DIABETES

Question 1

how is t2dm diagnosed?

Answer 1

fasting plasma glucose >7
OGTT >11
HbA1c of >48

Question 2

how is ‘pre-diabetes’ diagnosed?

Answer 2

fasting plasma glucose <7
OGTT between 7.8 - 11
HbA1c of 42-47

Question 3

what are the risk factors of t2dm?

Answer 3

south asian
male gender
obesity
lack of exercise
calorie and alcohol excess

Question 4

what are the 3 mechanisms by which insulin lowers blood glucose levels?

Answer 4

DECREASES hepatic gluconeogenesis

INCREASE in glucose uptake in adipose tissue and muscle (GLUT4)

Question 5

what are the symptoms of hyperglycaemia?

Answer 5

polyuria, polydipsia, visual blurring, genital thrush, lethargy, recurrent infections

Question 6

why do hyperglycaemic patients often feel thirsty?

Answer 6

kidneys attempt to excrete excess glucose from blood. Glucose is a solute, so water follows, causing dehydration

Question 7

explain the pathophysiology of t2dm…

Answer 7

liver, adipose tissue and muscle INSENSITIVE to actions of insulin

AND / OR

beta cell dysfunction, causing decreased levels of insulin

Question 8

what dietary interventions should be suggested for an obese patient with t2dm?

Answer 8

low calorie ketogenic diets - high fat, medium protein, low carb (preferred)

low glycaemic index diet - second choice

Question 9

what are the differentials if a patient presents with polyuria?

Answer 9

diabetes
hypercalaemia
diabetes insipidus

Question 10

what is the difference between diabetes insipidus and melitus?

Answer 10

insipidus is caused by pituitary pathologies, causing increased water excretion due to ADH disfunction

no glucose in urine of pt with insipidus!!

Question 11

what are the main symptoms of hypercalcaemia?

Answer 11

TATT
polyuria OR anuria
muscle aches
urinary stones
headaches
depression
arhythmias (although uncommon)

Question 12

you have been asked to discuss the implications of a t2dm diagnosis with a patient. How would you go about this?

Answer 12

• explain t2dm in lay terms
• lifestyle advice
• dietary change
• potential long term complications
• medical management
• management of cardiovascular risk

Question 13

what are the names of 3 educational programmes that address t2dm?

Answer 13

XPERT
DESMOND
DAFNE

Question 14

which tests make up the annual diabetes review workup?

Answer 14

lipid profile
HbA1c
urine albumin creatinine ratio
eGFR
diabetic foot exam
fundoscopy

Question 15

explain the algorithm for t2dm pharmacological management…

Answer 15

1. lifestyle
2. metformin
3. metformin + ddp4 / glicazide / sglt2 / thiazolidinedione
4. metformin + 2 of above
   5a. insulin therapy
   5b. metformin + sulfonyl urea + GLP1 agonist

Question 16

what type of drug is metformin?

Answer 16

biguinide

Question 17

the ‘gliptins’ belong to which family of hypoglycaemics?

Answer 17

DPP4 inhibitors

Question 18

what is the mechanism of action of the ‘flozins’?

Answer 18

SGLT2 inhibition

Question 19

what is the function of GLP1?

Answer 19

released by the intestine in response to food, it has 4 effects;

• increases insulin secretion
• decreases hepatic gluconeogenesis
• delays gastric emptying
• increases satiety

Question 20

the ‘azides’ belong it which family of hypoglycaemia drug?

Answer 20

sulfonylureas

Question 21

which is the only hypoglycaemic drug to cause hypos?

Answer 21

sulfonylureas e.g. glicazide

Question 22

the ‘tides’ are belong to which family of hypoglycaemics?

Answer 22

GLP1 analgoues

Question 23

pioglitazone is an example of which class of hypoglycaemic drug?

Answer 23

thiazolidineiones

Question 24

what is mature onset diabetes of the young (MODY)?

Answer 24

a type of t2dm
rare, autosomal dominant
affects young people

Question 25

what is latent autoimmune diabetes of adults? (LADA)

Answer 25

a form of t1dm
picked up in 30’s
slower progression to t1dm

Question 26

how should insulin be managed during acute illness?

Answer 26

patients should NOT stop using insulin when ill, infact it is more important