Diabetes

Question 1

Name four types of diabetes

Answer 1

Monogenic, steroid-induced, cystic fibrosis-related, syndrome-related, gestational diabetes

Question 2

Name two autoantibodies involved in type 1 diabetes

Answer 2

GAD65, islet cell, insulin, IA2A

Question 3

List the three mechanisms of type 1 diabetes development?

Answer 3

1 autoimmunity
2 genetics
3 environmental

Question 4

Name a gene that increases risk of T1D

Answer 4

DR3/DR4

Question 5

Name two ketones

Answer 5

beta hydroxybutyrate and acetoacetate

Question 6

State three osmotic symptoms of T1D in children

Answer 6

thirst
polydipsia
polyuria
nocturia
nocturnal enuresis (bed wetting)

Question 7

List three other symptoms of T1D in children aside from osmotic symptoms

Answer 7

weight loss
lethargy
behaviour change
infection (balantis, candidiasis)

Question 8

What is ‘walking wounded’ in relation to diabetes?

Answer 8

initial presentation of T1D without DKA and minimal/absent dehydration

Question 9

State two symptoms in DKA associated with cerebral oedema

Answer 9

headache
irritability
condusion
unrousable

Question 10

State two symptoms in DKA that are not associated with cerebral oedema

Answer 10

ketotic breath
laboured breathing
N/V
abdo pain

Question 11

List three signs of DKA on examination

Answer 11

sunken eyes
skin turgor reduced
CRT >2 sec
cool peripheries
tachy
hypotension
abdo tenderness

Question 12

Four differentials for diabetes presentation

Answer 12

MODY
Exocrine pancreatic disease
Steroid-induced
Syndromal

Question 13

Name one syndromal cause of diabetes

Answer 13

Down’s, Prader Willi

Question 14

Name two examples of exocrine pancreatic causes of diabetes

Answer 14

cystic fibrosis, haemochromatosis

Question 15

What happens to sodium in diabetes/hyperglycaemia?

Answer 15

pseudohyponatraemia

Question 16

List two abnormal findings on U+E’s in diabetic patient

Answer 16

Hyperkalaemia
Hyponatraemia
Hyperureaemia (dehydration)

Question 17

List investigations for complications of long term high HbA1c

Answer 17

1 Urinalysis- microalbuminaemia
2 Autoantibodies
3 TPO- hypothyroidism 
4 Adrenal antibody- adrenal insufficiency
5 EMA and tTG- coeliac disease
6 Thyroid function
7 Synacthen test- adrenal insufficiency

Question 18

List three regimens for insulin

Answer 18

Twice daily (before breakfast and evening meal)
Split evening- mix at breakfast, rapid before tea, long acting before bed (no need to top up whilst at school)
Basal bolus- Rapid acting before meals, long acting before tea or bed
Correction dose (if BM too high)

Question 19

What is the target range for blood glucose in diabetics?

Answer 19

4 to 8 mmol/L

Question 20

When is ketosis likely to occur?

Answer 20

> 14 mmol/L

Question 21

List three complications of DKA

Answer 21

cerebral oedema
electrolyte abnormalities
dysrhythmias
renal failure

Question 22

List two autonomic symptoms of hypoglycaemia

Answer 22

pallor, sweating, nausea, tachy

Question 23

List neuroglycopenia symptoms of hypoglycaemia

Answer 23

slurred speech, seizure, coma, death

Question 24

What is the management of T1D when ill?

Answer 24

maintain CHO and fluid intake
BG and ketone testing frequently
NEVER STOP INSULIN