Diabetes Mellitus

Question 1

Define T1DM

Answer 1

Autoimmune destruction of B cells causing absolute insulin deficiency

Question 2

How does T1DM present?

Answer 2

Polyuria
Polydipsia
Wt loss
Lethargy
Can present as DKA

Question 3

What is associated with T1DM?

Answer 3

Other autoimmune conditions

HLA-D3 and HLA-D4,

Question 4

Define T2DM

Answer 4

Insulin resistance with B cell dysfunction causing relative insulin deficiency

Question 5

How does T2DM present?

Answer 5

Polyuria
Polydipsia
Lethargy
Complications, HHS (Hyperosmolar, Hyperglycaemia State)

Question 6

What is T2DM associated with?

Answer 6

Obesity
Low exercise
Calorie + Alcohol excess

Question 7

How can you diagnose DM in a symptomatic patient?

Answer 7

↑ plasma venous glucose detected once
- Fasting ≥7mM
- Random ≥11.1mM
HbA1C - above 6.5% (Above 48mmol/mol)

Question 8

How can you diagnose DM in an asymptomatic patient?

Answer 8

↑ venous glucose on 2 separate occasions
- Or, 2h OGTT ≥ 11.1mM
HbA1C - above 6.5% (Above 48mmol/mol)

Question 9

What are some of the secondary causes of DM?

Answer 9

Drugs - Steroids, Thiazides, Atypical neuoletics
Pancreatic disorders - CF, Cancer, Chronic pancreatitis
Endocrine disorders - Acromegaly, T4, Cushings, Phaechromocytoma
Glycogen storage diseases

Question 10

What it Metabolic syndrome?

Answer 10

Central obesity (↑ waist circumference) and two of:

• ↑ Triglycerides
• ↓ HDL
• HTN
• Hyperglycaemia

Question 11

What monitoring should be done in a patient with DM?

Answer 11

4 C’s
Control (glycaemic) - HbA1C 45-50 mmol/mol (6.3-6.7%). BP, Lipids, Capillary blood glucose fasting: 4.5-6.5mM
Complications - Macrovascular Vs Microvascular - Pulses, BP, CVS, Fundoscopy, U+Es, Foot check
Competency - Injection technique, Injection sites, BM monitoring
Coping - Psychosocial, Occupation, Domestic

Question 12

What lifestyle modifications should be done in a patient with DM? DELAYS

Answer 12

DELAYS
D - Dietary changes - Decrease fat, Na and calories
E - Exercise more
L - Lipids - Primary prevention with statins if > 40 y/o
A - Ambulatory BP - 50 y/o
Y - Yearly/6monthly check up
S - Smoking cessation

Question 13

What anti hypertensive is best for treating HTN in DM?

Answer 13

ACEi
β-B mask hypoglycaemic state
Thiazides ↑ glucose

Question 14

What education groups exist for patients with T1DM?

Answer 14

DAFNE

Dose Adjustment For Normal Eating

Question 15

What education groups exist for patients with T2DM?

Answer 15

DESMOND

Diabetes Education and Self Management for Ongoing and Diagnosed