Diabetes

Question 1

Diabetes

Answer 1

high glucose levels due to insufficient insulin

Question 2

where is insulin produced

Answer 2

beta islet of langerhan cells in the pancreas

Question 3

types

Answer 3

Type 1 and type 2

Question 4

Type 1 pathology

Answer 4

B cells islet of langerhan are destroyed so not producing insulin

Question 5

Type 2 pathology

Answer 5

Insulin being produce but because of build up of adipose tissue or excess FA in blood, insulin isn’t sensitive

Question 6

causes of type 2

Answer 6

obesity

bad diet

Question 7

signs of type 1

Answer 7

polyuria
polydyspepsia 
wetting bed
increased thirst
weight loss
not thriving

Question 8

signs of type 2

Answer 8

polyuria
polydipsia
obesity

Question 9

investigation

Answer 9

random glucose test - >11
fasting glucose test - >6.9
HbA1c - >48
OGTT - >11

Question 10

criteria for the investigations

Answer 10

symptomatic + 1 test

asymptomatic + 2 tests

Question 11

management type 1

Answer 11

give insulin

can have it as a pump, injection

Question 12

types of insulin given

Answer 12

long-acting and short acting

Question 13

management type 2

Answer 13

lifestyle factors and education
metformin
sulfalazine
thiazolidime 
DPP-4
3GLT-2
GLP-1

insulin

Question 14

cautions and side effects of type 2 medications

Answer 14

metform - GI disturbance, stop if eGFR<30
Sulfonylureas - hypoglycaemic, weight gain (caution in elderly)
thazolidinediones - avoid in ostoeoporosis (post menopausal women), avoid in bladder cancer, heart failure, weight gain
SGLT-2 inhibitors - uro/genital infections, weight loss
DDP4 - reduce dose in renal and stop in acute pancreatitis, weight loss

Question 15

complications of diabetes

Answer 15

increase CVS risk
diabetic foot ulcers
retinopathy
neuropathy 
nephropathy
DKA
hypoglycaemic

Question 16

DKA

Answer 16

uncontrolled lipolysis resulting excess FA and ketones

causes:
infection
missed insulin dose
MI

signs:
abdo pain
vomiting
weak
fruity breath
deep breathing
(fever if infection)

investigations:
urinalysis 
pH <7.3
CAP blood - >11 (+ diabetes) or >13
CAP ketones - >3

management:
IV fluids
fixed rate insulin AFTER commencing fluid
stop short acting insulin, continue long acting
blood glucose <15mmol/l - start 5% dextrose
correct electrolyte imbalance

complication:
children - cerebral oedema

Question 17

hypoglycaemic state

Answer 17

low glucose levels

causes:
diabetes medications
adrenal insufficiency
alcohol

signs:
tremor
sweating
irritable
drowsy
nausea 

investigation:
blood glucose

management:
if there is IV access, give IV
short acting insulin - lucozade/IV insulin
long acting insulin - biscuits, toast

severe:
IM glucagon

monitor serum osmolality for clinical improvement

Question 18

what can you check to differentiate between type 1 and type 2

Answer 18

C-peptide

anti-glutamic acid decarboxylase

Question 19

what BP is aimed in diabetics

Answer 19

140/90

Question 20

what organisms causes diabetic foot ulcers

Answer 20

staph aureus

pseudomonas aeruginosa

Question 21

when should a statin be offered for type 1 diabetics

Answer 21

over 40 yrs old
have had had diabetes for >10yrs
CVD risk
presence of nephropathy

Question 22

what does it mean to have an impaired glucose tolerance

Answer 22

fasting glucoses levels between 6.1 and 7

Question 23

how my hypoglycaemic events does it take for px to surrender driving licence and in what time frame

Answer 23

at least 2 events in 12 months

Question 24

what does an unrecordable glucose reading mean

Answer 24

high levels

Question 25

how often does a patient need to monitor diabetes during the day

Answer 25

at least 4 times a day

including before each meal before bed