Diabetes mellitus - Presentation & Management

Question 1

How does type 1 Diabetes usually present?

Answer 1

Polyuria/Nocturia
Polydipsia
Weight loss
Usually in younger patients, acute presentation with short duration of symptoms

Question 2

How does type 2 Diabetes usually present?

Answer 2

Polyuria/Nocturia
Polydipsia
Tired
Usually in older patients, subacute presentation with more chronic duration of symptoms

Question 3

What is the pathology of type 1 Diabetes?

Answer 3

Autoimmune destruction of B cells in islet of langerhans causing decreased insulin secretion

Question 4

What is the pathology of type 2 Diabetes?

Answer 4

Insulin resistance with some reduction in insulin secretion and pancreatic function

Question 5

What are some of the risk factors for type 2 Diabetes?

Answer 5

Obesity
Lack of physical activity
Hx of Gestational diabetes
Impaired glucose tolerance
Low fibre diet
Metabolic syndrome
FH

Question 6

What concentration of glucose (fasting) is diagnostic of Diabetes?

Answer 6

7 mmol/L or above

Question 7

What concentration of glucose (random) is diagnostic of Diabetes?

Answer 7

11 mmol/L or above

Can give 75g of glucose and if 11.1 or above also diagnostic of Diabetes

Question 8

What is the management of Diabetes?

Answer 8

Patient education about the disease and its complications
Lifestyle advice - Loose weight and exercise more, smoking cessation
Reduction of risk factors for the complications of Diabetes eg manage HTN, hyperlipidaemia
Monitoring for complications of Diabetes
Type 1 - Insulin regime
Type 2 - Metformin, Gliclazide, Insulin

Question 9

What is an acute complication of untreated type 1 Diabetes?

Answer 9

Diabetic Ketoacidosis (Nausea/Vomiting, confusion, widespread abdominal pain, increased resp rate)

Question 10

What is an acute complication of untreated type 2 Diabetes?

Answer 10

Hyperosmolar Hyperglycaemic state - HHS, previously called HONK (Hyoerosmolar, non ketotic state)
Weakness, visual impairment, nausea/vomiting, lethargy, confusion, dehydration

Question 11

What is a common trigger of DKA/HHS?

Answer 11

Infection

Question 12

What are the chronic complications of Diabetes?

Answer 12

Diabetic neuropathy
Diabetic Nephropathy
Diabetic retinopathy
CVD, PAD, CV events
Diabetic ulcers
Frequent infections
Lengthened healing time