7.1 Diabetes Mellitus

Question 1

What brings down glucose in body?

Answer 1

Insulin
Somatostatin
Amy Lin
GLP-1

Question 2

What brings glucose up?

Answer 2

Glucagon
Cortisol
Growth hormone
Epinephrine

Question 3

Pancreas exocrine cells secrete?

Answer 3

Digestive enzymes

Question 4

Beta cells secrete?

Answer 4

Insulin

Question 5

Alpha cells secrete?

Answer 5

Glucagon

Question 6

Delta cells secrete?

Answer 6

Somatostatin

Question 7

What are secondary causes of inadequate insulin production?

Answer 7

CF
Drugs
Surgery
Malignancy

Question 8

Criteria for Diabetes mellitus fasting glucose?

Answer 8

> 7mmol/L

Question 9

Criteria for Diabetes mellitus OGTT?

Answer 9

> 11.1 two hours post-load

Question 10

Criteria for Diabetes mellitus hba1c?

Answer 10

> 6.5%

Question 11

Seasonal variation in DM1?

Answer 11

Peak in winter

Question 12

Definition of T2DM?

Answer 12

High body mass index
Acanthosis nigricans
Negative DM autoantibodies
Elevated fasting insulin and C-peptide

Question 13

When to suspect Monogenic diabetes?

Answer 13

Dx first 6/12 of life
No islet antibodies
No insulin requirements after 5 years old
No DMII features
Mild stable fasting hyperglycaemia
Associated deafness/renal disease

Question 14

Criteria for Diabetes mellitus random blood glucose?

Answer 14

Plasma glucose of >11.1

Question 15

Associated autoimmunity in DMI?

Answer 15

Thyroid

Coeliac

Question 16

DMI when to refer?

Answer 16

If ketones are present

Question 17

What are the blood glucose targets for paeds?

Answer 17

Before meals: 3.5-7
After meals: 4-9
Parent’s bedtime (5-8)
BEfore exercise (7-10)

Question 18

What is considered hypo in kids?

Answer 18

<3.5

Question 19

What is target Hba1c for paeds?

Answer 19

<7.5%

Question 20

Principles of insulin pump?

Answer 20

Vary the rate

Bonus for meals

Question 21

Diabetes ketoacidosis presentation?

Answer 21

Polyuria
Polydipsa
Weight loss
Kiss all respiration
Ketone breath

Vomiting
Lethargic
Abdo pain

Question 22

Diabetes ketoacidosis Mx: main things

Answer 22

• 10mL/KG bolus 0.9% saline over 1-2 h
• K+ replacement
• Insulin infusion 0.05-0.1units/kg/hour, 1-2 hours after fluids

Question 23

When is Diabetes ketoacidosis severe pH wise?

Answer 23

<7.1

Question 24

When is Diabetes ketoacidosis severe sodium wise?

Answer 24

<130

>160

Question 25

When is Diabetes ketoacidosis severe potassium wise?

Answer 25

<3.0 or >5.5

Question 26

When is Diabetes ketoacidosis severe age wise?

Answer 26

<2

Question 27

What does metformin do?

Answer 27

Acts on insulin target cells in liver, fat, muscle
Inhibits hepatic glucose production
Improves insulin sensitive
Lipids: decreases TG, vLDL

Question 28

When child is sick, what is Mx of diabetes?

Answer 28

Test BGL Q2h
Treat underlying illness
Give extra fluids
Never omit insulin
May need extra insulin

Question 29

Sick day mx, when to seek medical review?

Answer 29

If checking BGLs every 2 hours and after 2 extra insulin doses still not improving

Question 30

Sick day management with pump?

Answer 30

Increase insulin

Extra via pen until ketones cleared

Question 31

Mild to moderate hypoglycaemia Rx?

Answer 31

10-15g carbs
150-200mL juice
2tsp honey
4-7 jelly beans
Recheck BGL after 10-15 minutes

Question 32

Severe hypoglycaemia Rx?

Answer 32

IM glucagon 0.5-1.0mg

IV 10% dextrose 2mL/kg continuous infusion