Diabetes

Question 1

What type of drug is exenatide?

Answer 1

GLP-1 mimetic

They increase insulin secretion and decrease glucagon secretion. They also result in weight loss.

Question 2

What are the requirements for GLP-1 mimetic therapy??

Answer 2

BMI > 35
1% hba1c drop in 6 months
3% weight loss in 6 months

Question 3

What type of drug is sitaglipin?

Answer 3

Dipeptidyl peptidase 4 (DPP-4) inhibitor

Oral, no hypoglycaemia and no weight gain.

Question 4

Diagnostic criteria for diagnosis diabetes?

Answer 4

Symptomatic

• Fasting blood glucose >7.0mmol/L
• Random glucose >11.1 mmol/L (or after 75g OGTT)
• HBA1C >6.5% (48mmol)

Assymptomatic
-same as above but on 2 occasions

Question 5

What is seen in HHS and how is it managed?

Answer 5

Long history, no acidosis, glucose high eg. >35! Dehydration, osmolatiy >320. No ketones.

Slow rehydration over 2 days

(no insulin unless poor response eg glucose doesn’t fall by 5mmol/l/hour or ketonemia)

Maintain 10-15mmol/l of glucose to prevent cerebral odema.

Treat the cause

Question 6

How does Latent Autimmune Diabetes of Adulthood (LADA) present?

Answer 6

Slow onset (several months), young-ish, not increased body habitus.

Can treat with oral hypoglycaemics initially before insulin therapy is needed.

Question 7

Which antibodies are present in LADA?

Answer 7

Glutamic acid decarboxylase AB (GAD)
Islet cell AB (ICA)
Insulinoma-associated AB (IA-2)
Zinc transporter AB (ZnT8h

Question 8

How does MODY present?

Answer 8

Younger patients with asymptomatic hyperglycaemia without complications like DKA.
But can also be symptomatic eg polyuria, polydipsia

Question 9

At what HBA1C level do you add a 2nd anti-diabetic drug?

Answer 9

7.5% (58mmol)

Question 10

When to start drug therapy (metformin) in someone with T2DM on lifestyle interventions?

Answer 10

If HBA1C rises to 6.5% (48)

Question 11

What is first line anti-hypertensive in any person with diabetes? What BP should be aimed for?

Answer 11

ACEi

<140/80 (<130/80 if end organ damage)

Question 12

What’s the atorvastatin dose for primary and secondary prevention of cardio risk?

Answer 12

P - 20mg

S- 80mg

Question 13

Blood glucose targets on waking and before meals in T1DM?

Answer 13

4-7 before meals

5-7 on waking

Question 14

Whats the joint British diabetes societies diagnostic criteria for of DKA?

Answer 14

PH <7.3
Glucose > 11 or known diabetic
Bicarbonate < 15
Ketones > 3 in blood or urine ketones +++

Question 15

How do you manage DKA?

Answer 15

Fluids - 0.9% saline (unless BM <15, can use 5% dextrose) usually need 5-7 litres! Regime: 1L/1Hr, 1L/2hr, 1L/2hr, 1L/4hr….

If systolic <90bpm consider 500ml fluid challenge.

Insulin - 0.1unit/kg/hour

Potassium
>5.5 - nil
3-5.5 - 40 KCL (10mmol per hour)
<3.5 - senior review

Watch/monitor for cerebral odeama - esp children and young adults. Neuro-obs needed

Question 16

What’s the treatment for diabetic neuropathic pain?

Answer 16

1st: amitriptyline, duloxitine, gabapentin,or pregabalin.

Tramadol for rescue therapy.

Question 17

What are the symptoms of gastroparesis?

Answer 17

BloAting, vomiting and erratic blood sugars (disbetics)

Management with pro-kinetic agents: metoclopramide, dimperidone, or erythromycin.

Question 18

What is impaired fasting glucose?

Answer 18

Fasting glucose between 6.1-7.

Question 19

What is impaired glucose tolerance?

Answer 19

Fasting glucose <7, and OGTT between 7.8-11.1

Question 20

In MODY 3 with HFN-1a gene what is the best treatment?

Answer 20

Sulfonylureas (glicazide)

Question 21

What test is useful to determine whether diabetes is type 1 or 2, in hard to distinguish cases?

Answer 21

C-Peptide
Lower in patients with type 1 as the pancreas isn’t making enough insulin precursor (broken down into insulin and c-peptide)

Question 22

How do we stratify diabetic foot risk?

Answer 22

Low - no risk factors other than callus

Mod - deformity, neuropathy or non-critical limb ischemia

Severe - prev ulceration, prev amputation, on renal RT, neuropathy and non critical limb ischemia, neuropathy with callus and/or deformity, non critical limb ischemia and callus and or deformity.

Mod and severe need to regularly be followed up in the local diabetic foot centre.