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Question 1

T1DM

• define
• age/ sex
• patho
• RF
• symptoms
• signs
• Ix
• Mx

Answer 1

define
- autoimmune destruction of beta islet cells

age/ sex
- young

RF

• genetics
• infection - CMV

symptoms

• polyuria, polydypsia
• weight loss, fatigue
• gradual onset
• blurred vision

signs
- urine dip - glucose

Ix

• fasting glucose - >7.1
• OGTT/ normal - >11
• HbA1c >48

Mx

• lifestyle, education, DAFNE, alcohol
• insulin - b.d intermediate and RA for meals

Question 2

T2DM

• define
• age/ sex
• RF
• symptoms
• signs
• Ix
• Mx

Answer 2

define
- insulin reduced sensitivity to glucose&raquo_space; IN insulin production&raquo_space; pancreas tires&raquo_space; DM

age
- middle aged

RF
- obesity, fhx, asian/ black, in age, high carb diet

symptoms and Ix
- same as above

Mx

• education, 5-10% wt loss, 20-30mins exercise/ day
• diet - fat <35% and carb 40-60%
• metformin
• metformin + DDP4-I/ sulphonylurea/ thiazolidinediones/ SGLT-2 I
• metformin + 2 above OR insulin

Question 3

HHS

• define
• patho
• RF
• symptoms
• signs
• Ix
• Mx

Answer 3

define

• T2 complication, hyperosmolar hyperglycaemia
• serum osmolality = 2[Na+] + urea + glucose and >320 is HHS

RF

• infection
• b-blockers, thiazide diuretics, steroids, G6 foods, MI

symptoms
- polyuria, polydypsia, drowsy, coma, seizures

Mx
- 1L 0.9% saline over 1hr, then 3-6L over 12hrs
– poss initial increase in Na+ than decrease
- insulin infusion once fall in gluocse <5mmol/L/hr
- able to eat - start s.c. insulin
- stop IV insulin after an hour
- potassium >5.5 - senior, if normal can add K+ into fluids
- prophylactic LMWH
IF KETONES, TREAT AS DKA

Question 4

DKA

• define
• RF
• symptoms
• signs
• Ix
• Mx

Answer 4

define
- hypergylcaemia and ketones

patho
- breakdown of fatty acids&raquo_space; acetyl-CoA&raquo_space; acetoacetate&raquo_space; blood&raquo_space; IN acid and IN k+ level

symptoms
- N+V, abdo pain, confusion, drowsy, coma, dehydration, kussmaul breathing, sweet breath

Ix

• pH <7.3 or bicard <15, glucose >11, ketones >+3 or urine >2
• ph 7.1-7.3 - mod, pH <7.1 - severe

Mx

• IV fluids 1L of 0.9% saline over 1hr or 500ml if SBP<90
• 2/3rd L over 2hr and 4th over 4h
• IV insulin - 50 units insulin + 50ml saline at 1unit/ml and infuse at 0.1unit/kg/hr
• infuse until glucose <14
• correct hyperkalaemia along the way
• 10% glucose at 125ml/hr

Question 5

DM drugs

• biguandies
• thizalidodines
• sulphonylureas
• DDP4-I
• GLP-1 mimetics
• SGLT-4 I
• insulin

Answer 5

see fc on anki