Diabetes Mellitus

Question 1

Main side effects of Biguinides (e.g. Metformin)

Answer 1

Lactic Acidosis

GI disturbances e.g. diarrhoea

Question 2

Main Side effects of Sulfonylureas (e.g. Gliclazide)

Answer 2

Hypoglycaemia

Weight Gain

Question 3

Main side effects of Thiazolidinediones (e.g. Pioglitazone)

Answer 3

Weight gain

Fluid retention

Worsening heart failure

Question 4

Main side effects of SGLT2 Inhibitors (e.g. Dapgliflozin)

Answer 4

DKA when used with insulin

Higher risk of urinary tract infections

Question 5

Main Side effects of DPP4-Inhibitors (e.g. Sitagliptin)

Answer 5

Hypoglycaemia

GI upset

Question 6

Main side effects of GLP1 analogues (e.g. Exenatide)

Answer 6

Pancreatitis when used with Thiazolidinediones (e.g. Pioglitazone)

Hypoglycaemia

GI upset

Question 7

Main side effects of Intestinal alpha-glucosidase inhibitors (e.g. Acarbose)

Answer 7

Flatulence

GI disturbance

Question 8

Diabetes Mellitus Diagnosis

Answer 8

If symptomatic one of the following results is sufficient:
- Random blood glucose =11.1mmol/l
- Fasting plasma glucose =7mmol/l
- 2 hour glucose tolerance =11.1mmol/l
- HbA1C =48mmol/mol (6.5%)
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If the patient is asymptomatic two results are required from different days.

Question 9

Impaired glucose tolerance vs. impaired fasting glucose

Significance

Answer 9

Impaired fasting glucose: a fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l

impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

patients with IGT are more likely to develop T2DM and cardiovascular disease than patients with IFG

Question 10

Diabetes HTN management

What do you use

Aims?

Answer 10

ACE inhibitors

NICE recommend the following blood pressure targets for diabetics:
if end-organ damage (e.g. renal disease, retinopathy) < 130/80 mmHg
otherwise < 140/80 mmHg

Question 11

What bacteria usually affects diabetic ulcers?

Answer 11

Pseudomonas

Question 12

Painful Diabetic neuropathy management

Answer 12

1. tricyclics (Amitriptyline)
2.
-pregabalin
-gabapentin
-opiates (tramadol) 
-SNRI's such as Duloxetine.

Question 13

Gastroparesis

Pathology

Answer 13

Gastroparesis is a recognised gastro-intestinal complication of diabetes, related to poor glycaemic control.

It is caused by nerve damage to the autonomic nervous system.

The vagus nerve is responsible for controlling the gastric muscles and if this is damaged can lead to

Question 14

Gastroparesis

Clinical Features

Answer 14

delayed gastric emptying

offensive egg smelling burps due to bacterial overgrowth

early satiety

abnormal stomach wall movements

morning nausea and fluctuations in blood glucose levels as there is often a mismatch between food ingested food a meal and the insulin dose being injected that would normally be intended to cover the glucose rise after eating that meal.

Question 15

Gastroparesis

Management

Answer 15

Treatment includes the use of motility agents such as

• metoclopramide or domperidone
• tight glycaemic control
• antibiotics such as Erythromycin to kill off the bacterial overgrowth
• botox injections to relax the gastric outflow obstruction.
• Gastric pacemakers are occasionally used if all else fails.