness or tingling, especially of the hands and feet)
- Premature loosening of teeth
- Recurrent infections (e.g., boils)
- Diabetes can also manifest through complications or a diabetic coma.
Investigations
-
Plasma Glucose Testing:
- Fasting glucose ( normal < 100 mg%)
- 2 hours post-prandial glucose ( normal < 140 mg% )
- Oral Glucose Tolerance Test (OGTT)
- Impaired Glucose Tolerance(IGT):
- Fasting Glucose (≥ 100 & < 126 mg%)
- 2 hours post-prandial ( ≥ 140 & < 200 mg% )
- Overt Diabetes:
- Fasting glucose (≥ 126 mg%)
- 2 hours post-prandial glucose (≥ 200 mg%)
- Symptoms of diabetes and a random glucose concentration ≥ 200 mg/dl
- Impaired Glucose Tolerance(IGT):
- Glycosylated Hemoglobin (HbA1c)
- formed by the linkage of glucose to the beta-chains of Hemoglobin A
- used to estimate diabetic control over the preceding 8-12 weeks
- normal level is 6% of total Hb
-
Urine Analysis:
- Glucose: using strips or, less commonly, solutions (e.g., Benedict's reagent)
- Ketone bodies: using strips or Rothera's sodium nitroprusside test
- Home Blood Glucose Monitoring (HBGM) or urine glucose testing is used to monitor treatment.
Management
- Patient education is paramount in the management of diabetes.
- Dietary changes, sensible exercise, and self-monitoring of blood glucose levels are essential to maintain blood glucose within acceptable bounds.
- Type 1 diabetes always requires insulin therapy via injection.
- Blood glucose levels should be maintained as close to normal (80-120 mg/dl) as possible.
- Some physicians may suggest a target range of 140-150 mg/dl for patients who experience frequent hypoglycemic episodes.
- Treatment of type 2 diabetes often begins with lifestyle modifications, such as:
- Increasing physical activity
- Decreasing carbohydrate intake
- Weight loss
- Oral antidiabetic drugs may be introduced if lifestyle modifications are insufficient
- Insulin therapy becomes necessary for patients with type 2 diabetes who fail to respond to oral medications or experience progressive impairment of beta cell insulin secretion
- Patients with type 2 diabetes should also be evaluated for cardiovascular risk factors and treated accordingly.
Insulin Therapy for Type 1 Diabetes
- Treatment often involves a combination of regular insulin, NPH insulin, or synthetic insulin analogs (e.g., Humalog, Novolog, Lantus, Levemir)
- Insulin pumps (e.g., FLEXIBLE-PUMP) are also an option for type 1 diabetes
- Blood glucose monitoring is essential for all insulin-dependent patients.
Acute Complications of Diabetes
- Diabetic Ketoacidosis(DKA):
- A serious and potentially life-threatening medical emergency.
- Caused by low insulin levels, leading to the liver turning to fat for fuel (ketogenesis)
- Elevated ketone bodies in the blood decrease blood pH, leading to metabolic acidosis.
- Often presents with dehydration, rapid and deep breathing, and abdominal pain.
- Can cause:
- Hypotension
- Shock
- Renal failure
- Brain edema
- Death
- More common in type 1 diabetes than type 2.
- Hyperosmolar hyperglycemic state:
- A serious condition with many similarities to DKA but a different origin and treatment.
- Caused by very high blood glucose levels (> 300 mg/dl), leading to osmotic water movement from cells to the blood.
- This causes increased blood osmolarity and the kidneys dump glucose into the urine.
- Results in dehydration and potentially coma if fluid is not replaced.
- More common in type 2 diabetes than type 1.
- Hypoglycemia:
- Defined as abnormally low blood glucose levels (below 70 mg/dl).
- Can cause:
- Agitation
- Sweating
- Symptoms of sympathetic nervous system activation
- Altered or loss of consciousness, potentially leading to coma, seizures, brain damage, or death.
- Caused by:
- Too much or incorrectly timed insulin
- Too much or incorrectly timed exercise
- Insufficient food intake
- Treated with sugary drinks or food, and in severe cases, with glucagon injection.
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Description
Test your knowledge on Diabetes Mellitus, a disturbance of carbohydrate metabolism characterized by insulin deficiency or resistance. This quiz covers Type 1 and Type 2 diabetes, their causes, and associated mechanisms. Learn about the impact of obesity and insulin on glucose tolerance.
