Diabetes

Question 1

What is Diabetes Mellitus?

Answer 1

High blood sugar over prolonged time.

Question 2

What is T1DM?

Answer 2

Autoimmune, destruction pancreatic beta cells = hyperglycaemia.

Question 3

What is T2DM?

Answer 3

Hyperglycaemia due low insulin sensitivity (resistance) or production.

Question 4

Presentation of DM?

Answer 4

Triad: Polyuria, Polydipsia + Fatigue

Other signs: unexplained weight loss, blurred vision, nephropathy, thrush.

Question 5

Investigations for DM?

Answer 5

1) HbA1c
2) Bloods - Glucose (most important), FBC, U&Es, LFTs, TFTs etc. - rule in/out
3) Urine dipstick - Glucose (most important), ketones, pH etc.
4) ABG - Check for Acidosis, rule out respiratory failure

Question 6

Diagnostic Criteria for DM?

Answer 6

One of:
1) Symptoms AND fasting glucose >7mmol/L or random glucose 11.1mmol/L.
2) Raised serum glucose on 2 SEPARATE occasions
(fasting >7, random >11.1 or 2h glucose tolerance >11.1)
3) HbA1c > 48 mmol/mol

Question 7

Managing DM?

Answer 7

T1DM: Insulin regimen
T2DM
1) Lifestyle - diet, weight, exercise
2) Metformin (avoid if eGFR <36)
3) Dual Therapy: Add sitagliptin (DPP4 inhibitor)
4) Triple Therapy:  Add sulfonylurea
5) Insulin regimen

Question 8

What is DKA + common triggers?

Answer 8

Lack of insulin = body compensates by releasing ketones (fatty acids), turns the blood acidic.
Life threatening complication, mostly in T1DM.
Infection = common trigger

Question 9

Criteria for DKA?

Answer 9

Random Blood glucose >11.1 mmol/L
Serum Ketones >3mmol/L
Metabolic Acidosis - pH <7.35, HCO3- <15

Question 10

Assessing + Managing suspected DKA?

Answer 10

1) ABCDE + Obs
2) Bloods + ABG - call help if severe.
3) FIGPICK protocol
Fluids - 0.95 saline 500ml bolus
Insulin Infusion
Glucose monitoring - <14 =dextrose infusion
Potassium every 4h
Infection - managing underlying causes
Chart regular fluids
Ketones - monitor blood levels.