Diabetes

Question 1

Diabetes - Type 1 
What is it 
Symptoms
(Associated genes) 
Diagnosis 
Treatment

Answer 1

What is it
-autoimmune destruction of b cells (make insulin)

Symptoms (PPPG)/signs

• polyuria, polydypsia, polyphagia, glucosuria
• weight loss
• may have ketonuria (ketoacidsois)

genes (HLA-DR3 DR4)

Diagnosis

• 2x high random plasma glucose + symptoms >11
• 2x high fasting glucose >7
• high post-prandial glucose post GTT (>11)
• -> If second test negative –> retest in 3-6 months
• HBa1c - >50 + symptoms
• or plus high fasting glucose >7, or random glucose >11

Treatment

• insulin injections
• test hba1c every 3 -6 months
• Manage fasting glucose and post prandial glucose

Question 2

Type 2 diabetes
Risk factors
Symptoms

Answer 2

Risk factors
-older adults, obese, fam history, sedentary lifestyle, metabolic syndrome factors

Symptoms

• polyuria, polydipsia, polyphagia, blurred vision, fatigue
• may present with nonketonic hyperosmolar hyperglycaemia

When to screen

• all patients with risk factors for diabetes (HTN, obesity, fam hist, indian,asian, pacific maori)
• Patients >45 men, >55 women (healthy)

Question 3

Complications of Diabetes

• how to reduce
• screening
• treatment

Answer 3

Eyes -Retinopathy

• post 3-5years of diabetes
• control hyperglycaemia + HTN
• annual eye exam
• Laser photocoagulation therapy for retinal neovascularisaiton

Diabetic nephropathy 
-glomerular hyperfilatration with microalubinuria 
>10years
-prevention - ACE , BP control 
-nodules seen on kidney biopsy 

Neuropathy

• peripheral nerves - burning pain, foot trauma, infections, ulcers
• treat - preventative foot care, analgesia (amitriptyline, gabapentin, NSAIDs)
• delayed gastric emptying
• neurogenic bladder - decrease sensation to void, overflow incontinence, erectile dysfunction

Macrovascular

• CVD , cerebrovascular, peripheral vascular disease
• Most common cause of death in patients.

Question 4

Diabetic keto-acidosis
Vs Hyperosomlar hyperglycaemic state

Precipitants
Symptoms
Lab values
Treatment

Answer 4

Precipitants
Both -stress (infections, MI, trauma, alcohol), or non-compliance w insulin therapy

Symptoms
DKA - abdo pain, N, V, kussmaul respirations, Mental state changes, fruity, acetone breath
HSS - profound dehydration, mental state changes

Lab values 
DKA - glucose >250 
-metabolic acidosis 
-ketones - urine, serum 
-Increased anion gap 
-Serum osmolality normal
-can often have hyperkalaemia w total body stores deplete. (due to acidosis causing extracellular shift of potassium) 
HHS - glucose >600 
No acidosis, ketones, anion gap norma
-serum osmolality >320 

Treatment
DKA - Fluids, potassium, continuous insulin, phosphorus
-treat trigger
-monitor response by looking at anion gap
HHS - aggressive fluids, electrolyte replacement, insulin
-treat event
–> use Normal saline for initial resus, then continue with 5% dextrose to fluids once glucose is <250

Question 5

Treatment for type 2 DM

• lifestyle
• Pharmacotherapy
• General health

Answer 5

Lifestyle
-diet, weight loss, low saturated fats and sugar , exercise

General health

• Statin
• BP control (ACE first line)
• Screening - CVD, nephropathy (microalbuinria), retinoapthy (eye exams), neuropathy (foot care evaluation)

Target >55 hba1c

Question 6

Types of drugs used, and side effects

Answer 6

(in book)

Question 7

Metabolic syndrome

Answer 7

-is insulin resistance syndrome associated with a decreased risk of CAD and mortality from CVD event

WEIGGHT (3/5 for diagnosis) 
waist expanded
Imparied glucose
hypertension
HDL decreased
triglyceride increased

treat - intensive weight loss, aggressive cholesterol management, BP control, Metformin
-lifestyle modification

Question 8

Other things that can cause diabetes

Answer 8

Drugs e.g., thiazide diuretics, atypical antipsychotics, and steroids.
Haemochromatosis.
Endocrine e.g., Cushing’s disease, acromegaly.