Diabetes

Question 1

What advice should you give someone who has diabetes and is sick?

Answer 1

Don’t stop your insulin

Maintain your calorie intake

Check your blood glucose at least 4 times a day and check for ketonuria

Question 2

Which 5 groups with diabetes should you admit?

Answer 2

• Vomiting
• Dehydrated
• Ketotic
• Child
• Pregnant women

Question 3

What class of medication is Metformin?

Answer 3

A biguanide

Question 4

How does Metformin work?

Answer 4

Increases insulin sensitivity

Question 5

What impact on weight does Metformin have?

Answer 5

Decreases weight

Question 6

At what eGFR level should you avoid prescribing someone Metformin and why?

Answer 6

Avoid metformin if eGFR <36 ml/min as there is a risk of lactic acidosis

Question 7

List 3 side effects of Metformin

Answer 7

Nausea
Diarrhoea
Abdo pain

Question 8

What are gliptins biochemically? How do they work?

Answer 8

Gliptins are DPP4 inhibitors. They increase incretin levels (which stimulate a reduction in glucose) by blocking the enzyme which breaks it down (DPP4)

Question 9

How do Glitazones work?

Answer 9

They increase insulin sensitivity.

Question 10

List 4 side effects of Glitazones

Answer 10

1) Hypoglycaemia
2) Fractures
3) Fluid retention
4) Increased LFTs

Question 11

What are the 3 contraindications of Glitazones?

Answer 11

1) Past or present CCF
2) Osteoporosis
3) Monitor weight: stop if putting on weight or becoming oedematous

Question 12

How do sulfonylureas work? Name an example

Answer 12

They increase insulin secretion

E.g. gliclazide

Question 13

Name 2 side effects of sulfonylureas

Answer 13

Hypoglycaemia and increased weight

Question 14

How do SGLTI work?

Answer 14

= Selective Sodium-Glucose Co-transporter 2 inhibitor.

They block reabsorption of glucose in kidneys and promote excretion of XS glucose in the urine.

Question 15

Name 2 possible side effects of using SGLTI?

Answer 15

Dehydration/ hypovolaemia

DKA

Question 16

How do Glucagon-like peptide (GLP) analogues work?

Answer 16

They work as incretin mimetics (therefore they stimulate a reduction in glucose levels by increasing insulin release).

Question 17

Which diabetic medication, except insulin, is given via a subcutaneous injection?

Answer 17

GLP analogues

Question 18

At what eGFR should you stop taking incretin mimetics?

Answer 18

Stop is eGFR <30.

Question 19

At what point would you consider dual or triple therapy in someone with diabetes?

Answer 19

If their HbA1C is over 58 mmol/mol.

Question 20

What is classed as pre-diabetes?

Answer 20

Hb1Ac 42-47 mmol/mol.

Question 21

Which 2 anti-diabetic medications should you consider in someone who is suffering from severe osmotic symptoms or weight loss?

Answer 21

Insulin or sulfonylurea.

Question 22

At what HbA1c should you consider starting a type 2 diabetic on insulin sooner?

Answer 22

If it’s over 75 mmol/ mol.

Question 23

What is a normal level of ketones?

Answer 23

< 0.6 mmol

Question 24

At what ketone level is urgent medical review required?

Answer 24

> 3.0 mmol

Question 25

What is the treatment for DKA?

Answer 25

Fluid resuscitation and fixed rate insulin infusion (0.1 unit/ kg/ hr).

Question 26

What are the 3 criteria needed to diagnose hyperglycaemia hyperosmolar state?

Answer 26

• Hypovolaemia
• Blood glucose > 30 mmol w/o significant ketosis/ acidosis
• Plasma osmolality >320

Question 27

What are the 2 treatments you should give to someone in a hyperglycaemic hyperosmolar state?

Answer 27

Rehydrate them with normal saline and give them variable rate IV insulin,

Question 28

What food should someone who is experiencing a hypo have?

Answer 28

15 - 20 grams of fast-acting carbs

Question 29

How does diabetes accelerate atherosclerosis?

Answer 29

Diabetes -> inflammation -> slows blood flow -> accelerates atherosclerosis

Question 30

How should a pregnant woman’s medications be managed if she has known diabetes?

Answer 30

Stop statin/ ACEi
Give folic acid 5mg
Take aspirin from 12 weeks to reduce the risk of pre-eclampsia

Question 31

What screening must occur in a pregnant woman with known diabetes?

Answer 31

Eye screening
Scan at 10-12 weeks, 18-20 weeks (repeated screening for congenital abnormalities), 28, 32 and 36 weeks to assess foetal growth.

Question 32

How often must a pregnant patient with known diabetes be reviewed?

Answer 32

Every 2 weeks

Question 33

What are normal fasting and 2 hour OGTT results?

Answer 33

Fasting = >5.6 mmol

2 hour = > 7.8 mmol

Question 34

What sign would you seen on fundoscopy in a diabetic patient with background retinopathy?

Answer 34

Cotton wool spots

Question 35

What changes occur in maculopathy in someone with diabetes and what is the clinical relevance?

Answer 35

Leakage of fluid from retinal capillaries around the fovea - this is sight-threatening!

Question 36

Typically when during the pregnancy would gestational diabetes occur?

Answer 36

20 weeks into gestation

Question 37

Name 3 risk factors for gestational diabetes

Answer 37

• BMI >30
• South Asian
• PCOS

Question 38

When should a pregnant woman be assessed for gestational diabetes and how does this occur?
What about if they have already had previous GDM?

Answer 38

Screen w/ OGTT @ 24-28 weeks.

If previous GDM - screen @ 16 weeks.

Question 39

What screening should be done for pregnant GDM patients after they have given birth?

Answer 39

A postnatal fasting glucose at 6-13 weeks should be done to check for T2DM.

Question 40

What 3 things are needed for the diagnosis of DKA?

Answer 40

1) Acidaemia: venous blood pH <7.3 or HCO3- <15.0 ol/L
2) Hyperglycaemia: Blood glucose >11.0 mmol/L or known DM
3) Ketonaemia: > 3 mmol/L or significant ketonuria (more than 2+ on dipstick