Diabetes

Question 1

what tests indicate diabetres

Answer 1

fasting glucose >7
OGTT/random >11.1
HbA1c >6.5% / >48mol/mol

Question 2

what defines impaired glucose tolerance

Answer 2

random glucose = 7.8 - 11.1

Question 3

what defines impaired fasting glucose

Answer 3

fasting glucose = 6.1 - 7

Question 4

how is osmolality calculated

Answer 4

2 (Na + K) + Urea + Glucose

Question 5

what is the normal ranges for osmolality

Answer 5

275-295 mOsmol/Kg

Question 6

how is the osmolar gap calculated and what is normal

Answer 6

measured osmolality (frozen plasma) - calculated osmo (non frozen)

Normal= <10mM

Question 7

how is the anion gap calculated

Answer 7

Na + K - cl - Bicarb

Question 8

what is a normal anion gap

Answer 8

~18

Question 9

what does a high anion gap suggest

Answer 9

extra ketones, methanol, lactate, metformin

Question 10

what is the treatment ladder for T2DM

Answer 10

1 = metformin
2 = M + sulphonylureas/thiazolidanides/gliptins
3 = triple therapy 
4 = metformin + sulphonylurea + GLP1 analogue

Question 11

give some exaples of drugs used in diabetes dual therapy

Answer 11

sulphonylureas - gibeclamide
thiazolidanides - pioglitazone
gliptins - DPP4 inhib

Question 12

what is needed for a diagnosis of DKA

Answer 12

diabetes +
ketones >3 +
acidosis (Ph <7.3)

Question 13

what is the management of DKA

Answer 13

fluids + insulin (0.1u/kg/hr) + 10% dextrose (when BM <15)

Question 14

what is needed for a diagnosis of HHS (Hyperosmolar Hyperglycaemic State)

Answer 14

Ph >7.3
osmolarity > 320
BM > 30
no ketones

Question 15

management of HHS

Answer 15

fluids (3-6L in 12hr)
monitoring (to avoid rapid correction in Na)
insulin when BM starts to drop