Diabetes

Question 1

How does T1DM typically present?

Answer 1

1+ of the following:

Rapid weight loss
DKA
Hx of autoimmune disease - personal or fh
Bmi <25
Age <50

Question 2

When is c-peptide measuring indicated in diabetes?

Answer 2

When diagnostic uncertainty between T1DM and monogenic forms of DM
Eg MODY and LADA

Or atypical oresentation of T1dm

Question 3

What is c-peptide

Answer 3

Cleavage product if pro insulin

Gives an indication if insulin is being formed in oancreatic b cells.

Longer half life than insulin

Question 4

When would you measure autoantibodies in diabetes?

Answer 4

They are usually positive in LADA - latent autoimmune diabtes in adults

Question 5

Diagnosis for T1Dm adults?

Answer 5

Usually just clinical diagnosis

Can do as in kids:
Plasma glucose fasting/random/ogtt : see ludley notes

2. Ketones; +ve plasma/urinary

glutamic acid decarboxylase, insulin, islet cells, islet antigens (IA2 and IA2-beta), and the zinc transporter ZnT8 -> these are not alwyas tested for.

Question 6

How does MODY present?

Answer 6

Epidemiology 1-2%
Presents so young as is genetic
FH DM

Like type 1 or 2 depending on type

Question 7

What are the ivx for MODY?

Answer 7

Same work up

There will be no autoantibodies

High HDL - good cholesterol

Genetic testing!

Question 8

side effects of Sulphonylureas?

Answer 8

sulphonylureas (gliclazide, glibenclamide) – SEs: weight gain, hypoglycaemia

Question 9

How does LADA present?

Answer 9

Age 30 above
Similar to t2dm but really is a type of t1dm

Positive for at least 1 of 4 autoantibodies found in t1dm

Question 10

which diabetes drugs can cause bladder cancer, osteoporosis (# risk) and is contraindicated in bladder cancer?

Answer 10

Thiazolidinedione eg Pioglitazone

Question 11

criteria for HHS / HONK?

Answer 11

1. profound hyperglycaemia (glucose >30 mmol/L [>540 mg/dL]),
2. hyperosmolality (effective serum osmolality >320 mOsm/kg [>320 mmol/kg]), and
3. volume depletion in the absence of significant ketoacidosis (pH >7.3 and bicarbonate >15 mmol/L

Question 12

complications of HHS?

Answer 12

Of treatment;
Quick correction of Hyponatraemia - cerebral oedema and central pontine myelinolysis (look for a deteriorating conscious level) as well as fluid overload.

Question 13

when might continuous glucose monitoring be indicated?

Answer 13

Gastroparesis; CGM +- sc insulin pump

Erratic BMs despite initial therapy in T1DM and insulin dependent T2DM

Question 14

how do we monitor for Diabetic nephropathy?

Answer 14

yearly ACR

• Microalbuminuria is the first sign of diabetic nephropathy

Question 15

how is Diabetic nephropathy mx?

Answer 15

ACEi is protective in diabetic nephropathy and CKD, but toxic in AKI

started if ACR >3.0mg/mmol

• Monitor eGFR
• If there is a drop >20%, stop the ACEi

Question 16

Define Diabetic nephropathy?

how does it present?

Answer 16

Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (>10 years) with albuminuria and/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage.

presentation; much like CKD

Question 17

complications of diabetic neprhopathy?

Answer 17

End stage renal disease

hyperkalaemia

All sx as in patients with CKD;
secondary hyperparathyroidism due to hyperphosphataemia and vitamin D deficiency

Question 18

microvascular complications of DM?

Answer 18

Retinopathy
Neuropathy -> Charcot foot, peripheral neuropathy
Nephropathy

Question 19

MACROvascular complications of DM?

Answer 19

Cerebrovascular disease - strokes

Cardiovascular disease - MIs

Peripheral vascular disease -> diabetic foot

Question 20

how does diabetic foot present?

Answer 20

Loss of foot sensation

Foot pain

Foot ulcer !

Foot deformity

then can progress

Question 21

complications of diabetic ffoot?

Answer 21

Infection of ulcer;
Osteomyelitis
Charcot arthropathy - see CMT cards Neuro
Gangrene
Amputation

Question 22

complications of diabetic retinopathy?

Answer 22

Cataracts

Glaucoma

Iatrogenic (pan retinal photocoagulation);

• Macular oedema
• visual field loss