Diabetes

Question 1

Name anti-hypertensive therapies

Answer 1

ACE and Ang II
B blockers
Ca channel blockers
Diuretics
Alpha  blockers

Question 2

Name drugs used to slow diabetic progression

Answer 2

Glycaemic control

Antihyperglycaemics

• metformin
• sulphonylurea
• glitazones
• acarbose (alpha glucosidase inhib)
• incretin (GLP1) enhancers and mimetics

Insulins
USAI (ins aspart - novorapid)
SAI (neutral - actrapid)
IAI (isophane - humulin NPH)
LAI (lantus)

Antihypertensives

ACE inhibitors (T1/T2DM) and ARBs (T2DM) are equally effective in the treatment of diabetic nephropathy

Question 3

Metformin

Mechanism of action?
Side effects?
Contraindications?

Answer 3

Improves insulin sensitivity
 Possibly ↓ GNG and ↑ glycolysis

SE -
Anorexia
N +V + D + cramps
Lactic acidosis (particularly in renal, hepatic or cardiovascular disease coexist)

CI -
Renal impairment

Question 4

Sulphonylurea (+ example)
Mechanism of action?
Side effects?
Contraindications?

Answer 4

Glicazide

inhibits K+ ion pump on B cell membrane, causing influx of calcium and increased release of insulin

SE-
hypoglycaemia

CI

Question 5

Diabetic foot pathogenesis/ risk factors associated with DM

Answer 5

Neuropathy
Sensory (prone to injury with delay in seeking medical attention)
Autonomic (dry skin)
Motor (abnormal posturing leading to pressure points with callus formation)

PVD
Poor blood flow to ulcer impairs healing and promotes infection (immune response hindered)

Hyperglycaemia has immunosuppressive effects with impairment of neutrophil function = increased risk of infection

Question 6

Microorganisms that infect diabetic leg wounds

Answer 6

Most wounds have poly microbial (5-7) infection

Superficial wounds in antibiotic naive individuals (cellulitis, ulcers)
–> GPC (S aureus including MRSA, S. pyogenes, coagulase -ve staph)

Deep chronic ulcers in people previously treated with antibiotics
–> GPC, enterococci, pseudemonas aeruginosa

Wounds complicated by gangrene, osteomyelitis, septic arthtritis and symptoms/signs of systemic toxicity (bacteraemia, septic shock)
–> GPC, enerococci, pseudemonas and anaerobes (clostridium, bacteroides, anaerobic strep)

Question 7

Complications of DM

Answer 7

Related to advanced glycosylated end products:
- crosslink type I and type Iv collagen

MICROVASCULAR
*Retinopathy
Proliferative 
-Retinal detachment, preretinal and vitreous haemorrhage
Nonproliferative 
-Macula oedema
- Fundoscopy shows:
       cotton wool spots (nerve infarct)
       intraretinal haemorrhage
       microaneurysm

*Nephropathy
Glomerular lesions
Vascular lesions
Pyelonephritis

*Neuropathy
Sensory (glove and stocking)
Autonomic (impotence, postural hypotension, gatroparesis)
Mononeuropathy (CN 3,4,6)

MACROVASCULAR
*Accelerated atherosclerosis related
IHD
CVD (Lacunar infacrts HTN

Question 8

Diagnostic criteria diabetes

Answer 8

Random glucose > 11.1 mmol/L 
(normal  7.8 mmol/L
(normal 7.8 
2hr > 11.1
- restrict carb intake in week before test

Question 9

Insulin side effects

Answer 9

Hypoglycaemia
(delayed, insufficient meal or excessive exercise) –> sweating, palpitations, tremor, headache, visual disturbance

Weight gain

Lipodystrophy/atrophy
Lump or dent in skin at injection site (repeated injections) - fat degneration

Question 10

Signs and Symptoms of DKA

Answer 10

N + V
Drowsiness
Abdo pain
Leg cramps
Polydipsia
Polyuria
Kaussmal breathing
Ketotic fetor

Question 11

Differentiate between - arterial, venous, diabetic ulcers

Answer 11

Arterial

• punched out, clean base
• painful
• absent peripheral pulses
• atrophic skin changes - hair loss
• may contain greyish granulation tissue
• most commonly seen on dorsum of foot/toes

Venous

• irregular border
• painful
• medial or lateral maleoli
• moist granulating base (slough)
• skin pigmentation with haemosiderin deposition

Diabetic

• painless
• metatarsal head/ sole of toe