Diabetes Mellitus - Clinical Features MCQs

The patient has diabetic ketoacidosis , a condition still associated with mortality in patients with type-1 diabetes mellitus. There is a total body deficit of fluid and electrolytes. The most important initial treatment is intravenous saline as the hypovolaemia is the factor most likely to cause the patient to die. Intravenous insulin is required at an early stage; and, although it is normal, the potassium level will rapidly fall with fluid and insulin treatment and the patient will require potassium replacement. Intravenous bicarbonate should not be used immediately as it can cause massive fluid shifts and precipitate cerebral oedema. Reference: Harrison's Principles of Internal Medicine 21 st edition Pg:3115

If initial serum K+ is 3.3 mEq/L If initial K+ > 5.3 mEq/L, insulin therapy can be started without K+ administration. Potassium values to be monitored every 4 hours If initial K+ is between 3.3 and 5.3 mEq/L, insulin infusion to be started along with potassium supplementation because ongoing insulin supplementation would result in lowering of serum K+ due to transcellular shift Reference: ISPAD consensus guidelines on management of Young Diabetes mellitus, Harrison's Principles of Internal Medicine 21 st edition page 3115

Ans. is a and b i.e. Gestational diabetes and Maternal obesity Macrosomia is the term used to describe a large fetus. The recommended definition is fetal (neonatal) weight exceeding two standard deviations or above 90th centile for the appropriate normal population. According to ACOG : birth weight of > 4500gm is called as macrosomia. In Indian context Birth weight of > 4000 gm is called as macrosomia.

Immunology of Diabetes Society criteria for diagnosis of LADA Age at diagnosis > 30 years Presence of autoantibodies against islet antigens Not requiring insulin for at least 6 months after diagnosis of DM Also known as Type 1.5 Diabetes In the WHO classification of DM 2019, it has been renamed as 'Slowly evolving immune mediated diabetes of adults'. Reference: LADA - Diagnostic criteria proposed by Immunology of Diabetes Society

Explanation: According to the American College of Physicians, the target HbA1c for determining controlled diabetes is This value represents optimal glycemic contro l, though it may be adjusted to Glycated Hemoglobin (HbA1c) effectively assesses overall glycemic control and is suitable for diagnosing diabetes in asymptomatic individuals. HbA1c prediction in undiagnosed individuals: 7% - 6.5% : Pre-diabetic > 6.5% : Diabetic For patients with existing diabetes, HbA1c is used to evaluate the degree of effective control on diabetes. The cutoffs recommended by ACP for monitoring effective control include: HbA1c Pre-prandial capillary plasma glucose between 80-130 mg/dL Postprandial capillary plasma glucose

A lean patient with young onset diabetes can produce a diagnostic confusion between MODY and Type 1 Diabetes mellitus The clinical pointer in favor of MODY are: Strong family history Low insulin requirement ( No episodes of DKA Negative autoantibodies Detectable C-peptide levels after 2-3 years of diagnosis For the same duration and degree of glycemic control, MODY patients have been observed to have same risk for microvascular complications though the risk of macrovascular complications is decreased compared to type 2 Diabetes. Reference: Harrison's Principles of Internal Medicine 21 st edition page 3095

Imeglimin is an oxidative phosphorylation inhibitor which improves the mitochondrial dysfunction resulting in both beta cell defects and insulin resistance Colesevelam is the bile-acid sequestrant approved for use of Type 2 Diabetes meliitus Bempedoic acid is the ATP citrate lyase inhibitor approved for treatment in dyslipidemia Reference: TIMES trial - Imeglimin

Type 2 diabetes is associated with a 40-60% increase in the risk of cancer of the large bowel. This increase is linked to changes in HbA1c. Type 2 diabetes is associated with significantly higher rates of overall mortality and reduced disease free and recurrence free survival after chemotherapy/radiotherapy, and insulin has not been shown to have any effects on mortality. No association has been found between colonic malignancy and type 1 diabetes, nor gestational diabetes. A number of studies have independently linked high circulating concentrations of C Peptide, as a marker of insulin production, with increased colorectal cancer risk. The molecular basis has not been proven, but it may be reasonable to extrapolate that it is linked to the growth stimulation effects of insulin. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 81 Pg: 637