BMJ

Question 1

T1DM and T2DM progression to diabetic nephropathy

Answer 1

T1DM: 50%
T2DM: 15%
Diabetic nephropathy is more common in T1DM than T2DM

Question 2

What drugs can precipitate diabetic ketoacidosis?

Answer 2

Atypical antipsychotics - Olanzapine
Thiazide diuretics
Steroids
Beta sympathomimetics eg: dobutamine

Question 3

Risk of impaired glucose tolerance to t2dm

Answer 3

33% in 6 years

Question 4

Heavy goods vehicle and insulin

Answer 4

• nil hypoglycaemia events for 12 months that require help from other people
• stable bsls for 3 months

Question 5

Alcohol and glucogenesis

Answer 5

Alcohol inhibits glucogenesis and thus symptoms and perceptions of hypoglycaemia

Glucose sensing occurs in hypothalamus

Question 6

Erythromycin and diabetic gastropathy se

Answer 6

Can cause prolonged qt

Question 7

Stages of diabetic retinopathy

Answer 7

Diabetic Retinopathy 
Microanurysm
Hard Exudate
Retinal edema/thickening
Retinal hemorrhage

Maculopathy
Retinal edema/thickening at
macular region

Preproliferative
- Cotton wool spots
- Vascular abnormalities
- Venous beading
- Loop
- Segmentation
- IRMA (Intra retinal micro vascular
abnormalities)
- Large blot hemorrhages

Proliferated

• Neo-vascularization at disc
• Neo-vascularization else where

Advanced eye disorder

• Vitreous hemorrhage
• Pre-retinal fibrosis
• Tractional retinal detachment
• Rubiosis

Even with proliferative diabetic retinopathy, there is normal visual acuity

Question 8

What is a cause of low fsh and low testosterone (hypogonadotropic hypogonadism) with type 1 diabetes

Answer 8

Haemochromatosis
Ferritin deposition in the pituitary

Laboratory tests
↑ Serum iron
↑ Ferritin in serum (> 200 μg/L)
↓ Total iron-binding capacity (TIBC)
↑ Transferrin saturation (> 45%)
↑ Liver enzymes (AST, ALT)

Question 9

What shoulder condition is common in T1DM

Answer 9

Frozen shoulder

Adhesive capsulitis

Question 10

Which drugs increase insulin sensitivity

Which drugs are insulin secretagogues?

Answer 10

Increase Insulin Sensitivity

• Metformin
• Glitazones

Insulin secretagoues
- Gliclazide, glimepiride and repaglinide are insulin secretagogues; they boost insulin secretion

Question 11

What % of new T1DM patients develop dka

Answer 11

25%

Question 12

Which medications are contraindicated with sildenafil

Answer 12

Nitrates or nitrates derivatives (nicorandil)

Question 13

What provides long term prevention of cardiovascular disease

Answer 13

Lipid modification !

Question 14

When do you check Hba1c?

Answer 14

3-6 months

Question 15

What is a sign of isolated hypertriglyceridemia

Answer 15

Lipaemia retinalis is an association between hypertriglyceridaemia and a pale pink milky appearance to the retinal vessels or even to the retina itself.

Xanthelasma and corneal arcus are associated with hypercholesterolaemia, and xanthopsia is yellowing of the vision.

Question 16

In a study healthy volunteers are given 50 mls of 50% dextrose solution by one of two routes. Route A is intravenous and route B is via a nasogastric tube.

Every 15 minutes the plasma insulin level and glucose are measured and plotted on a graph.

Which of the following statements would best describe the likely results comparing route A to route B in this experiment?

(Please select 1 option)

A. Insulin higher, glucose lower in route A
B. Insulin higher, glucose higher in route A
C. Insulin and glucose the same in route A and route B
D. Insulin higher, glucose higher in route B
E. Insulin higher, glucose lower in route B

Answer 16

E. Insulin higher, glucose lower in route B

Glucose given via the gut elicits a greater insulin response as compared to the same quantity given intravenously even though the plasma glucose peak is higher when it is given IV. This phenomenon is called the ‘incretin effect’.

The incretin effect denominates the phenomenon that oral glucose elicits a higher insulin response than does intravenous glucose.

The two hormones responsible for the incretin effect, glucose-dependent insulinotropic hormone (GIP) and glucagon-like peptide-1 (GLP-1), are secreted after oral glucose loads and augment insulin secretion in response to hyperglycaemia.

The investigation of the incretin effect is not usually performed using the same quantity of glucose as in this question. An ‘isoglycaemic study’ is often used where an infusion of glucose is designed to copy exactly the blood glucose profile generated in an individual or animal by a certain enteral glucose load.

Exenatide (synthetic exendin-4) is a new agent for the treatment of type 2 diabetes. Exendin-4 occurs naturally in the saliva venom of the North American lizard called the Gila Monster. It mimics the action of the gut hormone GLP-1 (Glucagon-like peptide 1).

Question 17

What is chylomicronaemia

Answer 17

• Chylomicronaemia is due to a circulating inhibitor of lipoprotein lipase (type 1c hyperlipidaemia), which typically presents with eruptive xanthoma and abdominal colic.
• The episodes of abdominal pain, eruptive xanthoma and strong family history should lead you to think of a form of familial hyperlipidaemia.
• Chylomicronaemia is due to a circulating inhibitor of lipoprotein lipase (type 1c hyperlipidaemia). It typically presents with eruptive xanthoma and abdominal colic. Complications include retinal vein occlusion, acute pancreatitis, steatosis, and lipidaemia retinalis.

Question 18

Which of the following is the strongest independent predictor of cardiovascular death in a patient with impaired glucose tolerance?

Answer 18

TRIGLYCERIDES
Triglycerides are seen as the strongest independent risk factor for cardiovascular death, ahead of other more established risk factors such as smoking, body weight or blood pressure in Impaired Glucose tolerance or type 2 diabetes.

Question 19

In a newly diagnosed diabetic with poor control and blurred vision what is the cause

Answer 19

Osmotic changes in the lens

Question 20

Cause of anaemia and diabetes

Answer 20

Normally due to reduced erythropoietin release due to diabetic nephropathy

Question 21

Histopathology of the pancreas in T2DM

Answer 21

Amyloid deposition in the pancreas causing reduce beta cell mass

Question 22

What type of fat is high trigs associated with?

Answer 22

Increased central fat

Question 23

What is candida intertrigo

Answer 23

Common in obese patients with diabetes - fungal infection (like a chub rub)
- oral fluconazole

Question 24

What cholesterol medications are not always recommended in t2dm?

Answer 24

Fibrates

Ezetimibe

Question 25

What medication in diabetes reduces both micro vascular and macro vascular se

Answer 25

Antihypertensives

Statins only reduce macrovascular not micro

Question 26

Why is Metformin now used after mi

Answer 26

Due to tissue hypoxia and increased risk of developing lactic acidosis

Question 27

Characteristics of PPAR gamma

Answer 27

• Intracellular receptor that is activated by FREE FATTY ACIDS (natural endogenous ligand) and the THIAZOLINEDIONES, eg: pioglitazone
• On ligand binding, it associates with retinoid X receptor and couples with DNA producing downstream gene activation with protein synthesis that control adipocyte differentiation and function and also related to cellular anti-inflammatory effects.