Diabetes Mellitus

Question 1

What is Diabetes mellitus?

Answer 1

= Metabolic disorder with multiple causes characteristic by chronically elevated blood glucose (hyperglycaemia) levels, with disturbances of carbohydrate, fat and protein
metabolism (endocrine disease)

Question 2

What are the associated co-morbilities of Diabetes?

Answer 2

• Blindness
• non-traumatic limb amputation
• Cardiovascular disease
• Renal dialysis
• CKD

Question 3

What is type 1 diabetes?

Answer 3

Type 1 = Absolute deficiency of insulin caused by pancreatic B cell destruction

Question 4

What is Type 2 diabetes?

Answer 4

= caused by combination of:

• peripheral resistance of no insulin action
• inadequate secretory response by pancreatic B cells

Question 5

What is gestational diabetes?

Answer 5

= glucose intolerance with onset or first recognition during pregnancy

• increase risk of maternal complications such as pre-clampsia

Question 6

Symptoms of diabetes?

Answer 6

• Hyperosmolar effects of excessive glucose in
  blood stream (diuresis)
• Polyuria, polyphasia, polydipsia
• frequent infections
• Poor wound healing
• Signs of insulin resistance- hyperpigmentation of skin, skin tags, central obesity

Question 7

Chronic complications of diabetes?

Answer 7

KNIVES
K - Kidneys
N - Nerves
I - Infections
V - Vasculature
E - Eyes
S - Skin

Question 8

OGTT results Fasting

• Diabtes
• Normal NGT
• Impaired fasting glucose

Answer 8

Diabetes >7

Normal <6.1

Impaired fasting glucose 6.1-6.9

Question 9

What are the three aspects for glycaemia management to BG control in T2DM?

Answer 9

1. Diet
2. Exercise
   3 Medications - oral or injectable

Question 10

Indications for insulin

Answer 10

• type 1 diabetes

- type 2 where inadequately controlled with diet, exercise and oral anti-diabetic drugs

Question 11

What are the two common regimes for insulin (glycaemia management)

Answer 11

1. Split mix

2. Basal Bolus

Question 12

What is split mix and what are ads and Dis?

Answer 12

= 2 injections per day using mixed insulin preparations
- given before breakfast and dinner

Advantages:

• simple and convenient
• lower risk of hypos

Disadvantages

• decreased flexibility
• cannot skip meals

Question 13

What is Basal Bolus and what are ad and dis?

Answer 13

= 4 injections per day.

• 3 injections short acting insulin before meals
• once daily (nightime) injections of long acting insulin

Advantages:

• flexibility
• better BSL control

Disadvantages:

• regular BSL monitoring
• fails to cover snacks
• higher risk of hypos

Question 14

What are the four types of insulin?

Answer 14

Raid acting
Short acting
Intermediate action
Long acting

Question 15

What are the injectable glycemic management medications?

Answer 15

• Insulin
• GLP-1 Antagonists
• DPP-4 inhibitors
• GLP1-GIP agonists

Question 16

What are the oral glacemia management?

Answer 16

• Biguanides
• Thiazolidinediones
• sulfonylureas
• alpha glucose dash
• SGLT2 inhibitors