Diabetes: Clinical Perspective

Question 1

Define hypoglycaemia (numerically)

Answer 1

Blood glucose lower than 4mM

Question 2

What is impaired awareness of hypoglycaemia (IAH)?

Answer 2

Acquired syndrome where the warning symptoms of hypoglycaemia diminish in intensity, change in nature, or are lost altogether. This means that you can’t tell when you’re about to have a hypo, which have implications for driving and lifestyle

Question 3

How does insulin deficiency lead to ketoacidosis and hyperglycaemia?

Answer 3

. Insulin deficiency leads to mobilisation of fats and amino acids (ketogenesis)
. Reduced peripheral use of glucose and ketones
. Leads to hyperglycaemia and ketoacidosis

Question 4

Give 4 macrovascular complications of T2D

Answer 4

Increased risk of stroke, MI, CVD, and increased risk of peripheral vascular disease (which in turn can lead to MI or stroke)

Question 5

Give 3 microvascular complications of T2D

Answer 5

Diabetic nephropathy leads to kidney failure, diabetic retinopathy leads to blindness, diabetic neuropathy leads to foot wounds and ulcers

Question 6

What is HbA/Hb1? Why is it measured?

Answer 6

. Glycated haemoglobin

. Used to measure plasma glucose concentration

Question 7

What is the glycaemic target for most people? Who does this normally differ for? What factors need to be considered when determining an individual’s glycaemic target?

Answer 7

. Less than 7%
. Normally tighter target for younger, healthier people (6-6.5%)
. Normally looser for older people with comorbidities or prone to hypos (7.5-8%)
. Need to consider age, weight, comorbidities, duration of disease

Question 8

Which drugs do diabetics use to lower blood glucose?

Answer 8

Human insulin or insulin analogues