Diabetes Mellitus

Question 1

What is the normal fasting blood glucose levels?

Answer 1

< 6.1 mmol/L

Question 2

What is the fasting blood glucose level for prediabetes?

Answer 2

6.1 - 6.9 mmol/L

Question 3

What is the fasting blood glucose level for diabetes?

Answer 3

7+ mmol/L

Question 4

What is the normal 2h postprandial blood glucose level?

Answer 4

< 7.8 mmol/L

Question 5

What is the 2h postprandial blood glucose level for prediabetes?

Answer 5

7.8 - 11 mmol/L

Question 6

What is the 2h postprandial blood glucose level for diabetes?

Answer 6

11.1 mmol/L

Question 7

What is a normal HbA1c?

Answer 7

< 43 mmol/mol

Question 8

What is a prediabetic HbA1c?

Answer 8

43 - 47 mmol/mol

Question 9

What is a diabetic HbA1c?

Answer 9

> 48mmol/mol

Question 10

How would you treat prediabetes? (3)

Answer 10

• NO MEDICATION
• Lifestyle advice (diet, exercise, weight loss)
• Annual review

Question 11

What is type 2 diabetes mellitus (T2DM) (2)

Answer 11

Inappropriately low insulin + peripheral insulin resistance

Question 12

What is T2DM caused by? (2)

Answer 12

Insulin resistance/ beta-cell dysfunction

Question 13

What are the risk factors for T2DM? (7)

Answer 13

Male
Asians
Obesity
Genetics
Lack of exercise
Elderly
High-calorie intake

Question 14

What are the symptoms of T2DM?

Answer 14

• Asymptomatic!

- If very severe, develop signs of hyperglycaemia

Question 15

How would you investigate T2DM? (4)

Answer 15

• Random glucose
• Fasting glucose
• 2H Postprandial glucose
• Finger-prick HbA1c test

Question 16

How do you treat T2DM? (5)

Answer 16

Lifestyle changes: weight loss, exercise, healthy diet
If no change ie HbA1c rises to 58mmol/mol =
- Biguanide (metformin)
- Gliclazide (sulfonylurea)/ DPP4i (sitagliptin)
- + insulin

Question 17

What is type 1 diabetes mellitus (T1DM)?

Answer 17

Insulin deficiency from autoimmune beta-cell destruction

Question 18

When is the onset of T1DM?

Answer 18

Adolescent onset

Question 19

What are the clinical presentations of T1DM? (4)

Answer 19

Hyperglycaemia

• Polydipsia (thirst)
• Polyuria
• Unexplained weight loss
• Lethargy

Question 20

How do you investigate T1DM? (3)

Answer 20

• Blood/ urine: low glucose, high ketones
• Autoantibodies
• C-peptide levels: low

Question 21

How do you treat T1DM?

Answer 21

Insulin!

Question 22

What causes diabetic ketoacidosis (DKA)?

Answer 22

Insufficient insulin (only in T1DM)

Question 23

What are the clinical presentations of DKA? (3)

Answer 23

• Fruity breath
• Kussmaul breathing (deep + rapid breathing)
• Dehydration

Question 24

How would you diagnose DKA? (3)

Answer 24

Blood:

• Acidotic
• Hyperglycemic
• Ketonemic

Question 25

How would you treat DKA? (3)

Answer 25

- Fluids - Insulin - Electrolyte replacement (K+)

Question 26

What is hypoglycaemia?

Answer 26

Too much insulin/ oral hypoglycemic agents

Question 27

What are the clinical presentations of hypoglycaemia? (4)

Answer 27

- Odd behaviour (aggression) - Sweating - Raised pulses - Seizures

Question 28

How would you treat hypoglycemia? (2)

Answer 28

Glucose (give food/ IV infusion) | Glucagon

Question 29

What is hyperglycaemic hyperosmolar state (HHS)?

Answer 29

Insufficient oral hypoglycemic agents (hyperglycemia causes high osmolarity w/out significant ketoacidosis)

Question 30

What are the clinical presentations of HHS? (2)

Answer 30

Signs of dehydration (dizzy, palpitations)

Question 31

How would diagnose HHS?

Answer 31

Blood glucose test

Question 32

How would you treat HHS? (3)

Answer 32

``` LMWH prophylaxis (anticoagulation) Fluids ``` *insulin (only if severe)

Question 33

Which (T2DM) medications cause weight loss?

Answer 33

Biguanide (metformin)

Question 34

Which (T2DM) medications cause weight gain?

Answer 34

Gliclazide (sulfonylurea) | Glitazone (pioglitazone)

Question 35

Which (T2DM) medications don’t cause any weight change?

Answer 35

DPP4i (sitagliptin)