Diabetes

Question 1

Complications of Diabetes

Answer 1

1 . Macrovascular disease - CAD, cerebrovascular and peripheral vascular disease)

2. MIcrovascular disease - retinopathy, nephropathy, peripheral neuropathy

Question 2

Pathophysiology of Type 1 DM

Answer 2

Autoimmune destruction of beta islets in the pancreas (auto antibodies)

Question 3

Pathophysiology of Type 2 DM

Answer 3

Slow decline of pancreatic beta cell function (overall reduction in insulin secretion overtime) + insulin resistance

Question 4

Percentage of Different Causes of Diabetes

Answer 4

Type 1 - 5%

Type 2 - 90%

Gestational

Drug induced (immunosuppression - cyclosporin or tacrolimus, antipsychotic medications & HIV protease inhibitors - …navir)

Pancreatitis

Cystic Fibrosis

MODY - maturity onset diabetes of young

LADA - latent autoimmune diabetes of adults

Question 5

Screening period for gestational diabetes + how to screen

Answer 5

24-28 weeks of pregnancy + OGTT (75g)

Question 6

How to diagnose Diabetes Mellitus

Answer 6

Fasting Glucose >/= 7

Random Glucose >/= 11.1

HbA1c >/= 6.5%

OGTT (75g) - 2 hours post BSL >/= 11.1

Question 7

Management of Diabetes

Answer 7

Diet

Exercise

Pharmacotherapy (OHAs + Insulin)

Insulin Pumps

Surgery (Bariatric or Bypass/Roux-en-Y)

Question 8

List the situations where HbA1C is INACCURATE

Answer 8

Haemodialysis

Haemolytic Anaemia

Haemoglobinopathies

• result in falsely lowered results as Hb does not last 120 days

Question 9

Main adverse effect of sulfonylurea (glicalazide + glimepride)

Answer 9

HYPOglycaemia

Question 10

Hypoglycaemic Agent that DECREASES weight

Answer 10

GLP-1 mimetics - Exenatide [BYETTA} + Liraglutide

Question 11

Contraindication to Thiazolidinediones (…glitazones)

Answer 11

CCF and fluid overload (as it can exacerbate the problem)

Question 12

Adverse Effect if Biguanides

Answer 12

GI upset (diarrhoea and abdo pain) Lactic Acidosis (rare) Cease if there is acute or chronic liver dysfunction or acute renal impairment

Question 13

MOA of DPP4 (…gliptins)

Answer 13

Slow gastric emptying and suppression of glucagon secretion

Question 14

MOA of GLP-1 mimetics

Answer 14

Slow gastric emptying, suppression of glucagon secretion, increase satiety

Question 15

Diabetic Retinopathy features

Answer 15

Non proliferative: Oedema Hard exudates Tiny haemorrhages Microaneurysms Soft exudates (cotton wool spots) Proliferative: Angiogenesis / Neovascularisation Intraocular bleeding Retinal detachment (secondary fibrosis and contraction)

Question 16

Treatment for Diabetic Retinopathy

Answer 16

Laser Photocoagulation Burn off part of the retina (1/3) but this results in poor blood flow to the remaining 2/3 But there is loss of peripheral vision Alternative treatment is injection of VEGF inhibitors every 4-8 weeks Bevacizumab Ranibizumab

Question 17

Mechanisms that prevent hypoglycaemia

Answer 17

Insulin secretion switches OFF Mechanisms for glycogenolysis BSL < 4 - glucagon and adrenalin release BSL < 3.3 - cortisol and growth hormone release

Question 18

Causes of fasting hypoglycaemia in non-diabetic patients

Answer 18

Insulinoma Insulin injection Ingestion of sulfonylurea

Question 19

Testing for hypoglycaemia in non-diabetics

Answer 19

Confirm Whipple’s Triad:

Hypoglycaemic symptoms

Low plasma glucose (on LAB test, not glucometer)

Prompt resolution of symptoms post glucose ingestion

Question 20

How much does 1 unit of insulin equate to in carbohydrates (grams)

Answer 20

1unit = 10-15g