Diabetes

Question 1

what is diabetes

Answer 1

Type 2 diabetes mellitus is a metabolic disorder in which persistent hyperglycaemia is caused by a combo of reduced insulin secretion and decreased insulin sensitivity

Question 2

how is the diagnosis of diabetes made

Answer 2

made by:

• HbA1c > or = 6.5%
• fasting glucose of >7mmol/L or random glucose of >11.1mmol/L on 2 seperate occasions
• fasting glucose of >7mmol/L or random glucose of >11.1mmol/L on one occasion PLUS symptoms of hyperglycaemia

Question 3

what clinical features can you present with on suspected diabetes

Answer 3

polydipsia, polyuria, blurred vision, unexplained weight loss, recurrent infections, and tiredness
acanthosis nigricans

Question 4

what are the microvascular complications of diabetes

Answer 4

• retinopathy
• nephropathy
• neuropathy

can = diabetic foot disease

Question 5

what are the macrovascular complications of diabetes

Answer 5

Atherosclerotic cardiovascular disease: Coronary heart disease, cardiomyopathy, arrhythmias and sudden death, cerebrovascular disease and peripheral artery disease

Question 6

what screening and monitoring is done for diabetes complications

Answer 6

• Ensure all people with type 2 diabetes have their cardiovascular risk factors assessed at least annually
• Assess for symptoms or signs suggesting autonomic neuropathy​
• Screen for symptoms of peripheral neuropathy
• To assess for diabetic kidney disease: albumin creatinine ratio adn eGFR
• Diabetic eye screening

Question 7

what is the HbA1c target for an adult with diabetes?

Answer 7

<48mmol/L HbA1c

Question 8

what is desmond and dafne

Answer 8

Dose Adjustment for Normal Eating - DAFNE
skills-based education programme in which adults with type 1 diabetes learn how to adjust insulin to suit their free choice of food

Diabetes Education and Self-Management for Ongoing and Newly Diagnosed - DESMOND
structured group education programme for adults with type 2 diabetes. supports people in identifying their own health risks and responding to them by setting their own specific behavioural goals

Question 9

what is the role of metformin

Answer 9

metformin = first line treatment for TIIDM
it icnreases insulin sensitivty and decrease heptic glucose production
it can can GI Upset

Question 10

what are other hypoglycaemic options for type II diabetic control?

Answer 10

• sulfonylurea - glicazide
• glitazones - pioglitazone
• SGLT2 inhibitors - dapagliflozin
• DPP4 inhibtors - sitagliptin
• GLP1 agonists - exenatide