Diabetes

Question 1

Type 1 diabetes is

Answer 1

absolute insulin deficiency in which little or no endogenous insulin secretory capacity due to destruction of insulin-producing beta-cells in pancreatic islets of Langerhans. Has auto-immune basis in most cases, & occur at any age, but most commonly before adulthood.

Loss of insulin secretion = hyperglycaemia & metabolic abnormalities. If poorly managed; retinopathy, nephropathy, neuropathy, premature CVD, & peripheral arterial disease

Question 2

Typical features in adult patients presenting with type 1 diabetes are

Answer 2

Hyperglycaemia (random BG >11 mmol/L)
Ketosis
Rapid weight loss, BMI <25 kg/m2
Age younger than 50 years, FHX of autoimmune disease (though not all features may be present).

Question 3

HBA1c target for Type 1 DM

Answer 3

48 mmol/mol (6.5%) or lower

Question 4

BG concentration aims for patient of Type 1 DM
1) waking
2) before meals
3) 90mins after meals
4) driving

Answer 4

1) fasting BG: 5–7 mmol/L on waking;
2) BG : 4–7 mmol/L before meals at other times of day;
3) BG: 5–9 mmol/L at least 90 minutes after eating;
4) BG: at least 5 mmol/L when driving

Question 5

Type 1 diabetic monitor BG at least

Answer 5

x4 a day

Question 6

Multiple daily injection basal-bolus insulin regimens

Answer 6

1 or more separate daily injections of intermediate-acting insulin or long-acting insulin analogue as the basal insulin; PLUS multiple bolus injections of short-acting insulin before meals

Question 7

Mixed (biphasic) regimen

Answer 7

1, 2, or 3 insulin injections per day of short-acting insulin mixed with intermediate-acting insulin. ~ insulin preparations may be mixed by patient at time of injection, or premixed can be used.

Question 8

Continuous subcutaneous insulin infusion (insulin pump)

Answer 8

Regular / continuous amount of insulin (usually in form of a rapid-acting insulin analogue or soluble insulin), delivered by programmable pump and insulin storage reservoir via subcutaneous needle or cannula.

Question 9

Recommended insulin regimen for Type 1 diabetics

Answer 9

1st choice = multiple daily injection basal-bolus insulin regimens

Question 10

What is insulin recommended basal-bolus insulin regimens for type 1 ?

Answer 10

BD ~ Insulin detemir (long-acting) unless already meeting agreed treatment goals on another insulin regimen.
OD~ Insulin glargine (100 units/ml)OD ~ if insulin detemir not tolerated, or if BD regimen not acceptable.
OD ~ Insulin degludec is alternative if concern about nocturnal hypoglycaemia.
OD ~ ultra-long acting insulin (insulin degludec, or insulin glargine 300 units/ml) as alternative in who need help with injection administration from carer or HCP

Question 11

Is non-basal-bolus insulin regimens recommended for newly diagnosed type 1 diabetes ?

Answer 11

Non-basal-bolus insulin regimens (e.g. twice-daily mixed [biphasic], basal-only, or bolus-only regimens) NOT recommended in newly diagnosed type 1 diabetes.

Question 12

Offer continuous subcutaneous insulin infusion (insulin pump) therapy to ,…

Answer 12

disabling hypoglycaemia or high HbA1c levels (69 mmol/mol [8.5%] or above) with multiple daily injection therapy

Question 13

Persistent poor glucose control, leading to erratic insulin requirements or episodes of hypoglycaemia, may be due to

Answer 13

adherence, injection technique, injection site problems, BG monitoring skills, lifestyle issues (diet, exercise & alcohol), psychological issues, organic causes i.e. renal disease, thyroid disorders, coeliac disease, Addison’s disease or gastroparesis.

Question 14

INCREASE insulin requirements due to

Answer 14

Infection, stress, accidental or surgical trauma

Question 15

DECREASE insulin requirements due to

Answer 15

more risk of HYPO
~ physical activity, intercurrent illness, reduced food intake, impaired renal function, & in certain endocrine disorders.

Question 16

Impaired awareness of hypoglycaemia

Answer 16

ability to recognise usual symptoms lost, or when symptoms blunted or no longer present.

Question 17

Patients’ awareness of hypoglycaemia should be assessed

Answer 17

Annually using Gold score or the Clarke score.

Question 18

what class of drug can impair hypoglycaemia symptoms

Answer 18

Beta blockers !!! by reducing warning signs such as tremor.

Question 19

Diabetes mellitus is

Answer 19

group of metabolic disorders in which persistent hyperglycaemia caused by deficient insulin secretion or by resistance to the action of insulin. = leads to abnormalities of carbohydrate, fat and protein metabolism

Question 20

Types of diabetes

Answer 20

Type 1
Type 2
Gestational diabetes
Secondary diabetes (caused by pancreatic damage, hepatic cirrhosis, or endocrine disease OR endocrine, antiviral, or antipsychotic tx)

Question 21

DVLA advice for diabetes

Answer 21

~ if using insulin should always carry BG meter + test strips alwats
~ Check BG no more than 2 hours before driving & every 2 hours while driving.
~ BG should be at least 5 mmol/L while driving
~ if treated with insulin always have fast-acting carbohydrate with you.
~ If BG <4 mmol/L, or warning signs of hypoglycaemia develop, = NOT drive or stop vehicle, wait until 45 minutes after BG returned to normal (at least 5 mmol/L), before continuing their journey.

Question 22

Notification to DVLA and monitoring of blood-glucose concentrations may also be necessary for some drivers taking like

Answer 22

oral antidiabetic drugs, particularly those which carry risk of hypoglycaemia (e.g. sulfonylureas, meglitinides).

Question 23

Alcohol and diabetes

Answer 23

make signs of hypoglycaemia less clear, & cause delayed hypoglycaemia; drink less or with food

Question 24

oral glucose tolerance test

Answer 24

measuring BG after fasting, and then 2 hours after drinking standard anhydrous glucose drink
~ for diagnosis of impaired glucose tolerance ONLY !!
~ can be also to test for gestational diabetes.

Question 25

HbA1c test is a

Answer 25

HbA1c forms when RBC exposed to glucose in plasma.
~ HbA1c test reflects average plasma glucose over previous 2 to 3 months & provides good indicator of glycaemic control. Unlike oral glucose tolerance test, an HbA1c test can be performed at any time of day and does not require any special preparation such as fasting.

Question 26

HbA1c used in

Answer 26

used for monitoring glycaemic control in both Type 1 & Type 2 diabetes + diagnosis of type 2 diabetes

Question 27

HbA1c NOT used in

Answer 27

~ type 1 diabetes
~ Pregnancy/ 2months post partum
~ Children
~ had symptoms of diabetes for <2 months
~ high diabetes risk + acutely ill
~ Tx with medication that cause hyperglycaemia
~ acute pancreatic damage/ end-stage CKD
~ HIV infection

Use with caution in anaemia, recent blood transfusion

Question 28

how often is HbA1c done

Answer 28

Type 1 : every 3-6 months
Type 2 : every 3-6 months, if stable every 6 months

Question 29

Hypoglycaemia

Question 30

Pregnancy and diabetes

Question 31

Diabetes complications

Question 32

Diabetic hyperglycaemic emergencies

Question 33

Insulin treatment summaries

Question 34

DM symptom

Answer 34

~ polyphagia (excessive hunger)
~ polydipsia
~ polyuria
~ weight loss
~ fatigue
~ blurred vision
~ poor wound healing

Question 35

LONG TERM diabetes compliactions

Answer 35

~ Macrovascular; CVD
statins = primary prevention in T1DM or T2MD with QRISK>10%

~ Microvascular; retinopathy, nephropathy, neuropathy, diabetic foot
ACE/ARBs