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Questions and Answers
What is the primary characteristic of Type 1 diabetes mellitus?
Which factor is most commonly associated with the risk of developing Type 2 diabetes mellitus?
What is the observed incidence rate of diabetes mellitus in the population?
Which of the following best describes the aetiology of Type 2 diabetes mellitus?
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How does abdominal fat contribute to the pathophysiology of Type 2 diabetes mellitus?
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What is the typical age of onset for Type 1 Diabetes Mellitus (IDDM)?
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Which statement is true regarding the severity of Type 2 Diabetes Mellitus (NIDDM)?
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In terms of body weight, how do individuals with Type 2 Diabetes (NIDDM) typically present?
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Which of the following is generally true for insulin treatment in Type 1 Diabetes Mellitus (IDDM)?
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Which of the following symptoms is particularly associated with Type 1 Diabetes Mellitus (IDDM)?
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What is the normal fasting plasma glucose level?
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What test is used to estimate diabetic control over several weeks?
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Which of the following is true regarding complications of diabetes?
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What is the principal treatment for type 1 diabetes?
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What is the target average glucose level for type 1 diabetes patients?
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Which of the following is NOT a first-line treatment for type 2 diabetes?
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What combination is used in many type 1 diabetes treatments?
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What lifestyle modification is recommended to manage the risk of cardiovascular disease in diabetic patients?
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What might lead to the necessity of insulin therapy in type 2 diabetes?
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Which of the following drugs is commonly used for type 1 diabetes management?
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What is the primary reason for self-monitoring blood glucose levels in diabetes management?
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What is the main consequence of low insulin levels during diabetic ketoacidosis (DKA)?
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Which of the following is a common symptom of hyperglycemic hyperosmolar state?
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In cases of hypoglycemia, what is a potential severe consequence if left untreated?
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What serious complications can arise from diabetic ketoacidosis?
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How does hyperglycemia affect kidney function in hyperglycemic hyperosmolar state?
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What is the typical blood glucose level considered to indicate hyperglycemic hyperosmolar state?
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Which of the following factors can lead to hypoglycemia in diabetic patients?
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In what way is diabetic ketoacidosis (DKA) different from hyperglycemic hyperosmolar state?
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Study Notes
Diabetes Mellitus
- It is a disease marked by disrupted carbohydrate metabolism, stemming from insulin deficiency, resistance or a combination of both.
- This leads to hyperglycemia, potentially accompanied by glucosuria.
- It also affects protein and fat metabolism.
- Occurring in roughly 1-2% of the population, it is the most prevalent endocrine disorder.
Primary Diabetes
- Accounts for over 95% of diabetes cases.
- Type 1: Insulin-dependent diabetes mellitus
- Previously called "juvenile-onset diabetes".
- Characterized by insulin deficiency due to pancreatic beta-cell damage.
- Type 2: Non-insulin-dependent diabetes mellitus
- Previously called "maturity onset diabetes".
- May involve insulin resistance, abnormal insulin structure, or both, coupled with reduced insulin secretion.
- In some cases, insulin secretion may become completely absent.
Factors Contributing to Type 2 Diabetes
- Central obesity: Fat concentrated around the waist, particularly in relation to abdominal organs, increases the risk of insulin resistance.
- Abdominal fat secretes adipokines, hormones that can potentially impair glucose tolerance.
- Family history: A significant predisposition to developing type 2 diabetes exists among those with close relatives who have the condition.
Differences Between Type 1 and Type 2 Diabetes
- Type 1: Usually develops before 30 years old, typically between 12 to 14 years old, more common in males.
- Type 2: Usually develops after 40 years old, more common in females.
- Type 1: Individuals are usually underweight.
- Type 2: Individuals are usually overweight.
- Type 1: Severe, unstable and often referred to as "brittle diabetes".
- Type 2: Mild or moderate and often more stable.
- Type 1: Requires insulin.
- Type 2: Usually doesn't initially require insulin but may eventually need it as the disease progresses.
- Oral hypoglycemic agents are ineffective for Type 1 diabetes, but effective in Type 2, at least at the onset.
Presenting Signs and Symptoms of Diabetes
- Can be asymptomatic and discovered accidentally.
- Common symptoms:
- Polyuria (increased urination).
- Polydipsia (increased thirst).
- Polyphagia (increased hunger, with weight loss specifically noticeable in type 1 diabetes).
- Pruritis (itching, particularly in the groin and anal areas).
- Parathesia (numbness or tingling).
- Premature loosening of teeth.
- Recurrent infections, such as boils.
Investigations for Diagnosing Diabetes
- Plasma glucose measurements:
- Fasting: Normal level is less than 100mg/dL.
- 2-hour post-prandial on an oral glucose tolerance test (OGTT): Normal level is less than 140mg/dL.
- Impaired glucose tolerance (IGT):
- Fasting level between 100 and 126 mg/dL (IFG).
- 2-hour post-prandial level between 140 and 200 mg/dL.
- Overt diabetes:
- Fasting level greater than or equal to 126 mg/dL.
- 2-hour post-prandial level on OGTT greater than or equal to 200 mg/dL.
- Symptoms of diabetes with a causal plasma glucose concentration of greater than or equal to 200 mg/dL.
Importance of Glycosylated Hemoglobin (HA1c)
- Indicates the average blood glucose concentration over the preceding 8 to 12 weeks.
- Helpful for assessing diabetic control.
- Normal level is 6% of total hemoglobin.
Urine Analysis
- Detects glucose: using strips or, less commonly, solutions such as Benedict's reagent.
- Detects ketone bodies: using strips or employing the Rothera's sodium nitroprusside test.
Monitoring Treatment
- Home blood glucose monitoring (HBGM), or urine glucose testing.
Management of Diabetes
- Emphasizes patient education, dietary support, regular exercise, and self-monitoring of blood glucose levels.
- Aims to keep blood glucose levels within a desirable range.
- Type 1 diabetes: Requires lifelong insulin therapy via injections, alongside precise blood glucose monitoring for optimal control.
- Type 2 diabetes: Usually begins with lifestyle modifications such as increasing physical activity, reducing carbohydrate intake and losing weight.
- If these fail: Oral antidiabetic drugs are added as a next step to aid in improving insulin production.
- As the disease progresses: Insulin therapy may become necessary.
Key Points for Managing Diabetes
- Patient education is crucial.
- It is essential to control blood pressure and cholesterol to reduce cardiovascular disease risk.
- Lifestyle modifications are central to management, including:
- Exercising regularly.
- Smoking cessation.
- Consuming a healthy diet.
- Wearing diabetic socks and shoes to improve foot health.
- Taking appropriate medications for blood pressure control, if needed.
Insulin Therapy for Type 1 Diabetes
- Frequently involves combining regular and NPH insulin, or synthetic insulin analogs (such as Humalog and Novolog).
- Insulin pumps (e.g., FLEXIBLE-PUMP) offer an alternative.
- Blood lancets are used to draw blood for testing glucose levels.
Acute Complications of Diabetes
- Diabetic ketoacidosis:
- Life-threatening emergency.
- Occurs due to low insulin levels, causing the liver to metabolize fat for fuel, leading to ketosis.
- Elevated ketone bodies in the blood lower pH, resulting in DKA.
- Symptoms include dehydration, rapid and deep breathing, and abdominal pain.
- Can result in hypotension, shock, renal failure, brain edema, and death.
- More prevalent in Type 1 diabetes.
- Hyperglycemia hyperosmolar state:
- Shares symptoms with DKA but has a different origin and requires distinct treatment.
- Characterized by excessively high blood glucose levels (above 300 mg/dL).
- Water moves osmotically from cells into blood and the kidneys eliminate glucose in urine, leading to dehydration.
- Requires urgent medical attention, usually starting with fluid replacement.
- Lethargy can progress to coma.
- More common in Type 2 diabetes.
- Hypoglycemia:
- Blood glucose level below 70 mg/dL.
- Symptoms include agitation, sweating, and symptoms associated with sympathetic nervous system activation.
- Can lead to altered consciousness, coma, seizures, brain damage, and death.
- Caused by factors such as excessively high or incorrectly timed insulin, excessive exercise, or insufficient food intake.
- Treated with sugary drinks or food, and in severe cases, glucagon injection.
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Description
This quiz explores diabetes mellitus, a disease characterized by disrupted carbohydrate metabolism due to insulin issues. It covers primary diabetes types, their characteristics, and contributing factors for type 2 diabetes such as central obesity. Test your knowledge on this prevalent endocrine disorder and its impact on metabolism.
