Diabetes

Question 1

Complications (classify and list)

Answer 1

Macro vascular

• coronary arteries
• peripheral
• stroke

Micro vascular

• diabetic retinopathy
• nephropathy
• neuropathy (impotence and diabetic foot)

Question 2

Clinic picture/presentation

Answer 2

Polyuria
Polydipsia 
Polyphagia 
Nocturnal enuresis
Weakness and Fatigue
DKA

T2:
Obesity
Acanthosis nigricans
Other co-morbidities: HPT 
Asym
Blurred vision/ esablished retinopathy 
Candidal vulvovangitis or balantitis 
Peripheral neuropathy 
Hyperosmolar hyperglycaemic state

Question 3

Diabetic Retinopathy

Answer 3

Hard and soft exudates (cotton wool spots )
Haemorrhages
Abnormal growth of blood vessels

Question 4

Diagnosis

Answer 4

Symptoms 
Fasting plasma > 7
Random plasma> 11.1 
Oral glucose tolerance test -75g of glucose, assess after 2 hours, >11.1 
Glycolated haemoglobin >6.5

Question 5

Aim of Tx

Answer 5

Educate 
Diet 
Exercise 
Screen for TOD
Pharmacotherapy

Question 6

Diet

Answer 6

Fruits and Vegetable
Starch foods must be wholegrain:
Oats, brown rice, wholegrain bread, unrefined maize
Fish (fatty fish with high omega 3)
Legumes(beans, lentils, chick peas)
Low fat milk and yoghurt
Vegetable fats( nuts, avocado, olives, sunflower)
Decrease processed meats and fatty red meat
Decrease sugar
Alcohol

Question 7

TOD

Screen when?

Answer 7

Retinopathy: ophthalmoscopy
Nephropathy: 
urine sample: annual: albumin-crest ratio ( if elevated reassess in 3 months)
Creat and eGFR (<60 means CKD)
Peripheral neuropathy:
Inspect feet and shoes
Ulcers, corns, calluses, infections
Pulses
Loss of sensation (monofilament)

Question 8

Tissue necrosis

Answer 8

Neuropathy
Infection
Ischaemia

Question 9

Investigations

Answer 9

Baseline: 
Vitals
1.  HGT 
Weight 
Dipstick

2. Foot
Eye
Waist circumference 
Lipogram
Hba1c 
Creat and EGFR

Every visit: 1
Annually: 1 and 2

Question 10

Targets:

Answer 10

Hba1c: 6.5%

7%

7-8.5%
Elderly 
Multiple co-morb
Limited life expectancy 
CKD 

If well controlled: every 6 months
If not: every 3 months

Question 11

Mom-glycaemic targets

Answer 11

BP: 140/90

BMI: 25kh/m

Prevent complications

Ensure co-morbidities

Question 12

Pharmacotherapy of T1

Answer 12

Basal and bolus regimen
0.6 units X weight (Kg) = total daily insulin
Bolus (mane 30min before breakfast)
Basal (Nocte no later than 10pm/30 mom before supper)

Question 13

Pharmacotherapy of T2

Answer 13

Metformin
Initiating dose: 500mg daily
Max:850g Three times a day

MOA: decreases hepatic glucose production

Sid: GIT - nause, diarrhoea, bloating

Benefits: affordable, doesn’t cause sever hypoglycaemia, HBA1C drops by 1.5%
Modest weight loss

CI: kidney disease (GFR less than 30)

Question 14

Second agent in T2DM

Answer 14

Sulphonyureas

Glicazide
Glimiperide
Glibenclamide

Question 15

Third agent

Answer 15

Incretin

Basal insulin

Question 16

Gold standard

Answer 16

Glicazide

Initial: 30 mg daily
Titration at 2-4intervals
Maintain: 60-120mg

Disadvantage: hypoglycaemia and weight gain r

Glimepiride
Start 1mg daily
Max 4mg daily

Question 17

CVS Targets

Answer 17

Stop smoking

BP 140/90

Total cholesterol <5
LDL< 3
Trigs< 2

Waist in males 94cm
Waist in females 70cm

Aspirin
Simvastatin