Diabetes mellitus

Question 1

What is diagnostic for diabetes mellitus ?

Answer 1

Random blood glucose greater than 11.1 mmol with symptoms. x2 without symptoms
Fasting glucose > 7mmol
HbA1c >48mmol

Question 2

What investigations would you arrange if you were considering new diagnosis of diabetes mellitus?

Answer 2

blood glucose, blood ketones
Blood gas. U+E, TFTs, coeliac screen, diabetes autoantibodies

Question 3

What yearly test do patients with type 2 diabetes mellitus require?

Answer 3

Urine protein:creatinine ratio
retinopathy screen

Question 4

What is the blood glucose target when driving?

Answer 4

At least 5mmol

Question 5

What is the formula for calculating what total daily dose (TDD) of insulin is required? What % of this should be the am bolus dose?

Answer 5

0.5–0.75 units/kg/day
30-40%

Question 6

How does hepatic nuclear factor 1 MODY present?

Answer 6

Patients usually present initially with post prandial hyperglycaemia that then develops into frank diabetes mellitus with typical symptoms.

Question 7

How does Glucokinase MODY present?

Answer 7

Patients present with non-progressive mild hyperglycaemia which is usually detected incidentally. It is a benign condition and therefore does not require any treatment or further monitoring.

Question 8

What are the diagnostic features of DKA?

Answer 8

BM> 11.1 mmol/l)
pH less than 7.3 or bicarbonate <15 mmol/l
ketonemia or a moderate to large ketonuria

Question 9

Define severe DKA

Answer 9

pH less than 7.1 or serum bicarbonate below 5 mmol/l

Question 10

Define mild DKA

Answer 10

pH less than 7.3 or serum bicarbonate below 15 mmol/l

Question 11

Define moderate DKA

Answer 11

pH less than 7.2 or serum bicarbonate below 10 mmol/l

Question 12

How much fluid defecit should you assume a patient in DKA is in?

Answer 12

Mild and moderate DKA: assume 5% dehydration
Severe DKA: assume 10% dehydration