Diabetes

Question 1

What is the criteria for DKA?

Answer 1

• ketonemia or significant ketonuria
• Blood glucose more than 11.1 or known diabetes
• bicarb less than 15 or venous pH less than 7.3

Question 2

What is the managment of DKA?

Answer 2

• 0/9% NaCl IV (1l over 1hr or if systolic <90 then 500ml bolus over 15 mins
• fixed rate intravenous insulin infusion (continue patients long acting insulin but stop their short acting)

Question 3

What is HHS?

Answer 3

complication of diabetes mellitus in which high blood sugar results in high osmolarity
without significant ketoacidosis.

Question 4

how does HHS present?

Answer 4

High glucose + high osmolarity (>320)

No elevated ketones

Question 5

How do you manage HHS?

Answer 5

• 0.9% NaCl Iv slow infusion over 24hrs
• LMWH prophylaxis
• only give insulin if glucose not decreasing by 5ml/L/hr

Question 6

What is the cut off for diagnosis of diabetes if symptomatic patient ?

Answer 6

• random glucose >11.1
• fasting glucose >7
• HBA1c >48

Question 7

What is the cut off for diagnosis of diabetes if asymptomatic patient?

Answer 7

• random glucose >11.1
• fasting glucose >7
• HBA1c >48

demonstrated on 2 occasions

Question 8

What is the criteria for diagnosis for gestational diabetes?

Answer 8

• random glucose >7.8 mmol

- fasting glucose >5.6mmol

Question 9

What is the management of gestational diabetes?

Answer 9

If fasting glucose less than 7 then trial diet and exercise. If after 2 weeks targets still not met then try metformin and after that its insulin

Question 10

What is the treatment for cranial diabetes insipidus

Answer 10

desmopressin

Question 11

What is the treatment for nephrogenic diabetes insipidus

Answer 11

thiazide like diuretic

Question 12

what is the reccomended treatment order for T2DM

Answer 12

1. metformin
2. Metformin + one of: (sulfonylurea, DPP4, pioglitazone, SGLT2)
3. metformin + two of: (sulfonylurea, DPP4, pioglitazone, SGLT2)
4. Metformin = three of: (sulfonylurea, DPP4, pioglitazone, SGLT2). Consider using GLP1 mimetic if BMI >35
5. Insulin

Question 13

what is a side effect of DPP4 inhibitors?

Answer 13

pancreatitis

Question 14

what are side effects/contraindications of TZDs (pioglitazone)?

Answer 14

weight gain, fluid retention (so do not use in Heart failure), increased fracture risk

do not use if history of bladder cancer

Question 15

what are side effects of sulfonylureas?

Answer 15

weight gain, hypos

Question 16

what is a side effect of GLP1 mimetics?

Answer 16

weight loss