19. Diabetes Mellitus 2

Question 1

What factors can precipitate DKA?

Answer 1

Infection
MI
Alcohol
eating disorders

Question 2

What are the symptoms of DKA?

Answer 2

Nausea and vomiting, abdominal pain
Gastroparesis
Acute renal failure
Coma

Question 3

What are the criteria for DKA?

Answer 3

Ketones >3mmol
Glucose >11 or known diabetic
Bicarb <17 or pH <7.3

Question 4

What is HHS?

Answer 4

Hyperosmolar hyperglycaemic state
a/w type 2: older patients plus a stressor
Similar effects as DKA

Question 5

What are the macrovascular complications of DM?

Answer 5

Atheroma
Very high risk of MI or stroke
Peripheral vascular disease
AAA

Question 6

What description is given to the appearance of microvascular lesions in DM?

Answer 6

Hyaline arteriolosclerosis: thickening of walls causes leaking and protein build up

Question 7

What causes microvascular damage in DM?

Answer 7

Advanced Glycosylation End Products

Stick to proteins in vessels

Question 8

What is seen on histology in diabetic glomerulosclerosis?

Answer 8

Kimmelstiel Wilson nodule

Question 9

What are the stages of diabetic nephropathy?

Answer 9

Microalbuminaemia <300mg in 24 hours
Macroalbuminaemia >300
End stage renal disease

Question 10

What drugs can be used in diabetic nephropathy?

Answer 10

ACE inhibitors and ARBs prevent protein loss

Question 11

What are the stages of diabetic retinopathy?

Answer 11

Background vascular damage
Pre-proliferative (ischaemic)
Proliferative
+/- maculopathy, cataracts, glaucoma

Question 12

What risks are associated with the proliferative stage of diabetic retinopathy?

Answer 12

Vitreous haemorrhage

Retinal detachment

Question 13

What is the treatment for diabetic retinopathy?

Answer 13

Laser photo-coagulation destroys proliferative blood vessels

Question 14

What are the effects of peripheral neuropathy?

Answer 14

Loss of pain and positional sense
Distortion of foot: nerve damage smooths tendons
Charcot’s arthropathy: unstable bones, flat, broad foot
Carpal tunnel
Cranial nerve palsies

Question 15

What are the effects of autonomic neuropathy?

Answer 15

Tachycardia, orthostatic hypotension
Gastroparesis, constipation, diarrhoea
Erectile dysfunction, bladder stasis
Lose ability to sense hypoglycaemia

Question 16

Why is there an increased risk of infection in diabetics?

Answer 16

Altered phagocyte function

Colonisation with staph aureus and candida

Question 17

What are the diabetes associated complications in pregnancy?

Answer 17

Large for gestational age baby
Complications at delivery
Pre-eclampsia
Miscarriage
Polyhydramnos

Question 18

What is gestational diabetes?

Answer 18

Transient hyperglycaemia caused by pregnancy hormones

Return to normal after delivery but may recur in subsequent pregnancies and higher lifetime risk of type 2

Question 19

When is gestational diabetes most likely to present?

Answer 19

24-28 weeks

Question 20

What are the signs of DKA?

Answer 20

Tachypnoea, ketotic breath
Neuro signs
Volume depletion
Absent bowel sounds

Question 21

What is the management of DKA?

Answer 21

Correct volume deficit
Insulin therapy
K+ replacement
Acidosis correction