Clinical aspects of Diabetes Mellitus and Complications

Question 1

what are the different ways you can diagnose diabetes

Answer 1

 Glycated Haemoglobin≥48mmol/mol

 Fasting blood glucose≥7.0mmol/L

 2hr blood glucose≥11.1mmol/L following OGTT

 Random blood glucose≥11.1mmol/L in presence of symptoms

Question 2

type 1 diabetes is a result of

Answer 2

ß cell destruction

 Symptoms when 80%  cell mass lost
 Environmental factors e.g viral infection

Question 3

type 2 diabetes is a result of

Answer 3

 Insulin resistance with relative insulin deficiency

 Secretory defect with insulin resistance

Question 4

the pathophysiology of type 1

Answer 4

autoantibodies:

 islet cell
 Insulin
 GAD (GAD65)
 tyrosine phosphatases

Strong HLA associations
 linkage to the DQA and DQB genes  influenced by the DRB genes.

Question 5

genetic factors of type 2 diabetes

Answer 5

 defect of beta cell

 insulin resistance

Question 6

environmental factors of diabetes

Answer 6

• obesity
• stress
• reduced physical activity

Question 7

Classical presentation of Type 2 DM

Answer 7

 Thirst, polyuria
 Malaise, fatigue
 Infections e.g. Candidiasis
 Blurred vision
 Complications
 Incidental finding

Question 8

acute complications of diabetes

Answer 8

 Diabetic Ketoacidosis
 Hypoglycaemia
 Other emergencies

Question 9

chronic complications of diabetes

Answer 9

 Microvascular
 Eyes, Kidneys, Nerves (Feet)  Macrovascular
 Heart, Brain, (Feet)

Question 10

Acidosis

Answer 10

• kussmaul respiration
• acetone on breath
• abdominal pain
• vomiting

Question 11

Hyperglycaemia

Answer 11

• dehydration
• tachycardia
• hypotension
• clouding of consciousness

Question 12

Neuroglycopaenic symptoms of hypoglycaemia

Answer 12

 dizziness 
 confusion 
 sleepiness 
 coma
 seizure

LACK OF GLUCOSE TO BRAIN

Question 13

Adrenergic symptoms of hypoglycaemia

Answer 13

 tachycardia 
 palpitations 
 sweating
 tremor
 hunger

fight or flight

Question 14

what is the blood glucose of someone who is hypoglycaemic

Answer 14

Blood glucose <=2.2mmoll-1

4 IS THE FLOOR

Question 15

HyperOsmolar Non-Ketotic coma (HONK)

Answer 15

 Elderly patients
 Often undiagnosed
 Intercurrent stress
- MI
- Chest Infection etc

Question 16

Metformin Associated Lactic Acidosis (MALA)

Answer 16

Renal impairment

Question 17

Stages of nephropathy

Answer 17

 Hyperfiltration
 Normal
 Microalbuminuria
 Overt Nephropathy 
 Chronic Renal Failure

Question 18

Management of nephropathy

Answer 18

 Screening
- Albustix
- Microalbuminuria 
- Creatinine
 Blood pressure
- Aggressive treatment ACEI/AIIRA 
- 130/80 or lower
 Hyperlipidaemia 
- Statin
 Good glycaemic control
 Diet