CIRCUIT Diabetes

Question 1

4 complications of diabetes

Answer 1

Vascular (e.g. eyes, kidneys, nerves, heart, blood vessels)
Neurological
Biochemical
Infection

Question 2

2 divisions of vascular complications due to diabetes?

Answer 2

Macrovascular

• Coronary artery
• Peripheral vascular
• Cerebrovascular

Microvascular

• Retinopathy
• Neuropathy
• Nephropathy

Question 3

Consequences of diabetic peripheral neuropathy?

Answer 3

Sensory neuropathy:

• Painless OR intensely painful (burning and allodynia)
• Tingling, numbness, reduced sensation
• Not noticing minor injuries

Motor neuropathy:
-Results in foot deformities and pressure sores

Question 4

S/S of autoneuropathy associated with diabetes

Answer 4

postural hypotension arrhythmia
diarrhoea
urinary retention
erectile dysfunction

Question 5

What is mononeuropathy

Answer 5

Single nerve affected e.g. in CN VI leads to right lateral rectus palsy (ophthalmoplegia)

Question 6

What are the acute and chronic biochemical complications of diabetes?

Answer 6

Acute:
Blurring of vision (osmotic effect of glucose = lens swelling)
Hypoglycaemia
Hyperglycaemia (HHS, hyperglycaemia hyperosmolar state)
Coma

Chronic
-Cataract

Question 7

Specific consequences to the feet due to diabetes

Answer 7

Peripheral vascular disease:

• Loss of foot pulses
• Ischaemic cold foot
• Foot ulceration

Peripheral neuropathy

• Damage due to loss of sensation
• Foot ulceration

Leads to…. ulceration + infection + osteomyelitis

Question 8

HbA1c aim?

Answer 8

Less than 48mmol/mol (=6.5%)

Question 9

Name 8 categories of drugs used in T2DM management?

Answer 9

Biguanide
Sulphonylureas
Thiazolidinediones (glitazones)
DPP-4 inhibitors (gliptins)
SGLT2 inhibitors (gliflozins)
Meglitinides
Insulin
GLP-1 agonists (incretin mimetics)

Question 10

Name an example for each of the following drugs for T2DM management:
Biguanide
Sulphonylureas
Thiazolidinediones (glitazones)
DPP-4 inhibitors (gliptins)

Answer 10

Biguanide: Metformin
Sulphonylureas: Glicazide
Thiazolidinediones (glitazones): Pioglitazone
DPP-4 inhibitors (gliptins): Sitagliptin

Question 11

Name an example for each of the following drugs for T2DM management:
SGLT2 inhibitors (gliflozins)
Meglitinides
Insulin
GLP-1 agonists (incretin mimetics)

Answer 11

SGLT2 inhibitors (gliflozins): Dapagliflozin
Meglitinides/ Acarbose
Insulin: SC injection
GLP-1 agonists (incretin mimetics): Exenatide

Question 12

What is the commonest Gram negative pathogen in community acquired urinary tract infection?
Antibiotic used?

Answer 12

E. coli

Antibiotic used: Ciprofloxacin (Cipro) and trimethoprim-sulfamethoxazole (Bactrim)

Question 13

Symptoms of diabetes

Answer 13

VS -cardiac symptoms, intermittent claudication, autonomic postural hypotension 
GI -diarrhoea, constipation, fungal inf.
GUS -urinary retention, impotence 
NS -lower extremity pain, numbness
Eyes -Visual problems
General -Infections

Question 14

With may you see on inspection of a diabetics legs?

Answer 14

Inspection of legs and feet
•Colour: pallor, cyanosis, redness
•Skin: hair loss, dry, eczema, atrophic shiny skin, pustules, abscesses, infections, including fungal infections nails and between toes
•Ulcers: legs, between toes and pressure points. Necrotic and missing toes.
•Deformity: neuropathic joints (Charcot joints due to loss of proprioception)
•Calluses: pressure from incorrectly fitting shoes

Question 15

What are the 4 classifications of diabetic retinopathy?

Answer 15

Background
Pre-proliferative
Proliferative
Macular Oedema

Question 16

Clinical features seen on ophthalmoscopy of background diabetic retinoapthy

Answer 16

Microaneurysms
Hard exudates
Retinal oedema
Haemorrhages