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Diabetes: types, pregnancy & complications flashcards

17 high-yield MRCP Part 1 cards from the Intellect Medicos Endocrinology & Diabetes course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. What HbA1c confirms a diagnosis of diabetes in the UK?

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   48 mmol/mol (6.5%) or above.

   Why? Without symptoms the result should be repeated. Fasting glucose ≥7.0 or random ≥11.1 mmol/L are the glucose criteria.

2. What HbA1c range defines pre-diabetes (non-diabetic hyperglycaemia)?

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   42–47 mmol/mol.

   Why? NICE (PH38) also counts a fasting plasma glucose of 5.5–6.9 mmol/L as high risk. WHO defines impaired fasting glucose as 6.1–6.9 mmol/L and impaired glucose tolerance as a 2-hour OGTT glucose of 7.8–11.0 mmol/L.

3. Which autoantibodies are measured to support a diagnosis of type 1 diabetes?

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   Anti-GAD and anti-IA2 antibodies.

   Why? They mark autoimmune beta-cell destruction and help separate type 1 from type 2 or MODY.

4. Which HLA type is most strongly associated with type 1 diabetes?

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   HLA-DR4 (more than DR3).

   Why? Type 2 diabetes has no HLA association.

5. Identical-twin concordance is higher in ______ diabetes (60–100%) than in type 1 (30–50%).

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   type 2

   Why? Type 2 diabetes has a stronger genetic component, despite having no HLA link.

6. A lean 45-year-old diagnosed with type 2 diabetes fails oral agents within a year. Which antibody would suggest LADA?

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   GAD antibodies.

   Why? Latent autoimmune diabetes in adults is slow-onset autoimmune diabetes that progresses to insulin dependence faster than type 2.

7. What is the inheritance pattern of MODY?

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   Autosomal dominant (monogenic).

   Why? There is usually a strong multigenerational family history; insulin secretion is impaired but insulin action is normal.

8. Which MODY subtype causes mild, stable fasting hyperglycaemia that needs no treatment?

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   Glucokinase (GCK) MODY — MODY 2.

   Why? The glucose "set point" is reset slightly higher, so complications are rare.

9. HNF1-alpha MODY (MODY 3) is characteristically very sensitive to which drug class?

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   Sulfonylureas (low dose).

   Why? Hyperglycaemia is progressive; insulin may be needed later. HNF4-alpha MODY (MODY 1) is also treated with sulfonylureas.

10. How is MODY confirmed?

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    Genetic testing.

    Why? Autoantibodies are negative and C-peptide is normal or mildly low; it is often misdiagnosed as type 1 or 2.

11. Name three drug classes that can cause secondary diabetes.

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    Glucocorticoids, thiazides, antipsychotics (also beta-blockers).

    Why? They worsen insulin resistance or reduce insulin secretion.

12. What are the NICE OGTT thresholds for diagnosing gestational diabetes?

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    Fasting glucose ≥5.6 mmol/L or 2-hour glucose ≥7.8 mmol/L.

    Why? OGTT is the diagnostic test, done at 24–28 weeks if risk factors (or soon after booking if previous gestational diabetes).

13. Gestational diabetes is diagnosed with a fasting glucose of 6.2 mmol/L and no complications. What is the first step?

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    Diet and exercise for 1–2 weeks; add metformin if targets are not met, then insulin.

    Why? If the fasting glucose is ≥7.0 mmol/L at diagnosis (or 6.0–6.9 with macrosomia or polyhydramnios), start insulin immediately.

14. What renal biopsy finding is specific for diabetic nephropathy?

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    Kimmelstiel–Wilson lesions (nodular glomerulosclerosis).

    Why? First-line treatment of diabetic kidney disease with albuminuria is an ACE inhibitor (or ARB). In type 2 diabetes an SGLT-2 inhibitor is also given for kidney protection (eGFR 20 or above).

15. Which drugs does NICE offer first-line for painful diabetic neuropathy?

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    A choice of amitriptyline, duloxetine, gabapentin or pregabalin.

    Why? If the first drug fails, switch to one of the other three. The course notes favour duloxetine over amitriptyline (less urinary retention) and pregabalin in renal impairment.

16. A patient on duloxetine for diabetic neuropathy is given tramadol. What is the risk?

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    Serotonin syndrome.

    Why? Both increase serotonergic activity. Duloxetine should also be used with caution in angle-closure glaucoma.

17. A man with type 2 diabetes develops thigh pain, proximal leg weakness and loss of the knee reflex. What is the diagnosis?

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    Diabetic amyotrophy.

    Why? It is a painful proximal (lumbosacral) neuropathy with mixed motor and sensory involvement.