Diabetes mellitus

Question 1

What is Diabetes Mellitus (DM)?

Answer 1

DM is a syndrome characterized by chronic hyperglycemia due to an absolute or relative deficiency of insulin.

Question 2

What is the primary cause of Type I Diabetes Mellitus?

Answer 2

Type I DM is primarily due to autoimmune destruction of pancreatic beta cells, resulting in an absolute insulin deficiency.

Question 3

What distinguishes Type II Diabetes Mellitus from Type I?

Answer 3

Type II DM involves a combination of insulin resistance and a relative insulin deficiency rather than absolute deficiency.

Question 4

What is the prevalence of diabetes in South Africa?

Answer 4

The prevalence is approximately 9.8%, with 7.7% in males and 11.8% in females.

Question 5

What are the diagnostic criteria for diabetes based on fasting plasma glucose (FPG)?

Answer 5

FPG ≥ 7 mmol/L with symptoms indicates diabetes.

Question 6

Name two acute complications of diabetes.

Answer 6

Diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic State (HHS).

Question 7

List three chronic complications of diabetes.

Answer 7

Chronic complications include stroke (CVA), ischemic heart disease (IHD), and peripheral vascular disease (PVD).

Question 8

What is diabetic neuropathy, and what are its two main types?

Answer 8

Diabetic neuropathy is nerve damage due to diabetes, divided into peripheral and autonomic neuropathy.

Question 9

Describe a key aspect of the diabetic foot examination.

Answer 9

The examination includes inspection, checking pulses, assessing sensation, vibration, joint position, and reflexes.

Question 10

Why is foot care critical for diabetic patients?

Answer 10

Proper foot care helps prevent diabetic foot ulcers and infections which can lead to serious complications like gangrene.

Question 11

What is glycated hemoglobin (HbA1c), and what level indicates diabetes?

Answer 11

HbA1c reflects average blood glucose over 2-3 months; a level ≥ 6.5% indicates diabetes.

Question 12

Why should diabetic patients rotate injection sites for insulin?

Answer 12

Rotating sites helps prevent lipodystrophy (dents or lumps) and ensures consistent insulin absorption.

Question 13

What is the primary use of Metformin in diabetes management?

Answer 13

Metformin is used to improve insulin sensitivity and lower blood glucose levels in Type II DM.

Question 14

What is the purpose of testing for urine glucose in diabetes management?

Answer 14

Testing for urine glucose helps monitor glucose control and detect hyperglycemia or hypoglycemia episodes.

Question 15

What are the cardiovascular risk factors for diabetic patients?

Answer 15

Key risk factors include high blood pressure, elevated cholesterol, and increased triglycerides.

Question 16

What lifestyle modification is strongly recommended for individuals at risk of developing Type II DM?

Answer 16

Regular physical activity and dietary changes to manage weight and improve insulin sensitivity.

Question 17

Which test is used to diagnose diabetes by measuring glucose levels after a glucose load?

Answer 17

The Oral Glucose Tolerance Test (OGTT), where a blood glucose level ≥ 11.1 mmol/L 2 hours after a glucose load confirms diabetes.

Question 18

What fasting plasma glucose (FPG) range indicates impaired fasting glucose (IFG)?

Answer 18

FPG between 5.6 and 6.9 mmol/L indicates impaired fasting glucose, a prediabetic state.

Question 19

What role does the hormone glucagon play in diabetes?

Answer 19

Glucagon raises blood glucose by stimulating the liver to release glucose, counteracting insulin’s effects.

Question 20

Name two macrovascular complications associated with diabetes.

Answer 20

Coronary artery disease and peripheral artery disease are major macrovascular complications of diabetes.

Question 21

In diabetic retinopathy, what are the two main types of eye damage?

Answer 21

Non-proliferative retinopathy (with microaneurysms) and proliferative retinopathy (with new, abnormal blood vessel growth).

Question 22

Why is the annual urinary albumin-to-creatinine ratio test important in diabetes?

Answer 22

It screens for early kidney damage (microalbuminuria), allowing for timely intervention to prevent kidney disease progression.

Question 23

What is the significance of a “honeymoon period” in newly diagnosed Type I DM patients?

Answer 23

It’s a temporary phase where insulin needs decrease as some beta cell function briefly returns.

Question 24

What type of diet is generally recommended for Type II diabetic patients?

Answer 24

A diet low in simple sugars and refined carbs and high in fiber, complex carbohydrates, and healthy fats.

Question 25

Name a skin condition commonly associated with diabetes.

Answer 25

Acanthosis nigricans, characterized by dark, thickened patches of skin, usually in skin folds.

Question 26

How often should HbA1c be checked in diabetic patients with stable glucose control?

Answer 26

Every 6 months, though high-risk or uncontrolled patients may need testing every 3 months.

Question 27

What is the main goal of using insulin therapy in Type I DM?

Answer 27

To replace insulin the body cannot produce, helping to manage blood glucose levels effectively.

Question 28

What is “hypoglycemia unawareness” in diabetic patients?

Answer 28

A condition where patients lose the ability to recognize the early symptoms of low blood sugar, increasing risk of severe hypoglycemia.

Question 29

Which type of diabetes is strongly associated with obesity and metabolic syndrome?

Answer 29

Type II Diabetes Mellitus is commonly linked to obesity and metabolic syndrome, as both contribute to insulin resistance.

Question 30

What are the key components of a diabetic foot examination?

Answer 30

The diabetic foot examination includes inspection, checking pulses, sensation tests, vibration perception, joint position sense, reflexes, and ankle joint assessment.

Question 31

Why is foot inspection crucial in diabetic patients?

Answer 31

Diabetic patients are prone to neuropathy and reduced blood flow, which increases the risk of unnoticed injuries, infections, and foot ulcers, potentially leading to severe complications like gangrene.

Question 32

What pulses should be checked during a diabetic foot exam?

Answer 32

The dorsalis pedis and posterior tibial pulses should be checked to assess blood flow to the foot.

Question 33

How is sensation tested in a diabetic foot examination?

Answer 33

Sensation is tested using tools like monofilaments, which help detect reduced sensitivity that may indicate neuropathy.

Question 34

Why is vibration perception important in a diabetic foot exam?

Answer 34

Vibration perception is tested to assess nerve function, as loss of this sensation is an early indicator of peripheral neuropathy in diabetic patients.

Question 35

What does testing joint position sense reveal in diabetic patients?

Answer 35

Joint position sense tests proprioception, which can be impaired in patients with diabetic neuropathy, increasing their risk of falls and foot injuries.

Question 36

How often should diabetic patients examine their feet?

Answer 36

Patients should check their feet daily for any signs of changes or injuries to prevent infections or complications.

Question 37

What footwear recommendations are made for diabetic patients to protect their feet?

Answer 37

Diabetic patients are advised to wear supportive shoes and socks to prevent injuries and deformities; they may also benefit from custom orthotics if prescribed by a podiatrist.

Question 38

What lifestyle habit is discouraged in diabetic patients to prevent foot complications?

Answer 38

Diabetic patients are advised to avoid smoking, as it can accelerate both macrovascular and microvascular complications, worsening blood flow issues in the feet.

Question 39

What additional care is recommended for diabetic patients regarding foot hygiene?

Answer 39

Daily washing, careful nail trimming, and proper care for corns and bunions are recommended to reduce infection risks and maintain foot health.

Question 40

A 55-year-old man with Type 2 diabetes presents with numbness and tingling in his feet. What complication is most likely responsible?

Answer 40

Diabetic neuropathy, a common complication affecting peripheral nerves due to prolonged hyperglycemia.

Question 41

A 62-year-old woman with poorly controlled diabetes complains of frequent urination, thirst, and fatigue. What is the likely cause?

Answer 41

Hyperglycemia, leading to osmotic diuresis, which causes polyuria, polydipsia, and fatigue.

Question 42

A 45-year-old diabetic patient is found to have poor dorsalis pedis pulses bilaterally. What could this indicate?

Answer 42

Peripheral vascular disease (PVD), a macrovascular complication common in diabetes due to atherosclerosis.

Question 43

A 68-year-old man with diabetes presents with sudden vision loss in one eye. What complication should be suspected?

Answer 43

Diabetic retinopathy, which can lead to retinal hemorrhages and sudden vision changes.

Question 44

A patient with diabetes presents with dry, cracked skin on their feet. Why is this a concern?

Answer 44

Dry skin can lead to cracks, which increase the risk of infections, particularly in diabetic patients with neuropathy.

Question 45

A 40-year-old diabetic woman reports pain in her calves while walking, which resolves with rest. What is the likely diagnosis?

Answer 45

Claudication due to peripheral arterial disease, a common issue in diabetic patients with compromised circulation.

Question 46

A 70-year-old diabetic man complains of episodes of sweating, tremors, and confusion after missing meals. What is the likely cause?

Answer 46

Hypoglycemia, potentially due to insulin or oral hypoglycemic medications without adequate food intake.

Question 47

A diabetic patient has recurrent episodes of foot infections that are slow to heal. What could be contributing to this?

Answer 47

Poor blood glucose control can impair immune function, increasing the risk of infections and delaying wound healing.

Question 48

A 50-year-old diabetic woman presents with loss of vibration sensation in her toes. What test might confirm this finding?

Answer 48

Tuning fork test, which can reveal diminished vibration sense, indicating peripheral neuropathy.

Question 49

A patient with Type 2 diabetes reports chest pain and shortness of breath. What complication should be considered, even if they have minimal pain?

Answer 49

Silent myocardial infarction, as diabetic neuropathy can cause atypical presentation of cardiac ischemia.

Question 50

A 65-year-old man with a history of poorly controlled diabetes presents with leg swelling, jugular venous distention, and decreased breath sounds. What complication is likely?

Answer 50

Diabetic cardiomyopathy or congestive heart failure, possibly due to longstanding diabetes leading to heart muscle dysfunction.

Question 51

A diabetic patient complains of blurry vision but no pain. Fundoscopy reveals microaneurysms and dot hemorrhages. What stage of retinopathy does this indicate?

Answer 51

Non-proliferative diabetic retinopathy, characterized by microvascular changes like microaneurysms and hemorrhages.

Question 52

A 58-year-old diabetic patient presents with a red, swollen foot but reports no pain. What underlying condition might this suggest?

Answer 52

Charcot foot, a severe complication of diabetic neuropathy, where repeated minor trauma goes unnoticed due to loss of sensation.

Question 53

A diabetic patient presents with lightheadedness and nausea upon standing. What is the likely cause?

Answer 53

Autonomic neuropathy, which can cause postural hypotension due to impaired vascular regulation.

Question 54

A diabetic patient reports frequent nocturnal sweating, nightmares, and morning headaches. What phenomenon could be responsible?

Answer 54

The Somogyi effect, where nocturnal hypoglycemia triggers a rebound hyperglycemia in the morning.

Question 55

A patient with diabetes has been experiencing delayed wound healing on their lower extremities despite proper hygiene. Laboratory results reveal high triglycerides and low HDL cholesterol. What factor is likely contributing?

Answer 55

Dyslipidemia, common in diabetes, which can worsen vascular health and impede wound healing.

Question 56

A patient presents with intermittent diarrhea, bloating, and abdominal discomfort. They have a longstanding history of diabetes. What condition might explain these symptoms?

Answer 56

Diabetic autonomic neuropathy affecting the gastrointestinal tract, leading to gastroparesis or diabetic enteropathy.

Question 57

A 45-year-old diabetic patient has blood glucose levels within the target range but exhibits irritability, confusion, and dizziness. What could explain this?

Answer 57

Hypoglycemia unawareness, a condition where the patient does not recognize the early symptoms of low blood glucose, which can occur in longstanding diabetes.

Question 58

A 62-year-old diabetic man has dry gangrene of the toes and diminished pulses. What is the primary mechanism behind this condition?

Answer 58

Peripheral arterial disease with ischemia, often due to atherosclerosis accelerated by diabetes.

Question 59

A diabetic patient with high blood pressure and proteinuria on urinalysis is noted. What complication is developing, and how should it be managed?

Answer 59

Diabetic nephropathy; management should focus on blood pressure control, glycemic control, and potentially ACE inhibitors or ARBs to reduce kidney damage.