Diabetes

Question 1

Questions to ask in diabetes history

Answer 1

o	Polyuria, nocturia, polydipsia
o	Weight loss/ gain
o	Fatigue, mood changes
o	Blurred vision
o	Frequent bacterial/ yeast infx
o	Leg sensory changes
o	Cuts/ wounds that heal slowly

Question 2

Microvascular complications from diabetes

Answer 2

• retinopathy
• nephropathy
• erectile dysfunction
• absent foot pulses
• ischaemic skin changes on foot
• abnormal vibration sense on foot

Question 3

Macrovascular complications from diabetes

Answer 3

• stroke
• heart attack
• hypertension
• intermittent claudication

Question 4

Normal fasting blood glucose for healthy patient (without diabetes)

Answer 4

3.9-5.5

Question 5

Normal HbA1C for healthy patient (without diabetes)

Answer 5

20-41.4

Question 6

Which patient populations would be screened for T2DM

Answer 6

• previous gestational diabetes
• age >65
• blacks + South Asians >35
• all pts who have MI, angina, stroke
• PCOS pts who are obese
• > 50 + obese/ family history/ hypertension

Question 7

What blood/ bedside tests would be done in diabetes screening

Answer 7

"	Fasting plasma glucose/ oral glucose tolerance test
"	HbA1c
"	Creatinine, eGFR
"	Cholesterol
"	Urine micro albumin

Question 8

Why is HbA1c a better test for diabetes compared to oral glucose tolerance test

Answer 8

• more reliable (encompasses more readings compared to 1 moment from 1 day)
• easier to measure complications risk
• doesn’t require fasting
• not affected by stress, diet, exercise

Question 9

MoA of metformin

Answer 9

Decreases insulin resistance

first line drug

Question 10

MoA of sulfonylurea

Answer 10

Increases insulin secretion from pancreatic b-cells

good second line drug because less risk of hypoglycaemia

Question 11

What BM level is considered hypoglycaemia

Answer 11

<4 mmol/L

Question 12

How to treat hypoglycaemia patient

Answer 12

Dextrosol tablets (if conscious)
IV dextrose (if unconscious)

Recheck BM after 10-15min, repeat treatment if still hypoglycaemic

Question 13

What does HbA1c measure

Answer 13

3 month average plasma glucose concentration

Question 14

Autonomic symptoms in hypoglycaemia

Answer 14

• sweating, anxiety, tremor, palpitations
• pallor

(early adrenergic features may be absent in patients with longstanding diabetes)

Question 15

Neurogenic symptoms in hypoglycaemia

Answer 15

• confusion
• coma, drowsiness
• seizures
• personality change
• focal neurology

Question 16

Difference between definition of DKA and HHOS

Answer 16

DKA has hyperglycaemia, acidosis, ketosis

HHOS has hyperglycaemia, increased water reabosrption, no ketosis

Question 17

Why is there no ketosis in hyperosmolar hyperglycaemia state

Answer 17

The low insulin levels are still sufficient to inhibit hepatic ketogenesis

Question 18

Symptoms of of DKA

Answer 18

• polyuria
• polydipsia
• weight loss
• reduced GCS
• dehydration (low BP, high HR)
• Kussmaul respiration
• abdominal pain

Question 19

What is kussmaul respiration

Answer 19

increased respiration to compensate acidosis

Question 20

What causes abdominal pain in DKA

Answer 20

Abdo pain secondary to metabolic acidosis

Question 21

Is DKA or HHOS more life-threatening

Answer 21

HHOS

• higher mortality rate
• frequently leads to coma

Question 22

DKA and HHOS - which occur more in type 1/2 diabetics

Answer 22

DKA: more in type 1
HHOS: more in type 2

Question 23

Is a hypoglycaemic event a contraindication to driving?

Answer 23

No if had prodrome.

Contraindicated if no prodrome (can drive again if he regains awareness of hypoglycaemia).