Diabetes melitus

Question 1

Ketoacidosis is seen commonly in which type of DM

Answer 1

DM 1 (IDDM- insulin dependant)

Question 2

Examples of type 3c DM

Answer 2

1. Chronic pancreatitis
2. Thiazide diuretics
3. Phoechromocytoma
4. Cushings
5. Acromegaly
6. PCOS
7. Hemochromatosis
8. High dose estrogen
9. Steroids

Question 3

Screening criteria for DM2

Answer 3

1. > 40yrs age - 3yrly (AUSDRISK score)
2. Impaired glucose tolerance test (prediabetics) - anually
3. > 30yrs in
   ●Fam h/o (1st degree relative)
   ●Obese
   ●High prevalence ethnic groups
4. > 18yrs in aborginals/torres island pts - anually
5. Gestational DM+
6. Antipsychotics, steroids
7. PCOS

Question 4

AUSDRISK score

Answer 4

DM screening
score =>12 - do FBS, HbA1c

Question 5

Tests and values for DM

Answer 5

1. FBS:
   ●<5.5mmol/L - normal
   ●6.1-6.9mmol/L - IFG (do OGTT)
   ●=>7mmol/L - DM+

●If clinical symptoms absent, perform FBS on a separate day - diagnosis

2. HbA1c - 6.5% or 48mmol/L
3. OGTT
   ●FBS =>7 - DM+
   ●Pl Glucose after 2 hrs of 75gms glu
   =<7.7mmol/L - normal
   7.8-11mmol/L - IGT
   =>11.1mmol/L - DM+

●Gold standard test for diagnosing diabetes
●Done in
Boderline cases
GDM diagnosis

Question 6

Diabetic nephropathy

Answer 6

Prevention essential
1. Microalbuminuria
2. Early morning sample - ACR (albumin-creatinine ratio)
3. Dipstick test - unreliable
4. Best - 24hr urinary protein

5. Rx for HTN in these cases:
   ACEI/ARB (protects kidney from diabetic nephropathy)

Question 7

Classification of insulin depending on time of action

Answer 7

1. Ultra short - lispro, aspart
2. Short - neutral
3. Intermediate - Isophane(NPH), lente
4. Long - ultralente, detemir, glargine
5. Biphasic - neutral + isophane

Question 8

Longer acting vs rapid insulin regimen

Answer 8

Long acting (basal) - 1 time/day
Rapid acting - before every meal, pt choose the dose

In DM1

Question 9

DM2 mx

Answer 9

1. 3-6months life style modification
2. Metformin DOC
3. Add
   Sulfonylurea
   Gliptins (DPP 4 inhibotors)
   Gliflozins (SGLT2 inhibitors)
   Glitazones (thiazolidinediones)
   GLP 1 receptor agonists (cardio protective)
4. Triple therapy
5. Metformin + insulin

Question 10

When do you start insulin in a DM2 pt

Answer 10

Uncontrolled DM with 3 oral agents

Question 11

Metabolic complications of DM

Answer 11

1. Hypoglycemia
2. Diabetic keto acidosis

Question 12

Mx of hypoglycemia in DM

Answer 12

1. Conscious pt -
   ●15gms refined carbs
   ●Check RBS every 15 mins
   ●RBS <4 - repeat step 1
   ●RBS >4 - 15gms of complex carb (yogurt, fruit etc)
2. Unconscious pt-
   ●30ml of 50% IV Glucose
   or
   ●Glucagon 1ml IM/SC

Question 13

DKA in DM

Answer 13

1. Vomiting, abdominal pain, dehydration
2. Severe acidosis - low BP, High PR, High RR
3. Ketones in urine, high RBS
4. Inv - blood ketones, ABG
5. First line mx: IV fluids
6. f/b IV Insulin (10units in 1 hr)