Diabetes Mellitus

Question 1

Pathophysiology of type 1 and type 2 diabetes mellitus?

Answer 1

Type 1 DM - hyperglycaemia due to deficiency of insulin production (autoimmune destruction of beta cells in 90% cases)

Type 2 DM - hyperglycaemia due to increased peripheral resistance to insulin action

Question 2

Presentation of T1DM?

Answer 2

Polyuria + polydipsia

• tiredness
• weight loss
• diabetic ketoacidosis (separate card)

Question 3

Presentation of T2DM?

Answer 3

Polyuria + polydipsia

Question 4

Risk factors for T1DM?

Answer 4

HLA DR3/4

Presence of other autoimmune conditions

Question 5

Risk factors for T2DM?

Answer 5

Obesity
Family history
Ethnicity (african/asian american)
Drugs

Question 6

Investigations for diabetes mellitus?

Answer 6

Blood glucose measurements
- fasting
- random
Oral glucose tolerance test (OGTT)

Question 7

Diagnosis of diabetes mellitus?

Answer 7

Fasting blood glucose ≥7

Random blood glucose >11.1

Question 8

Values for impaired fasting glucose and impaired glucose tolerance?

Answer 8

Impaired fasting glucose = 6.1-6.9

Impaired glucose tolerance = 2 hours after OGTT plasma glucose between 7.8-11 and fasting glucose <7

Question 9

Management of T1DM?

Answer 9

Insulin

Patient education

Question 10

Management of T2DM?

Answer 10

1st line = diet and lifestyle

2nd line = metformin +/- sulphonylurea (glimepiride) +/- insulin

Question 11

Complications of T1/T2DM and which is more common in each?

Answer 11

T1DM - diabetic ketoacidosis (DKA)

T2DM - hyperosmolar hyperglycaemic state (HHS)

Hypoglycaemia (specifically diabetic hypoglycaemia) can occur in both T1/T2 DM by over-treatment or delayed meals/alcohol/exercise

Question 12

Presenting symptoms of diabetic ketoacidosis?

Answer 12

Nausea and vomiting
Abdo pain
Kussmaul breathing (metabolic acidosis)
Sweet breath (ketones)

Question 13

1st line management of DKA?

Answer 13

IV fluids

- priority is to restore fluid volume and electrolyte balance