Clinical Aspect of Diabetes Mellitus

Question 1

What is the pathophysiology of type 1 diabetes mellitus

Answer 1

• Autoimmune disease with beta cell destruction.
• Autoantibodies against cells
• Strong HLA associations

Question 2

What are the factors that influence the development of type 2 diabetes

Answer 2

Genetic factors - Defect in beta cells and/or insulin resistance.
Environmental factors - Obesity, stress and reduced physical activity

Question 3

What is the classical presentation of type two diabetes mellitus?

Answer 3

• Thirst and polyuria,
• Malaise and fatigue,
• Infections (candidiasis),
• Blurred vision,
• Complications,
• Incidental findings

Question 4

Name examples of diabetes drugs

Answer 4

• Sulphonylureas, eg, gliclazide,
• Biguanides eg, metformin,
• Alpha glucoside inhibitors,
• Thiazolidinedione’s, eg, pioglitazone.
• GLP 1 Agonists eg, exenatide,
• SGLT2 inhibitors,
• Insulin

Question 5

Name some examples of acute and chronic complications of diabetes mellitus

Answer 5

Acute - Diabetic ketoacidosis, hypoglycaemia and other emergencies.
Chronic - Microvascular (eyes, kidney, nerves) and macrovascular (heart and brain)

Question 6

What are the clinical features of DKA

Answer 6

Hyperglycaemia - Dehydration, tachycardia, hypotension and clouding of consciousness.
Acidosis - Kussmaul’s respiration, acetone on breath, abdominal pain and vomiting

Question 7

Describe the development of diabetic ketoacidosis

Answer 7

Insulin deficiency leads to hyperglycaemia, glycosuria and osmotic diuresis. And ketosis, acidosis and gastroparesis.
This leads to volume repletion and renal hypoperfusion which leads to impaired excretion of H+ and ketone bodies.

Question 8

How can you treat diabetic ketoacidosis?

Answer 8

• Treat hyperglycaemia with insulin IV 6 units per hour.
• Treat dehydration with saline IV and then 5% dextrose.
• Carefully monitor potassium levels and replace as required

Question 9

What are the symptoms of hypoglycaemia?

Answer 9

Adrenergic symptoms - Tachycardia, palpitations, sweating, tremor and hunger. Can cause symptoms of flight or fight.
Neuroglycopenic - Dizziness, confusion, sleepiness, coma and seziures due to lack of glucose to brain

Question 10

What is the formal definition of hypoglycaemia

Answer 10

Blood glucose below 2.2mM however 4 IS THE FLOOR for diabetic patients

Question 11

What is the treatment of hypoglycaemia

Answer 11

• Glucogel,

- IV 50% dextrose

Question 12

What are some other diabetic emergencies?

Answer 12

• Hyperosmolar non-ketotic coma which can

- Metformin associated lactic acidosis

Question 13

What are the stages of nephropathy?

Answer 13

• Hyperfiltration,
• Normal,
• Microalbuminuria,
• Overt Nephropathy,
• Chronic renal failure

Question 14

What is the management of nephropathy

Answer 14

• Ensure blood pressure is 130/80 or lower. Use ACE/ARBs.
• Treat hyperlipidaemia with statins,
• Ensure good glycaemic control
• Ensure good diet