Diabetes Module

Question 1

differentials for T1DM?

Answer 1

T2DM
diabetes insipidus
hypercalcaemia
UTI

Question 2

presentation of diabetes insipidus?

Answer 2

unquenchable thirst

excessive urination

Question 3

prevalence of diabetes insipidus?

Answer 3

very rare

Question 4

what test is done to look for diabetes insipidus? what result is a positive test?

Answer 4

fluid deprivation test

if fluid output did not decrease it’s DI

Question 5

UTI clinical presentation?

Answer 5

frequent urination
painful urination
foul smelling urine

Question 6

why is hypercalcaemia on the differential for T1DM?

Answer 6

can get increased urine frequency and is very dangerous so should exclude

Question 7

clinical presentation for hypercalcaemia?

Answer 7

groans (constipation)
moans (depression/fatigue)
bones (sore)
stones (kidney)

Question 8

how is glucose normally absorbed in the body and where?

Answer 8

it is first passively secreted and then is actively reabsorbed in the kidney

Question 9

what happens to normal glucose absorption mechanisms when there is too much?

Answer 9

not all of it will be reabsorbed in the kidney so it will be excreted in the urine

Question 10

when would a random blood glucose be sufficient for diagnosis if the patient has no symptoms?

Answer 10

if they get over 11.1mmol/l twice

Question 11

main role of HbA1c in diabetes?

Answer 11

to measure long term blood glucose control in known diabetics

Question 12

name 2 diabetes investigations that arent essential for diagnosis?

Answer 12

HbA1c

islet antibodies

Question 13

what are the normal glucose concentration ranges?

Answer 13

3.6-5.8mmol/l

Question 14

how many hormones regulate blood glucose?

Answer 14

5

Question 15

why is hyperglycaemia more common than hypoglycaemia?

Answer 15

4 hormones increase plasma glucose concentration whereas only 1 (insulin) decreases it

Question 16

what biochemical process does insulin stimulate?

Answer 16

glycogenesis

Question 17

what biochemical processes does insulin inhibit?

Answer 17

glycogenolysis
gluconeogenesis
lipolysis

Question 18

what does insulin do to fatty acids?

Answer 18

encourages entry of fatty acids into adipose tissues of the body
promotes chemical reactions that use fatty acids

Question 19

what does a feedback loop mean?

Answer 19

controlled through its own action

Question 20

where is insulin made?

Answer 20

beta cells

Question 21

what happens once insulin is secreted?

Answer 21

stimulates uptake of glucose in peripheral tissues = less glucose in the blood = insulin stops secreting

Question 22

what things other than the feedback loop stop insulin from being released?

Answer 22

sympathetic nervous system eg during exercise

adrenaline

Question 23

name the 4 hormones that increase blood glucose levels

Answer 23

glucagon
adrenaline
cortisol
GH

Question 24

why are diabetic patients tired alot?

Answer 24

poor glycaemic control

Question 25

why do alot of T1D's experience weight loss?

Answer 25

increased lipolysis

Question 26

why do diabetic patients get visual blurring?

Answer 26

glucose can be absorbed by the lens of the eye causing it to change shape

Question 27

infections in which areas are most common to diabetics?

Answer 27

soft tissue GU (thrush) chest

Question 28

what is kussmaul breathing?

Answer 28

hyperventilation as a result of excessive ketones in blood

Question 29

what diabetes is kussmaul breathing foudn in?

Answer 29

T1

Question 30

can you use oral glucose lowering drugs in T1 patients?

Answer 30

no

Question 31

how should diabetic patients inject their insulin?

Answer 31

into the fatty tissue of their abdomen; rotate the needle as they inject

Question 32

is an insulin pump first or second line?

Answer 32

second

Question 33

what birth defect are children with diabetic mothers most liekly to get?

Answer 33

spina bifida and other CNS deformities

Question 34

do babies with diabetic mothers differ in size from normal babies?

Answer 34

tend to be bigger

Question 35

when is diabetes the most teratogenic during pregnancy?

Answer 35

8 weeks

Question 36

can glucose or insulin cross the placenta?

Answer 36

glucose

Question 37

why are babies with diabetic mothers bigger?

Answer 37

glucose crosses the placenta and if the mother has bad diabetic control it will give the baby too many nutrients

Question 38

why are babies of diabetic mums at a higher risk of hypo?

Answer 38

used to a high amount of insulin so are producing lots of insulin and when this is stopped they may get hypo

Question 39

is the risk to monozygotic twins having a concordance higher in T1DM or T2DM?

Answer 39

T2DM

Question 40

is metformin safe during pregnancy?

Answer 40

yes

Question 41

what birth risks should be made to a diabetic?

Answer 41

higher risk of stillbirth, preeclampsia, maternal death

Question 42

is there a correlation between age of diagnosis and decreased life expectancy?

Answer 42

yes

Question 43

clinical requirements for a metabolic syndrome diagnosis?

Answer 43

``` impaired glucose regulation/diabetes insulin resistance hypertension triglycerides >1.7mmol/l glucose intolerance obese ```

Question 44

what is the risk of a woman with gestational diabetes getting type 2?

Answer 44

30%

Question 45

what is acromegaly?

Answer 45

excess GH

Question 46

what is the link between acromegaly patients and diabetes?

Answer 46

1/3rd get it

Question 47

what test is usually done to check for both acromegaly and diabetes in acromegaly patients?

Answer 47

GTT

Question 48

what is cushings?

Answer 48

excess cortisol

Question 49

can diabetes associated with acromegaly and cushings be reversed?

Answer 49

yes potentially if the diseases are controlled well

Question 50

why should a patient with T2DM's protein intake be assessed?

Answer 50

too much protein can overload the kidneys

Question 51

how could you encourgae someone in tayside to exercise?

Answer 51

free membership | diabetic exercise classes

Question 52

what route are sulfonylureas taken?

Answer 52

orally

Question 53

why can't T1DM patients have sulfonylureas?

Answer 53

must be functioning beta cells

Question 54

main risk of sulfonylurea drugs?

Answer 54

hypoglycaemia

Question 55

what other drugs can interfere with the effectiveness of sulfonylurea drugs?

Answer 55

corticosteorids thiazides anti-psychotics

Question 56

what type of drug is metformin?

Answer 56

biguanide

Question 57

why is metformin good for type 2 diabetics?

Answer 57

suppresses appetite and T2's are usually overweight prevents absorption and production of glucose initiates glycolysis

Question 58

side effects of metformin?

Answer 58

``` lactic acidosis nausea vomiting diarrhoea metallic taste ```

Question 59

what comorbidities should you avoid giving metformin in?

Answer 59

``` renal failure alcoholism cirrhosis chronic lung disease cardiac failure ```

Question 60

what do thiaxolidinediones do?

Answer 60

bind to receptors in the nucleus and prevent gene expression

Question 61

name the only TZD licensed in the uk?

Answer 61

pioglitazone

Question 62

when should you give insulin in T2DM?

Answer 62

as a last resort

Question 63

why is insulin dose decreased if the patient has renal failure?

Answer 63

insulin is excreted by the kidneys

Question 64

the somogyi effect can occur when a patient is on what antidiabetic medication?

Answer 64

insulin

Question 65

what is the somogyi effect?

Answer 65

hyperglycaemia prouced by the body in response to hypo straight after insulin injection

Question 66

what tissues are particularly insulin independent?

Answer 66

retina nerves blood vessel walls

Question 67

what does insulin independent mean?

Answer 67

cannot regulate glucose influx so cant control their BGL

Question 68

what is the poyol pathway?

Answer 68

biochemical pathway used by insulin indeoendent tissues to decrease their BGL

Question 69

when will the poyol pathway be activated?

Answer 69

presence of raised intracellular glucose

Question 70

does glucokinase or aldose reductase have the higher KM?

Answer 70

aldose reductase

Question 71

what does aldose reductase do?

Answer 71

converts glucose into sorbitol in the poyol pathway

Question 72

what are you looking for from taking blood in a T2DM patient?

Answer 72

HbA1C

Question 73

what should you look for in a patient's urine who has T2DM?

Answer 73

creatinine | albumin

Question 74

what would proteinuria indicate in a diabetic patient?

Answer 74

kidney damage

Question 75

what could kidney damage in T2DM be from?

Answer 75

diabetic nephropathy | hypertension

Question 76

is glomerular filtration increased or decreased in diabetes?

Answer 76

increased

Question 77

what increases intraglomerular pressure in the kidneys? what is its consequence?

Answer 77

hypertrophic, overworked kidneys afferent arteriole of the kidneys dilates = glomerular sclerosis

Question 78

what are the effects of glomerular sclerosis on the kidneys?

Answer 78

thickening of basement membrane | disruption of normal protein cross links so large molecules can get through = worse filter

Question 79

leading cause of chronic renal failure?

Answer 79

diabetic nephropathy

Question 80

what would increased creatinine indicate?

Answer 80

ACUTE renal failure

Question 81

how often is creatinine measured?

Answer 81

annually

Question 82

what pathway is responsible for the vascular complications in T2DM?

Answer 82

poyol pathway

Question 83

what does hypertension do to the kidneys?

Answer 83

damages glomeruli causing proteinuria

Question 84

what is the BP target for most diabetics?

Answer 84

less than 140/80mmHg

Question 85

what is the BP target for diabetic patients at risk?

Answer 85

less than 130/80mmHg

Question 86

which vascular change is characteristic of diabetes?

Answer 86

capillary microangiopathy

Question 87

what is the effect of capillary microangiography on the body?

Answer 87

thickened, permeable and dilated small blood vessels causing microaneurysms and increased passive diffusion of proteins

Question 88

what vascular complication causes retinpathy, nephropathy and peripheral neuropathy?

Answer 88

capillary microangiopathy

Question 89

good screening questions to ask at review?

Answer 89

snacking between meals | compliance

Question 90

what condition could be causing dry feet and calluses from diabetes?

Answer 90

peripheral nueropathy

Question 91

cause of distended veins at the foot in someone with diabetes?

Answer 91

peripheal neuropathy

Question 92

name the 3 types of neuropathy that can occur in diabetic patients?

Answer 92

hyperglycaemic acute painful diabetic distal symmetrical

Question 93

which neuropathy tends to occur in diabetics with poor glycaemic control?

Answer 93

hyperglycaemic neuropathy

Question 94

clinical presentation of hyperglycaemic neuropathy

Answer 94

discomfort in lower legs

Question 95

when is a patient most likely to get acute painful diabetic neuropathy?

Answer 95

when they have weight loss and bad glycaemic control

Question 96

most common neuropathy?

Answer 96

distal symmetrical

Question 97

which neuropathy presents with the glove and stocking sensation?

Answer 97

distal symmetrical

Question 98

what si the glove and stocking sensation

Answer 98

sensation reduced over extremities of limbs

Question 99

what would you find on the feet of someone with DSN?

Answer 99

warm, dry feet foot ulceration oedema

Question 100

why does diabetic retiniopathy happen?

Answer 100

capillary microangiopathy

Question 101

why do you get dry feet in neuropathy?

Answer 101

nerve damage stops sweating

Question 102

why do you get foot ischaemia in diabetes?

Answer 102

damage to the nerves can lead to arteriovenous shunting which means blood blood bypasses the capillary vessels of the feet

Question 103

where do neuropathic foot ulcers present?

Answer 103

high pressure areas eg metatarsal heads or big toe

Question 104

where do ischemic foot ulcers present?

Answer 104

margins of the feet

Question 105

foot complication of severe neuropathy?

Answer 105

charcot foot

Question 106

which condition has a bag of bone appearance on x ray?

Answer 106

charcot foot