diabetes

Question 1

type 1 patho

Answer 1

autoimmune destruction of the pancreatic β cells

Question 2

what other diseases is type 1 associated with

Answer 2

autoimmune thyroid disease, Addison’s disease and pernicious anaemia

Question 3

clinical presentation of type 1

Answer 3

polyuria, polyphagia, polydipsia, blurred vision, glycosuria, macrovascular and microvascular disease, acetone breath, weight loss, Kussmaul breathing, nausea and vomiting

Question 4

kaussmauls breathing

Answer 4

laboured breathing - metabolic acidosis

Question 5

why weight loss in type 1

Answer 5

fluid depletion and breakdown of fat and muscle secondary to insulin deficiency

Question 6

dietary advice to type 1

Answer 6

low sugar, high carb, low fat

Question 7

conservative measures for type 1

Answer 7

BMI measurement 
Smoking cessation 
Decrease alcohol intake 
Regular blood glucose 
encourage excersize

Question 8

what should be monitored on type 1

Answer 8

HbA1c monitoring

Question 9

type 1 insulin

Answer 9

Short-acting (soluble) insulins
Short-acting insulin analogues
Longer-acting insulins

Question 10

investigations for type 1

Answer 10

Fasting plasma glucose
Random plasma glucose
HbA1c

Question 11

clinical features of type 2

Answer 11

polyuria, polyphagia, polydipsia, blurred vision, glycosuria, macrovascular and microvascular disease

Question 12

type 2 drugs

Answer 12

Metformin, Thiazolidinediones, incretins, SGLT2 inhibitors, Sulfonylureas

Question 13

metformin MOA

Answer 13

reduces glucose production by the liver and sensitizes target tissues to insulin

Question 14

Sulfonylureas MOA

Answer 14

promote insulin secretion

Question 15

common Sulfonylureas

Answer 15

Gliclazide and glipizide

Question 16

common side effects of Sulfonylureas

Answer 16

hypoglycaemia and weight gain

Question 17

only oral agent shown to reduce cardiovascular risk in diabetes

Answer 17

metformin

Question 18

Thiazolidinediones other name

Answer 18

glitazones

Question 19

what do Thiazolidinediones activate

Answer 19

peroxisome proliferator-activated receptor-gamma (PPAR-γ)

Question 20

what is peroxisome proliferator-activated receptor-gamma (PPAR-γ)

Answer 20

a nuclear receptor which regulates genes involved in lipid metabolism and insulin action

Question 21

Thiazolidinediones MOA

Answer 21

educe hepatic glucose production and enhance peripheral glucose uptake

Question 22

Thiazolidinediones side effects

Answer 22

weight gain, fluid retention and heart failure, anaemia and osteoporosis

Question 23

who is Thiazolidinediones contraindicated in

Answer 23

patients with heart failure

Question 24

Incretins mimic

Answer 24

glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1)

Question 25

where are (GIP) and (GLP-1) released from

Answer 25

intestine

Question 26

when are (GIP) and (GLP-1) released

Answer 26

after eating

Question 27

what does GLP1 do

Answer 27

promote insulin release, inhibit glucagon release, prolong gastric emptying and a reduce in hunger mediated by receptors in the brain

Question 28

SGLT2 inhibitors block

Answer 28

sodium/glucose transporter 2 (SGLT2)

Question 29

purpose of SGLT2

Answer 29

re-absorb glucose from the renal filtrate and restore it to the circulation

Question 30

type 2 investigations

Answer 30

Fasting plasma glucose Random plasma glucose HbA1c

Question 31

circumstances which people get diabetic ketoacidosis

Answer 31

Previously undiagnosed diabetes Interruption of insulin therapy The stress of intercurrent illness

Question 32

when might insulin be stopped

Answer 32

when a patient is not eating or vomitting - should not be stopped

Question 33

in type 1 when should insulin be stopped

Answer 33

never

Question 34

what is ketoacidosis

Answer 34

uncontrolled catabolism

Question 35

what happens when insulin is stopped - DKA

Answer 35

increase in hepatic gluconeogenesis

Question 36

in DKA there is peripheral lipolysis which leads to

Answer 36

increase in circulating free fatty acids

Question 37

in DKA what happens to the circulating free fatty acids

Answer 37

converted within the liver to acidic ketones

Question 38

what does production of acidic ketones in the liver result in

Answer 38

metabolic acidosis

Question 39

why is there dehydration in DKA

Answer 39

water and electrolyte loss from the kidney and exacerbated by vomiting

Question 40

what breathing do you get in DKA

Answer 40

Kussmaul’s respiration

Question 41

why are urea and creatine raised in DKA

Answer 41

as a result of dehydration

Question 42

management of DKA

Answer 42

Replace fluid and electrolyte loss, restore insulin and acid base balance

Question 43

HHS stands for

Answer 43

Hyperosmolar hyperglycemic state

Question 44

who gets HHS

Answer 44

uncontrolled type 2

Question 45

most common precipitating cause of HHS

Answer 45

infection

Question 46

how does HHS patient present

Answer 46

profound dehydration and a decreased level of consciousness

Question 47

management of HHS

Answer 47

Replace fluid and electrolyte loss, restore insulin and acid base balance

Question 48

drugs that can cause hypoglycaemia

Answer 48

insulin therapy and sulfonylurea therapy

Question 49

symptoms of hypoglycaemia

Answer 49

hunger, sweating, pallor and tachycardia

Question 50

treatment of hypoglycaemia

Answer 50

rapidly absorbed carbohydrate intravenous dextrose followed by a flush of normal saline Intramuscular glucagon Oral glucose

Question 51

why give saline after dextrose

Answer 51

its highly irritant

Question 52

Intramuscular glucagon action

Answer 52

acts rapidly by mobilizing hepatic glycogen and is particularly useful where intravenous access is difficult

Question 53

when is oral glucose given

Answer 53

replenish glycogen reserves once the patient revives.