Diabetes mellitus

Question 1

The classic symptoms of uncontrolled diabetes are:

Answer 1

polyuria (every hr or so)

polydipsia

loss of weight (type 1)

tiredness and fatigue

propensity for infections, esp. of the skin and genitals

Note: For every diagnosed diabetic there is at least one undiagnosed diabetic.

Question 2

Diagnosis

Answer 2

Fasting venous plasma glucose ≥7.0 mmol/L on two occasions or once if symptomatic

Random venous plasma glucose ≥11.1 mmol/L on two occasions or once if symptomatic

HbAlc > 6.5% (> 48 mmol/mol).

In asymptomatic or mildly symptomatic patients, the diagnosis is made on two separate elevated readings, either:

• a fasting test or
• 2 or more hrs postprandial (or the 2 values from an oral glucose tolerance test)

If random or fasting VPG lies in uncertain range (6.0–11.0 mmol/L) in either a symptomatic pt or one with risk factors, perform an OGTT.

Question 3

Diagnostic guidelines

Answer 3

Fasting serum glucose 2 hour serum glucose Interpretation

<6.0 mmol/L <7.8 mmol/L Normal glucose metabolism

>7.0 mmol/L >11.1 mmol/L Diabetes mellitus

Question 4

Management

Answer 4

The three key tasks:

1. Achieve strict glycaemic control (HbA1c ≤7%)
2. Achieve BP ≤130/80 mmHg (≤125/75 if proteinuria)
3. Achieve control of blood lipid levels

Question 5

Management

Both type 1 (IDDM) and type 2 (NIDDM):

Answer 5

patient education, reassurance and support

consider diabetic educator, dietitian

dietary control vital

exercise also very important

referral to ophthalmologist

Goals of management

Question 6

Goals of management of diabetes mellitus

Answer 6

Fasting blood glucose (ideal) 4.0–6.0 mmol/L

NHMRC recommendation 6.1–8.0 mmol/L

HbAIC % <7.0% (53 mmol/L)

Total cholesterol <4.0 mmol/L

LDL cholesterol <2.0 mmol/L

HDL cholesterol ≥1.0 mmol/L

Triglycerides <2.0 mmol/L

Blood pressure

• Without proteinuria <130/80 mm/Hg
• With proteinuria (1 g/day) <125/75 mm/Hg

BMI 18–25 (where practical)

Urinary albumin excretion

• Timed overnight collection <20 mcg/min
• Spot collection <20 mg/L

Albumin creatinine ratio

• Men <2.5 mg/mmol
• Women <3.5 mg/mmol

Cigarette consumption zero

Alcohol intake

• Men and women ≤2 standard drinks/day (≤20 g/day)

Exercise:

• At least 30 mins moderate exercise 5 or
• more times a week (total 150 mins/wk)

Question 7

Diet

Answer 7

Type 1 pts often require three meals and regular snacks each day.

Type 2 pts usually require less food intake and restriction of total intake.

Question 8

Principles of dietary management

Answer 8

Keep to a regular nutritious diet (follow GI index foods)

Achieve ideal body weight

Reduce calories (kilojoules), i.e. added sugar, dietary fat

Increase proportions of vegetables, fresh fruit, cereal foods

Follow a low carbohydrate, healthy fat diet