Diabetes Mellitus

Question 1

What is a normal value for HbA1c?`

Answer 1

Below 6% or 42 mmol/mol

Diabetis above 6,5% or 48 mmol/mol

Question 2

What are normal cholesterol levels?

Question 3

What are normal fasting glucose levels?

Question 4

Which grouops can not be diagnosed by a HbA1c levels?

Answer 4

• children
• pregnant
• on steroids
• anaemia/ haemoglinopathies
• asymptomatic, less than 2 months

Question 5

What is a Q score?

Answer 5

Score calculate for a CVS disease risk within the next 10 years (hear Attack and stroke)

Question 6

Define Diabetis Mellitus

Answer 6

Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance (that is, the body’s inability to effectively use insulin) and insufficient pancreatic insulin production, resulting in high blood glucose levels (hyperglycaemia).

Question 7

What are the risk factors for developing diabetis Mellitus?

Question 8

What are systemic signs of diabetis mellitus on physical examination

Answer 8

• acanthosis nigricans (sign of insulin resistance)
• risk factor: obseity
• irritation of foreskin
• thirst, polyuria, blurred vision, weight loss, recurrent infections, and tiredness

Question 9

Why is blurred vision a symtom of diabetis mellitus?

Answer 9

Osmotic effects on the lens of the eye may alter refraction and blur vision.

Question 10

What type of infection are people with DMT2 more prone to?

Answer 10

Generally more susptible to gential fungal infections + other UTIs (due to glycouria)

Question 11

What is the first line treatment to Diabetis?

Answer 11

Lifestyle intervention

• advise about healthy dieat (avoid refined carbohydrates, high fibres)
• encourage exercise
• Screening for diabetic complications

Question 12

What is the best first line treatment in patients with T2DM?

Answer 12

Metformin (for obese patients)

Question 13

What is the MOA of Metformin?

Answer 13

Activated AMP- activated protein kinase (AMPK)

• facilitation of GLUT-4 opening

1. Decreases Hepatic glucose production
2. Decrease intestinal glucose absorbtion
3. Improved insulin sensitivity

Question 14

What are the side effects of Metformin?

Answer 14

1. GI side-effects
   
   1. nausea, diarrhoea
   2. might be limited by using small dose first, then increasing
2. Lactic acidosis
   
   1. potentially fatal
   2. only seen if prescribed with contra-indication (e.g. renal failure)

Question 15

Next to metformin, what other drug classes can be used in the treatment of T2DM?

Answer 15

1. Sulphonamides
2. thiazolidinediones (glitazones
3. sulphonylurea therapy (increase endogenous insulin secretion) or subcutaneous insulin
4. AND OTHERS

Question 16

What is a typical lipid profile for a diabetic patient?

Answer 16

low HDL cholesterol + high triglycerides

–> very high risk of CVD

Question 17

What does the albumin: creatinine ration show?

Answer 17

Compares amounts of albumin vs Creatinine in urine

• normal ratio of albumin to creatinine is seen to be around less than 30 mg/g of creatinine.
  
  • 30mg/g - 300mg/g : microalbuminurea
  • >300mg/g macroalbuminurea

Sign of kidney damage, done in diabetis screening