Diabetes

Question 1

Associated antibodies for T1DM

Answer 1

Insulin autoantibody (IAA)
Insulinoma-associated protein 2 antibody (IA-2)
Zinc transporter 8 antibody (ZnT8)
Glutamic acid decarboxylase antibody (GADA)

Question 2

Dietary recommendations for T1DM & T2DM

Answer 2

Protein 10-20% kJ/day
Saturated fat < 10% kJ/day
Polyunsaturated fat 10% kJ/day
Carbohydrate (50-55%) and monounsaturated fats for the rest
Artificial sweeteners as required
Fibre 30g/day
Minimise cholesterol intake (<300 mg/day)

Question 3

Risk factors for T2DM

Answer 3

Family history (first degree relative)
Age >45
Overweight (BMI >27)
Race (Aboriginal- at risk with BMI >22; Maori; Pacific Islander)
Previous abnormal fasting glucose (6.1 x 7.0)
Gestational diabetes 
HTN
Polycystic ovaries

Question 4

What to do if BSL targets are not met after drug treatment

Answer 4

1. Make sure patient understands the point of treatment
2. Look again at diet, weight & exercise program
3. Ask about adherence; begin with side-effects & then ask whether the patient has been able to take the medication
4. Exclude infection and new medications that would interfere with sugars e.g. steroids

Question 5

How can the rate of progression to ESKD be modified?

Answer 5

1. Control of HTN
2. Treatment of UTIs
3. Dietary protein restriction
4. Possibly improving glucose control

Question 6

Complications of poor BSL control in pregnant women on the infant

Answer 6

Congenital malformations eg. Spina bifida
Macrosomia
Intrauterine foetal death in the later stages of pregnancy
Hypoglycaemia after delivery
Complications related to immaturity

Question 7

Causes of glucose intolerance

Answer 7

1. Diabetes Mellitus
2. Counter regulatory hormone excess (rare):
   - Acromegaly
   - Cushing’s syndrome
   - Phaeochromocytoma
   - Glucagonoma
3. Pregnancy
4. Drugs
   - steroids or oral contraceptives
   - streptozotocin
   - calcineurin inhibitors (tacrolimus and ciclosporin)
   - thiazide diuretics (secondary to hypokalemia)
   - olanzapine
   - phenytoin, diazoxide (insulin secretion inhibited)
5. Pancreatic disease
   - Chronic pancreatitis or carcinoma
   - Haemochromatosis
6. Chronic liver disease (insulin resistance)
7. Syndromes
   - Lipoatrophic diabetes
   - Type A / Type B syndrome
8. Inherited
   - monogenic diabetes (MODY)
   - diabetes insipidus, diabetes mellitus, optic atrophy & deafness (DMOAD)

Question 8

Complications of prolonged steroid use

Answer 8

Cushingoid appearance, moon face, buffalo hump, central obesity
Skin changes including striae, bruises & healing issues
Bone changes including osteoporosis & avascular necrosis
Proximal myopathy
Immune status & infectious episodes
Diabetes
Hypertension
Opthamological - cataracts / aggravation of glaucoma
Mood, sleep disturbance
Dyslipidaemia