Endocrine system - Part 2

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Questions and Answers

What is the primary characteristic of diabetes mellitus?

  • Decreased production of glucagon by the pancreas.
  • Increased sensitivity of cells to insulin.
  • Raised blood glucose levels (hyperglycaemia). (correct)
  • Elevated levels of insulin in the blood.

What is the estimated percentage of all diabetes cases that are classified as Type 2?

  • 90% (correct)
  • 30-40%
  • 5-10%
  • 50-60%

Which of the following is a typical symptom of diabetes mellitus?

  • Excessive thirst (polydipsia). (correct)
  • Decreased urination (oliguria).
  • Decreased appetite.
  • Weight gain.

Which of the following values indicates diabetes based on a Fasting Blood Glucose (FBG) test?

<p>Greater than or equal to 7.0 mmol/L (C)</p> Signup and view all the answers

Which of the following is characteristic of Type 1 diabetes?

<p>Autoimmune destruction of pancreatic β-cells (B)</p> Signup and view all the answers

Which of the following is considered a macrovascular complication of diabetes?

<p>Cardiovascular disease (D)</p> Signup and view all the answers

In the absence of insulin, what process is directly inhibited, preventing glucose from entering cells?

<p>Activation of GLUT 4 transporters (C)</p> Signup and view all the answers

Which of the following blood glucose ranges is considered normal?

<p>3.5 - 6.5 mmol/L (C)</p> Signup and view all the answers

What is the role of glucagon in glucose regulation?

<p>Stimulates glycogen breakdown. (A)</p> Signup and view all the answers

What is the primary function of insulin in glucose metabolism?

<p>To promote glucose uptake into cells. (B)</p> Signup and view all the answers

Which term describes the frequent urination that is a common symptom of diabetes?

<p>Polyuria (A)</p> Signup and view all the answers

What is the primary cause of Type 2 diabetes?

<p>Insulin resistance (A)</p> Signup and view all the answers

According to the International Diabetes Federation (IDF), which country has the highest number of people living with diabetes?

<p>China (A)</p> Signup and view all the answers

What percentage of the UK population is estimated to have diabetes?

<p>6.5% (C)</p> Signup and view all the answers

What is the primary characteristic of diabetic ketoacidosis (DKA)?

<p>High blood glucose and ketones (B)</p> Signup and view all the answers

What does the term 'glucolipotoxicity' refer to in the context of Type 2 diabetes?

<p>Toxic effects of excess glucose and lipids on pancreatic beta cells. (A)</p> Signup and view all the answers

A patient with type 1 diabetes is experiencing frequent episodes of hypoglycemia. Which modification to their insulin regimen would be LEAST appropriate?

<p>Increasing the basal insulin dose. (A)</p> Signup and view all the answers

What role does the liver play in the regulation of blood glucose levels?

<p>It stores or releases glucose, depending on the body’s needs. (D)</p> Signup and view all the answers

What laboratory measurement reflects the average blood glucose level over the past 2-3 months and is used in the diagnosis and monitoring of diabetes?

<p>Glycated hemoglobin (HbA1c) (A)</p> Signup and view all the answers

Which of the following is thought to be an environmental factor suggested by seasonality in the aetiology of Type 1 diabetes?

<p>Increasing incidence (C)</p> Signup and view all the answers

What distinguishes gestational diabetes from type 1 or type 2 diabetes?

<p>It develops during pregnancy in women not previously diagnosed with diabetes (C)</p> Signup and view all the answers

Microvascular complications of diabetes include all of the following EXCEPT:

<p>Peripheral artery disease (B)</p> Signup and view all the answers

What distinguishes Type 1 diabetes from Type 2 diabetes in terms of treatment?

<p>Type 1 diabetes requires insulin therapy from the time of diagnosis. (D)</p> Signup and view all the answers

Why is HbA1c used to diagnose and monitor diabetes?

<p>It measures blood sugar levels over time. (D)</p> Signup and view all the answers

Besides lifestyle interventions and metformin, what class of medications is often considered first-line for Type 2 diabetes in patients with established atherosclerotic cardiovascular disease (ASCVD)?

<p>SGLT2 inhibitors (B)</p> Signup and view all the answers

In the context of Type 2 diabetes, what is the effect of insulin-mediated glucose uptake in adipose tissue?

<p>Decreased. (D)</p> Signup and view all the answers

If the body cannot produce insulin well what type of diabetes can occur?

<p>Type 1 diabetes (D)</p> Signup and view all the answers

What is the estimated number of people living with diabetes worldwide?

<p>537 million (B)</p> Signup and view all the answers

Which of the following acute metabolic decompensations is MOST likely to present with Kussmaul breathing?

<p>Diabetic ketoacidosis (DKA) (D)</p> Signup and view all the answers

According to the information provided, what is the estimated number of people which will be affected by diabetes in the UK by 2030?

<p>1 in every 10 people (C)</p> Signup and view all the answers

In individuals with Type 1 diabetes, the autoimmune response primarily targets which cells in the pancreas?

<p>Beta cells, resulting in insufficient insulin production. (B)</p> Signup and view all the answers

What is the primary mechanism by which insulin resistance contributes to the development of Type 2 diabetes?

<p>Impaired glucose uptake by cells, leading to hyperglycemia. (D)</p> Signup and view all the answers

Which of the following diagnostic criteria indicates impaired glucose tolerance (IGT) based on an oral glucose tolerance test (OGTT)?

<p>2-hour blood glucose level of ≥ 7.8 mmol/L. (B)</p> Signup and view all the answers

Which of the following is NOT typically considered a symptom of diabetes mellitus?

<p>Unexplained weight gain (D)</p> Signup and view all the answers

Which of the following is a typical characteristic of Type 2 diabetes?

<p>The body's cells become resistant to insulin. (C)</p> Signup and view all the answers

What is the primary aim of treatment for both Type 1 and Type 2 diabetes?

<p>To maintain blood glucose levels as close to the normal range as possible. (A)</p> Signup and view all the answers

What is a key distinction between Type 1 and Type 2 diabetes concerning insulin production?

<p>In Type 1, the pancreas produces no insulin, while in Type 2, it may produce some, but not enough or the body can't use it well. (B)</p> Signup and view all the answers

Which of the following signs or symptoms is MOST indicative of diabetic ketoacidosis (DKA)?

<p>Elevated blood glucose with the presence of ketones and Kussmaul breathing. (D)</p> Signup and view all the answers

Which of the following long-term complications is directly associated with macrovascular damage in individuals with diabetes?

<p>Cardiovascular disease. (B)</p> Signup and view all the answers

Which of the following is considered a microvascular complication associated with diabetes mellitus?

<p>Nephropathy. (A)</p> Signup and view all the answers

What is the significance of monitoring HbA1c levels in diabetic patients?

<p>It reflects average blood glucose control over the past 2-3 months. (D)</p> Signup and view all the answers

What is the role of GLUT 4 transporters in glucose metabolism, especially in the context of insulin action?

<p>They are translocated to the cell membrane to facilitate glucose uptake into cells. (D)</p> Signup and view all the answers

In the context of diabetes aetiology, what is the primary implication of 'genetic predisposition'?

<p>It indicates an increased likelihood of developing diabetes due to inherited genetic factors. (D)</p> Signup and view all the answers

Which factor primarily distinguishes gestational diabetes from other types of diabetes?

<p>It is first diagnosed during pregnancy in women who did not have diabetes before. (C)</p> Signup and view all the answers

Which of the following factors is LEAST likely to be associated with an increased risk of developing Type 2 diabetes?

<p>Regular physical activity. (A)</p> Signup and view all the answers

What is the expected outcome by 2030 regarding diabetes prevalence in the UK, according to the information provided?

<p>1 in 10 people will be affected. (A)</p> Signup and view all the answers

What is the primary reason behind frequent urination (polyuria) in uncontrolled diabetes mellitus?

<p>Osmotic diuresis due to excess glucose in the kidney tubules. (A)</p> Signup and view all the answers

What is the primary mechanism underlying the development of cardiovascular complications in individuals with diabetes mellitus?

<p>Accelerated atherosclerosis due to glycation of blood vessel proteins. (D)</p> Signup and view all the answers

A patient with Type 1 diabetes consistently forgets to administer their insulin before meals. What is the MOST likely metabolic consequence of this?

<p>Postprandial hyperglycemia and increased risk of diabetic ketoacidosis (DKA). (A)</p> Signup and view all the answers

If a patient with Type 2 diabetes presents with increased thirst, frequent urination, and unexplained weight loss, which initial laboratory test is MOST appropriate to assess their condition?

<p>Fasting blood glucose (FBG) and HbA1c. (B)</p> Signup and view all the answers

In managing Type 2 diabetes, which of the following strategies primarily addresses insulin resistance at the cellular level?

<p>Increasing physical activity and weight loss (C)</p> Signup and view all the answers

A researcher is investigating the aetiology of Type 1 diabetes and observes a seasonal variation in new diagnoses. Which factor is MOST likely indicated by this observation?

<p>Environmental factors such as viral infections that trigger autoimmune responses. (A)</p> Signup and view all the answers

A woman is diagnosed with gestational diabetes during her pregnancy. What is the PRIMARY concern regarding the long-term health of her child?

<p>There is an increased risk of the child developing childhood obesity and type II diabetes later in life. (B)</p> Signup and view all the answers

Which of the following statements BEST describes the relationship between metabolic syndrome and Type 2 diabetes?

<p>Metabolic syndrome increases the risk of developing Type 2 diabetes due to shared pathophysiological mechanisms such as insulin resistance. (A)</p> Signup and view all the answers

An individual with long-standing Type 2 diabetes develops nephropathy. What is the MOST likely underlying mechanism leading to this complication?

<p>Chronic hyperglycaemia causing damage to the small blood vessels in the kidneys. (D)</p> Signup and view all the answers

In managing hyperglycemia in a patient with Type 2 diabetes and established cardiovascular disease (CVD), which class of glucose-lowering medications would be the MOST appropriate FIRST-LINE choice, according to current guidelines?

<p>SGLT2 inhibitors (e.g., empagliflozin) or GLP-1 receptor agonists (e.g., liraglutide) with proven cardiovascular benefit. (C)</p> Signup and view all the answers

A patient with diabetes is experiencing blurred vision which is found to be caused by diabetic retinopathy. Which of the following pathophysiological processes is MOST directly responsible for this patient's visual disturbance?

<p>Damage to retinal blood vessels leading to ischemia and neovascularization. (A)</p> Signup and view all the answers

A research team discovers a novel genetic mutation that confers virtually complete protection against the development of Type 2 diabetes, even in individuals with severe obesity and sedentary lifestyles. If this mutation were to affect a single molecular target, which of the following would be the MOST plausible target?

<p>A gain-of-function mutation in the gene encoding skeletal muscle GLUT4 transporters. (A)</p> Signup and view all the answers

Imagine a hypothetical scenario where researchers develop a 'perfect' artificial pancreas that meticulously mimics the function of a healthy human pancreas in a patient who is newly diagnosed with type 1 diabetes. One unique feature is that, in addition to insulin and glucagon, it continuously secretes small, precisely calibrated amounts of amylin. What specific, additional benefit would the inclusion of amylin provide, beyond what insulin and conventional glucose monitoring can achieve?

<p>Complete elimination of postprandial blood glucose spikes, leading to improved glycemic control. (D)</p> Signup and view all the answers

What is the typical fasting blood glucose (FBG) level in an individual without diabetes?

<p>Less than 7.0 mmol/L (D)</p> Signup and view all the answers

Which of the following is a common symptom associated with diabetes mellitus?

<p>Excessive thirst (C)</p> Signup and view all the answers

What type of diabetes is characterized by the autoimmune destruction of beta cells in the pancreas?

<p>Type 1 diabetes (D)</p> Signup and view all the answers

Which laboratory test is used to assess average blood glucose levels over the past 2-3 months?

<p>Glycated hemoglobin (HbA1c) (A)</p> Signup and view all the answers

Which of the following is considered a macrovascular complication of diabetes mellitus?

<p>Cardiovascular disease (B)</p> Signup and view all the answers

What is the primary role of GLUT4 transporters in glucose metabolism?

<p>Enabling glucose uptake into cells in response to insulin (B)</p> Signup and view all the answers

Which sign is most indicative of diabetic ketoacidosis (DKA)?

<p>Kussmaul breathing (D)</p> Signup and view all the answers

What is the primary aim of diabetes management?

<p>To maintain blood glucose levels as close to normal as possible (B)</p> Signup and view all the answers

Which of the following is a known risk factor for developing Type 2 diabetes?

<p>Genetic predisposition (A)</p> Signup and view all the answers

Which of the following is a potential long-term complication of diabetes?

<p>Kidney damage (C)</p> Signup and view all the answers

In the UK, what is the estimated prevalence of diabetes within the population?

<p>1 in 15 people (A)</p> Signup and view all the answers

What is the expected trend in diabetes prevalence in the UK by 2030?

<p>Increase to 1 in 10 (A)</p> Signup and view all the answers

Which sign or symptom differentiates Type 1 from Type 2 diabetes at the time of diagnosis?

<p>Autoantibodies (D)</p> Signup and view all the answers

What is a fundamental characteristic of Type 1 diabetes concerning insulin?

<p>Body not producing insulin (B)</p> Signup and view all the answers

What is the significance of monitoring HbA1c levels in patients with diabetes?

<p>To evaluate average blood glucose control over the past 2-3 months (D)</p> Signup and view all the answers

Elevated concentrations of which hormone promotes glycogen breakdown in the liver, resulting in increased blood glucose levels?

<p>Glucagon (B)</p> Signup and view all the answers

What is the primary physiological consequence of consistently missing pre-meal insulin doses in a patient with Type 1 diabetes?

<p>Elevated postprandial hyperglycemia (C)</p> Signup and view all the answers

What pathophysiological change primarily leads to the development of microvascular complications such as retinopathy and nephropathy in diabetes?

<p>Damage to small blood vessels from chronic hyperglycemia (D)</p> Signup and view all the answers

What is the primary concern regarding the long-term health of a child born to a woman who had gestational diabetes during pregnancy?

<p>Increased risk of developing Type 2 diabetes (A)</p> Signup and view all the answers

Which statement best describes the relevance of metabolic syndrome in the aetiology of Type 2 diabetes?

<p>Metabolic syndrome is a cluster of risk factors that increases the risk of developing Type 2 diabetes. (A)</p> Signup and view all the answers

What is the underlying mechanism by which nephropathy develops in individuals with longstanding Type 2 diabetes?

<p>Glomerular hyperfiltration and subsequent sclerosis (D)</p> Signup and view all the answers

Which of the following underlies the mechanism of reduced blood flow in cerebrovascular or cardiovascular disease in diabetes?

<p>Accumulation of atherosclerotic plaques that narrow arteries (B)</p> Signup and view all the answers

Why are later-generation sulfonylureas preferred over earlier ones in patients with Type 2 diabetes?

<p>They have a lower risk of causing hypoglycemia (B)</p> Signup and view all the answers

Which feature uniquely characterizes gestational diabetes mellitus (GDM)?

<p>Onset of hyperglycemia during pregnancy (A)</p> Signup and view all the answers

What explains the frequent urination (polyuria) associated with uncontrolled diabetes mellitus?

<p>Osmotic diuresis due to excess glucose excretion in the urine (C)</p> Signup and view all the answers

How can a person without diabetes keep their blood glucose level at a normal value?

<p>The liver promotes glycogen formation when glucose levels are high and promotes glycogen breakdown when glucose levels are low. (A)</p> Signup and view all the answers

In an individual experiencing frequent episodes of hypoglycemia, which change to diet would be most appropriate?

<p>Eat frequent small meals and snacks evenly spaced throughout the day (A)</p> Signup and view all the answers

Following bariatric surgery, what process related to diabetes improves almost immediately?

<p>Insulin resistance (A)</p> Signup and view all the answers

Of the signs listed, which would potentially be exhibited in a patient experiencing Diabetic Ketoacidosis?

<p>Ketotic Breath (D)</p> Signup and view all the answers

What percentage of women in the UK develop gestational diabetes during their pregnancies?

<p>5% (C)</p> Signup and view all the answers

What could be considered a non-modifiable risk factor for diabetes?

<p>Genetics (B)</p> Signup and view all the answers

What is the normal range for blood glucose levels (mmol/L)?

<p>3.5 - 6.5 (A)</p> Signup and view all the answers

Which of the following processes describes one way in which insulin lowers blood sugar?

<p>Stimulating glycogen formation (C)</p> Signup and view all the answers

What role do GLUT 4 transporters play in glucose regulation?

<p>Enabling insulin-mediated glucose uptake into cells (D)</p> Signup and view all the answers

Which of the following is a primary characteristic of diabetes mellitus?

<p>Any of these answers (C)</p> Signup and view all the answers

According to the International Diabetes Federation, which of the following countries has the highest number of people living with diabetes?

<p>China (D)</p> Signup and view all the answers

What percentage of women in the UK are estimated to develop gestational diabetes during pregnancy?

<p>5% (D)</p> Signup and view all the answers

Which of the following is NOT a typical symptom of diabetes?

<p>Weight gain (B)</p> Signup and view all the answers

A fasting blood glucose level of what value is considered diagnostic for diabetes?

<p>≥ 7.0 mmol/L (D)</p> Signup and view all the answers

In Type 1 diabetes, what is the primary cause of insulin deficiency?

<p>Autoimmune destruction of pancreatic B-cells (A)</p> Signup and view all the answers

Which of the following diagnostic values for the Oral Glucose Tolerance Test (OGTT) indicates diabetes?

<p>≥ 11.1 mmol/L (D)</p> Signup and view all the answers

What does the term 'polyuria' refer to in the context of diabetes symptoms?

<p>Frequent urination (D)</p> Signup and view all the answers

Which laboratory test measures average blood glucose levels over the past 2-3 months?

<p>HbA1c (D)</p> Signup and view all the answers

Which long-term complication is associated with macrovascular damage in diabetes?

<p>Cardiovascular disease (B)</p> Signup and view all the answers

Which of the following characterizes Type 1 diabetes?

<p>Autoimmune (D)</p> Signup and view all the answers

What is the estimated prevalence of diabetes in the UK?

<p>1 in 15 (C)</p> Signup and view all the answers

What is a key difference between Type 1 and Type 2 diabetes concerning insulin?

<p>Type 1 involves absolute insulin deficiency, while Type 2 involves insulin resistance or relative deficiency. (A)</p> Signup and view all the answers

What immunological factors influence the aetiology of Type 1 diabetes?

<p>Selective destruction of pancreatic B-cells (D)</p> Signup and view all the answers

What is the primary mechanism underlying the development of nephropathy in individuals with diabetes mellitus?

<p>Damage to small blood vessels and filters in the kidneys (D)</p> Signup and view all the answers

Which factor is considered a non-modifiable risk factor for gestational diabetes?

<p>Family history of diabetes (B)</p> Signup and view all the answers

How does the body respond to low blood sugar?

<p>By promoting glucagon release (A)</p> Signup and view all the answers

Which of the following is a risk factor for cerebrovascular disease in individuals with diabetes?

<p>High blood pressure (B)</p> Signup and view all the answers

What shared characteristic do metabolic syndrome and Type 2 diabetes share?

<p>Insulin resistance (B)</p> Signup and view all the answers

Why is understanding the 'pathophysiological' classification of diabetes potentially beneficial?

<p>It may lead to better patient phenotyping and therapeutic approaches. (A)</p> Signup and view all the answers

Based on current research, which statement best captures the interplay between genetic predisposition and environmental factors in type 2 diabetes development?

<p>Type 2 diabetes arises from a complex interplay, where genetic predispositions amplify the impact of adverse environmental factors. (A)</p> Signup and view all the answers

In the context of diabetes, which description best defines glucolipotoxicity?

<p>Combined toxicity from both elevated glucose and lipid levels, predominantly affecting pancreatic beta cells. (D)</p> Signup and view all the answers

If a novel drug were developed that selectively enhanced insulin signaling only in skeletal muscle, while simultaneously inhibiting insulin signaling in adipose tissue, what would be the most likely metabolic outcome in a patient with type 2 diabetes?

<p>Improved glycemic control accompanied by lipodystrophy. (A)</p> Signup and view all the answers

Imagine a scenario where a patient with longstanding uncontrolled Type 2 diabetes develops chronic kidney disease (CKD). Further research reveals that their podocytes, specialized cells in the kidney's filtration units, have undergone significant structural changes, particularly in the expression of nephrin, a key protein ensuring filtration integrity. If a new gene therapy were developed to selectively correct nephrin expression in these podocytes, what immediate physiological change would be most anticipated?

<p>Diminution or cessation of proteinuria (A)</p> Signup and view all the answers

What is the typical range for blood glucose levels in a healthy individual, measured in mmol/L?

<p>3.5 - 6.5 (D)</p> Signup and view all the answers

Which of the following best describes the underlying cause of Type 1 diabetes?

<p>Autoimmune destruction of pancreatic beta cells. (D)</p> Signup and view all the answers

Which of the following is a common sign of hyperglycaemia?

<p>Frequent urination (A)</p> Signup and view all the answers

What percentage of diabetes cases are classified as Type 1?

<p>Approximately 5-10% (D)</p> Signup and view all the answers

If a patient's HbA1c result is 6.8%, how would this be classified?

<p>Diabetic (C)</p> Signup and view all the answers

Which of the following statements accurately describes insulin's role in glucose regulation?

<p>It facilitates the uptake of glucose into cells. (A)</p> Signup and view all the answers

What is the primary feature of diabetes mellitus?

<p>Elevated blood sugar levels (C)</p> Signup and view all the answers

In the absence of insulin, what cellular event is directly impaired?

<p>Glucose uptake by cells (C)</p> Signup and view all the answers

What is the role of GLUT4 transporters in glucose metabolism?

<p>Facilitating glucose transport into cells (D)</p> Signup and view all the answers

Which of the following factors is considered a non-modifiable risk factor for Type 2 diabetes?

<p>Genetic predisposition (A)</p> Signup and view all the answers

Which description best fits Diabetes Mellitus?

<p>A chronic disease characterized by elevated blood glucose levels (B)</p> Signup and view all the answers

Glucagon's primary role in glucose regulation is to:

<p>Promote glucose production in the liver. (B)</p> Signup and view all the answers

What is the primary immunological characteristic of Type 1 diabetes?

<p>Autoimmune destruction of pancreatic beta cells (A)</p> Signup and view all the answers

Which of the following statements accurately distinguishes Type 1 from Type 2 diabetes?

<p>Type 1 diabetes involves an absolute deficiency of insulin. (B)</p> Signup and view all the answers

Which measurement is indicative of diabetes following an Oral Glucose Tolerance Test (OGTT)?

<p>A 2-hour plasma glucose level of ≥ 11.1 mmol/L (B)</p> Signup and view all the answers

Which of the following is a typical sign or symptom of diabetic ketoacidosis (DKA)?

<p>Kussmaul breathing (B)</p> Signup and view all the answers

What primary factor links metabolic syndrome and Type 2 diabetes?

<p>Insulin resistance (D)</p> Signup and view all the answers

If a patient has raised blood glucose levels that damage small blood vessels in the kidneys. What long-term complication would this cause?

<p>Nephropathy (A)</p> Signup and view all the answers

Which diagnostic criteria demonstrates diabetes according to a Fasting Blood Glucose (FBG) test?

<p>More than 7.0 mmol/L (C)</p> Signup and view all the answers

What is the likely outcome for diabetes prevalence in the UK by 2030?

<p>1 in every 10 people will be affected (B)</p> Signup and view all the answers

What is the major function of insulin?

<p>Removes glucose from the blood (B)</p> Signup and view all the answers

What is the aetiology of Type 2 Diabetes?

<p>Lifestyle choices combined with genes (B)</p> Signup and view all the answers

What is the primary reason for frequent urination (polyuria) in uncontrolled diabetes mellitus?

<p>Osmotic diuresis due to excess glucose in the urine. (D)</p> Signup and view all the answers

A patient with Type 2 diabetes is prescribed a medication that enhances insulin sensitivity in peripheral tissues. Which of the following intracellular mechanisms is MOST likely to be directly stimulated by this medication?

<p>Activation of protein kinase B (Akt) (A)</p> Signup and view all the answers

In an individual with long-standing Type 2 diabetes, which of the following pathophysiological changes MOST directly contributes to the development of macrovascular complications such as myocardial infarction and stroke?

<p>Endothelial dysfunction and accelerated atherosclerosis (B)</p> Signup and view all the answers

Two unrelated individuals are independently diagnosed with Type 1 diabetes at the ages of 10 and 45, respectively. If a comprehensive immunological analysis were performed on both patients at the time of diagnosis, which finding would be MOST likely to differ significantly between the two individuals?

<p>The diversity and breadth of T-cell receptors recognizing beta-cell antigens (C)</p> Signup and view all the answers

A researcher is designing a clinical trial to evaluate a novel therapy aimed at preventing the progression from impaired glucose tolerance (IGT) to Type 2 diabetes. Given the complexity of the disease's aetiology, which of the following outcome measures would provide the MOST comprehensive assessment of the therapy's effectiveness in addressing the underlying pathophysiological processes?

<p>Improvements in insulin sensitivity and beta-cell function (A)</p> Signup and view all the answers

Which term refers to excessive thirst, a common symptom of diabetes?

<p>Polydipsia (D)</p> Signup and view all the answers

In type 1 diabetes, which of the following processes leads to a deficiency in insulin?

<p>Autoimmune destruction of pancreatic beta cells (D)</p> Signup and view all the answers

According to the diagnostic criteria, what HbA1c level indicates diabetes?

<p>≥ 48 mmol/mol (6.5%) (B)</p> Signup and view all the answers

Which of the following complications of diabetes affects the eyes?

<p>Retinopathy (D)</p> Signup and view all the answers

What is the primary role of insulin in glucose metabolism?

<p>Facilitating glucose uptake into cells (D)</p> Signup and view all the answers

How does glucagon influence blood glucose levels?

<p>By stimulating glycogen breakdown (A)</p> Signup and view all the answers

Which cardiovascular risk factor is directly associated with diabetes?

<p>Smoking (B)</p> Signup and view all the answers

Which test is used to monitor average blood glucose levels?

<p>HbA1c (C)</p> Signup and view all the answers

In the absence of insulin, what is the primary effect on cells?

<p>Inability of glucose to enter cells (A)</p> Signup and view all the answers

Which of the following conditions is considered a microvascular complication of diabetes?

<p>Nephropathy (A)</p> Signup and view all the answers

Which of the following is considered a symptom of diabetes?

<p>Excessive thirst (D)</p> Signup and view all the answers

What is the estimated percentage of women in the UK who develop gestational diabetes during pregnancy?

<p>5% (C)</p> Signup and view all the answers

In individuals with type 2 diabetes, what is the initial step in the pathogenesis of the disease?

<p>Insulin resistance (D)</p> Signup and view all the answers

Which of the following factors primarily distinguishes gestational diabetes from other types of diabetes?

<p>Its onset during pregnancy (D)</p> Signup and view all the answers

In type 1 diabetes, what is the primary target of the autoimmune response?

<p>Pancreatic beta cells (D)</p> Signup and view all the answers

What is the main characteristic of diabetes mellitus?

<p>Elevated blood glucose levels (D)</p> Signup and view all the answers

Which of the following is a non-modifiable risk factor for type 2 diabetes?

<p>Genetic predisposition (C)</p> Signup and view all the answers

What is the underlying cause of polyuria in uncontrolled diabetes?

<p>Osmotic diuresis due to glucosuria (A)</p> Signup and view all the answers

How often should treatment be reassessed and modified in a patient diagnosed with Type 2 diabetes to avoid clinical inertia?

<p>Every 3-6 months (B)</p> Signup and view all the answers

In managing hyperglycemia in a patient with Type 2 diabetes and established cardiovascular disease, which class of glucose-lowering medications is generally preferred as a first-line choice due to demonstrated cardiovascular benefits?

<p>GLP-1 receptor agonists or SGLT2 inhibitors (A)</p> Signup and view all the answers

A researcher is investigating potential environmental factors contributing to the development of Type 1 diabetes. They observe a higher incidence of new diagnoses during the winter months. Which environmental factor would MOST likely be implicated by this observation?

<p>Increased prevalence of viral infections (A)</p> Signup and view all the answers

A 25-year-old patient with Type 1 diabetes presents with persistent hyperglycemia despite consistent insulin therapy, coupled with unexplained weight loss and increased hunger. Further investigation reveals significant levels of circulating antibodies against amylin, a hormone co-secreted with insulin by pancreatic beta cells. Assuming the patient's insulin regimen is optimized, what additional therapeutic agent would be most physiologically relevant to manage their condition?

<p>A synthetic amylin analogue (pramlintide) (A)</p> Signup and view all the answers

A scientist discovers a novel mutation in a gene encoding a previously unknown protein expressed exclusively in pancreatic alpha cells (which produce glucagon). This mutation causes a loss of function, such that the alpha cells are completely unable to secrete any glucagon at all. Intriguingly, individuals homozygous for this mutation exhibit near-complete protection against the development of Type 2 diabetes, despite being obese and sedentary. Which of the following indirect metabolic adaptations would be the most plausible explanation for this protective effect?

<p>Increased hepatic insulin sensitivity <em>due</em> to reduced baseline hepatic glucose output. (C)</p> Signup and view all the answers

Why is understanding the ‘pathophysiological’ classification of diabetes potentially beneficial?

<p>It helps to improve patient phenotyping and therapeutic approach (B)</p> Signup and view all the answers

What is the primary mechanism by which Type 1 diabetes develops?

<p>Autoimmune destruction of pancreatic beta cells. (A)</p> Signup and view all the answers

Which of the following is a typical early sign of nephropathy, a complication of diabetes?

<p>Elevated levels of protein in the urine. (B)</p> Signup and view all the answers

Which of the following would be the MOST specific test to differentiate between Type 1 and Type 2 diabetes in a newly diagnosed patient?

<p>Measurement of circulating islet autoantibodies. (C)</p> Signup and view all the answers

According to the International Diabetes Federation (IDF), which region is predicted to experience the greatest increase in diabetes prevalence by 2030?

<p>Africa. (B)</p> Signup and view all the answers

What distinguishes Type 1 from Type 2 diabetes in terms of aetiology?

<p>Type 1 is an autoimmune disease, whereas Type 2 is characterized by a combination of insulin resistance and impaired insulin secretion. (C)</p> Signup and view all the answers

Which of the following is the MOST common symptom of hyperglycaemia?

<p>Blurred vision (B)</p> Signup and view all the answers

Which of the following is a non-modifiable risk factor for diabetes mellitus?

<p>Genetic predisposition (D)</p> Signup and view all the answers

What key feature differentiates gestational diabetes from other forms of diabetes?

<p>It develops during pregnancy in women not previously diagnosed with diabetes. (B)</p> Signup and view all the answers

Besides the classic symptoms (polyuria, polydipsia, polyphagia), what other symptom is commonly associated with diabetes mellitus?

<p>Fatigue (A)</p> Signup and view all the answers

In terms of long-term health implications for the child, what is the primary concern related to gestational diabetes?

<p>Increased risk of developing type 2 diabetes and obesity later in life. (A)</p> Signup and view all the answers

You are reviewing the results of a 75-g oral glucose tolerance test (OGTT) for a patient. Which of the following 2-hour post-load glucose values is diagnostic of diabetes mellitus?

<p>11.1 mmol/L (A)</p> Signup and view all the answers

The Diabetes Prevention Program (DPP) demonstrated that lifestyle interventions are highly effective in preventing or delaying the onset of which type of diabetes?

<p>Type 2 diabetes. (D)</p> Signup and view all the answers

Neuropathy is a complication of diabetes that results from damage to what?

<p>Nerves (A)</p> Signup and view all the answers

What is the significance of HbA1c in diagnosing and monitoring diabetes?

<p>It provides an estimate of average blood glucose levels over the past 2-3 months. (D)</p> Signup and view all the answers

According to current estimates, what proportion of pregnancies in the UK are affected by gestational diabetes?

<p>Approximately 1 in 20 (C)</p> Signup and view all the answers

A patient with diabetes presents with the following symptoms: increased thirst, frequent urination, blurred vision, and unexplained weight loss. Which diagnosis is MOST LIKELY?

<p>Diabetes mellitus (B)</p> Signup and view all the answers

According to current projections, what share of the UK population is expected to have diabetes by the year 2030?

<p>1 in 10 (A)</p> Signup and view all the answers

What is the role of glucagon in regulating blood glucose levels?

<p>It stimulates the breakdown of glycogen in the liver, increasing blood glucose levels. (B)</p> Signup and view all the answers

Which of the following is a well-established risk factor for the development of Type 2 diabetes?

<p>Obesity (C)</p> Signup and view all the answers

In the context of Type 2 diabetes development, what is the primary initial effect of insulin resistance on glucose metabolism?

<p>Impaired suppression of hepatic glucose production. (D)</p> Signup and view all the answers

What is the primary reason behind the increased risk of cardiovascular disease (CVD) in individuals with diabetes mellitus?

<p>Accelerated atherosclerosis due to glycaemic and lipid abnormalities. (B)</p> Signup and view all the answers

Which of the following is a typical sign or symptom associated with Diabetic Ketoacidosis (DKA)?

<p>Fruity-smelling breath (D)</p> Signup and view all the answers

What is the underlying cause of polyuria (frequent urination) in uncontrolled diabetes mellitus?

<p>Osmotic diuresis due to excess glucose in the urine. (C)</p> Signup and view all the answers

In a patient with Type 1 diabetes who consistently skips pre-meal bolus insulin doses, which of the following metabolic consequences is MOST likely to occur?

<p>Postprandial hyperglycemia (A)</p> Signup and view all the answers

In a patient newly diagnosed with Type 2 diabetes, which of the following is the MOST appropriate initial step in management?

<p>Lifestyle modifications, including diet and exercise. (B)</p> Signup and view all the answers

Which of the following series of events BEST describes the pathogenesis of Type 1 diabetes?

<p>Viral infection -&gt; autoimmune reaction -&gt; destruction of beta cells -&gt; insulin deficiency. (B)</p> Signup and view all the answers

In a hypothetical scenario, researchers identify a genetic variant that completely prevents the development of insulin resistance, regardless of lifestyle. This variant most likely directly impacts which of the following cellular processes?

<p>IRS-1 phosphorylation and downstream signaling in skeletal muscle. (A)</p> Signup and view all the answers

In a patient with diabetes experiencing nephropathy, what underlying physiological process is primarily responsible for the damage to the kidneys?

<p>Elevated blood glucose levels damaging small blood vessels and filters in the kidneys. (B)</p> Signup and view all the answers

Which of the following best describes the role of GLUT4 transporters in individuals with normal glucose metabolism?

<p>They facilitate the transport of glucose into cells in response to insulin. (B)</p> Signup and view all the answers

Which statement accurately reflects the relationship between insulin resistance and Type 2 diabetes?

<p>As insulin resistance increases, the pancreas initially compensates by producing more insulin, but eventually fails. (A)</p> Signup and view all the answers

A patient presents with increased thirst, frequent urination, and unexplained weight loss. Their fasting blood glucose is 6.8 mmol/L. What does this value suggest?

<p>Suggests impaired fasting glucose. (B)</p> Signup and view all the answers

What is the primary immunological process involved in the aetiology of Type 1 diabetes?

<p>Autoimmune destruction of beta cells in the pancreas. (A)</p> Signup and view all the answers

Flashcards

What is Diabetes Mellitus?

Chronic disease with raised blood glucose levels, where the pancreas can't produce/respond to insulin.

Type 1 Diabetes

Type 1 is characterized by little to no insulin production, usually diagnosed in childhood or teens.

Type 2 Diabetes

Type 2 is characterised by cells not using insulin properly, often diagnosed in adults 40+, linked to lifestyle.

Common Diabetes Symptoms

Frequent urination (polyuria), excessive thirst (polydipsia), and fatigue are common signs.

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Diagnosing Diabetes

Tests include fasting blood glucose, random blood glucose, and HbA1c levels.

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Causes of Type 1 Diabetes

Genetic and environmental factors, causing selective destruction of β-cells in the pancreas.

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Causes of Type 2 Diabetes

Body weight, physical activity, genetics, and diet.

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Metabolic Syndrome and Diabetes Risk

Individuals with metabolic syndrome are at increased risk for developing Type 2 diabetes.

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Diabetes Complications

Microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (cardiovascular, cerebrovascular).

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Diabetic Retinopathy

High blood glucose damages small blood vessels in the eyes, potentially causing blindness.

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Diabetic Nephropathy

High blood glucose damages kidney's blood vessels/filters.

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Diabetic Neuropathy

High blood glucose damages nerves.

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Cardiovascular Disease & Diabetes

High blood glucose damages heart blood vessels.

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Cerebrovascular Disease & Diabetes

High blood glucose contributes to strokes.

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Gestational Diabetes

Hyperglycaemia during pregnancy in women without prior diabetes.

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Insulin/Glucose Regulation

Regulation involves a balance between insulin (decreases blood glucose) and glucagon (increases blood glucose).

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Insulin's Role in Glucose Uptake

Without insulin, glucose cannot enter cells. Insulin signals cells to insert GLUT4 transporters, allowing glucose entry.

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Type 1 Diabetes: Autoimmune Nature

Autoimmune disease where body destroys pancreatic beta cells causing insulin deficiency.

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Diabetes Prevalence in the UK

The number of people with diabetes in the UK is estimated to be 5.6 million which represents 6.5% of the UK population.

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Tests for Diagnosing Diabetes

Includes Fasting Blood Glucose (FBG), Random Blood Glucose (RBG), Oral Glucose Tolerance Test (OGTT), and HbA1c.

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Study Notes

Regulation of Insulin/Glucose

  • Normal regulation maintains blood glucose between 3.5-6.5 mmol/L
  • High blood sugar promotes insulin release from the pancreas
  • Insulin stimulates glucose uptake from the blood by tissue cells and glycogen formation in the liver
  • Low blood sugar promotes glucagon release from the pancreas
  • Glucagon stimulates glycogen breakdown in the liver, raising blood sugar

How Insulin Regulates Plasma Glucose Levels

  • Insulin signals the cell to insert GLUT 4 transporters into the membrane
  • GLUT 4 transporters allow glucose to enter cell

Diabetes

  • Diabetes is a chronic disease characterized by high blood glucose levels (hyperglycaemia)
  • It occurs when the pancreas cannot produce or respond to insulin
  • This results in abnormal carbohydrate metabolism and elevated blood glucose
  • Epidemiological, human, and molecular studies have clarified the pathophysiology of diabetes mellitus over the last 50 years
  • Pathophysiological classification improvements could better patient phenotyping and therapeutics

Types of Diabetes: Type 1

  • Type 1 diabetes was previously known as insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes
  • Accounts for 5-10% of all diabetes cases
  • There is little to no insulin produced, as beta cells in the pancreas cannot produce insulin well
  • It is usually diagnosed in people ages 0-40, including young children or teens
  • Treatment typically involves healthy eating and meal planning, increased physical activity, blood sugar checks, and insulin injections

Types of Diabetes: Type 2

  • Type 2 diabetes was previously known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes
  • Accounts for 90% of all diabetes cases
  • There is too little or ineffective insulin, where cells do not use insulin well, resulting in insulin resistance
  • Usually diagnosed in ages 40+, mostly adults, but increasingly occurring in children and teens who are overweight and obese
  • Treatment involves healthy eating and meal planning for weight management, increased physical activity, blood sugar checks, insulin injections (if needed), and oral medication (if needed)

Global Prevalence

  • Approximately 537 million people worldwide are living with diabetes
  • Which is estimated to be 1 in 10 of the world's adult population
  • The figure is expected to rise to 643 million by 2030
  • The International Diabetes Federation (IDF) identifies the top 5 countries with the highest number of people with diabetes:
    • China: 141 million
    • India: 74 million
    • Pakistan: 33 million
    • USA: 32 million
    • Indonesia: 20 million

UK Prevalence

  • The UK has an estimated 5.6 million people with diabetes
  • This number is an all time high
  • Diabetes affects 6.5% of the UK population, or 1 in every 15 people
  • It is estimated that 1 in 10 people in the UK will be affected by 2030
  • Type 2 diabetes is rapidly growing and now one of the world's most common long-term health conditions

Symptoms of Diabetes

  • Frequent urination (polyuria)
  • Excessive thirst (polydipsia)
  • Tiredness/Lack of energy (fatigue)

Signs of Diabetes

  • High blood glucose (hyperglycaemia)
  • Diabetic ketoacidosis

Diagnosing Diabetes

  • Tests used to diagnose diabetes include:
    • Fasting Blood Glucose (FBG)
    • Random Blood Glucose (RBG)
    • Oral Glucose Tolerance Test (OGTT)
  • In 2011, the World Health Organization (WHO) included HbA1c
  • HbA1c is a measure of the quantity of haemoglobin that has been glycosylated
  • Diagnosis values are as follows:
    • FBG Diabetes ≥ 7.0 mmol/L, Impaired fasting glucose (IFG) 6.1 – 6.9 mmol/L, Impaired glucose tolerance (IGT) < 7.0 mmol/L
    • OGTT Diabetes ≥ 11.1 mmol/L, Impaired fasting glucose (IFG) < 7.8 mmol/L, Impaired glucose tolerance (IGT) ≥ 7.8 mmol/L
    • HbA1c Diabetes ≥ 48 mmol/mol (6.5%), Impaired fasting glucose (IFG) 42 – 46 mmol/mol (6.0 – 6.4%), Impaired glucose tolerance (IGT) 42 – 46 mmol/mol (6.0 – 6.4%)

Type 1 Diabetes Aetiology:

  • Type 1 is an autoimmune disease
  • It involves the selective destruction of pancreatic beta-cells by T cells
  • Causes insulin deficiency
  • Several circulating antibodies target pancreatic beta-cells
  • The cause is unknown
  • Peak incidence occurs in childhood
  • A combination of genetic and environmental factors
  • Genetic factors suggested by genetic markers and absence of antibodies
  • Environmental factors suggested by seasonality and increasing incidence

Type 2 Diabetes Aetiology:

  • Risk factors include body weight, physical activity, smoking, alcohol consumption, genetic predisposition, gene & environment interaction, epigenetics, gestational diabetes
  • Positive risk profile results in normoglycaemia
  • Negative risk profile results in beta cell dysfunction and insulin resistance
  • Body organs/parts affects are liver, adipose tissue, skeletal muscle

Type 2 Diabetes Management

  • Diet & lifestyle modification: Improves insulin sensitivity and glucose control through healthy eating, weight management, and increased physical activity
  • Metformin: Usually the first-line medication prescribed
  • Addition of secondary and tertiary medications: Different classes of drugs may be added to metformin
  • Insulin: Used when other treatments are insufficient to control blood glucose levels

Metabolic Syndrome and Type 2 Diabetes

  • Individuals with metabolic syndrome are at increased risk of developing type 2 diabetes
  • CVD and type 2 diabetes is characterized by insulin resistance
  • Those with metabolic syndrome also have:
    • Increased BMI
    • Increased triglycerides
    • Increased LDLs
    • Decreased HDLs
    • Hypertension
    • Disrupted glycaemia

Diabetes-Associated Complications: Microvascular

  • Affect small blood vessels
  • Retinopathy which affects the eyes
  • Nephropathy which affects the kidneys
  • Neuropathy which affects the nerves

Diabetes-Associated Complications: Macrovascular

  • Affect large blood vessels
  • Cardiovascular disease which affects the heart
  • Cerebrovascular disease which affects the brain

Retinopathy

  • Caused by high blood glucose levels damaging the back of the eye (retina)
  • Stages include: background, pre-proliferative, and proliferative retinopathy

Nephropathy

  • High blood glucose levels damage the small blood vessels and tiny filters in the kidneys
  • Symptoms include:
    • Swollen ankles, feet, and hands
    • Blood in urine
    • Tiredness
    • Shortness of breath
    • Nausea

Neuropathy

  • It is a result of high blood glucose levels that damage small blood vessels supplying nerves
  • Types of neuropathy include:
    • Diabetic peripheral neuropathy
    • Diabetic sensory neuropathy
    • Diabetic autonomic neuropathy
    • Diabetic motor neuropathy

Cardiovascular Disease (CVD)

  • High blood glucose levels damage blood vessels of the heart
  • Glucose sticks to red blood cells, accumulates in the blood, obstructs vessels, and damages those vessels
  • Risk factors consist of high HbA1c levels, blood pressure and cholesterol, smoking, and being overweight/obese

Cerebrovascular Disease

  • The most common type is stroke
  • Atherosclerosis is the main contributing factor
  • Plaque can restrict blood flow, oxygen, and nutrients to the brain
  • When the plaque bursts, it can trigger a blood clot blocking blood flow to the brain

Gestational Diabetes

  • Gestational diabetes affects pregnant women who have never had diabetes before
  • But who have high blood glucose levels during pregnancy

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