Diabetes Questions Flashcards
A 19-year-old man presents to the Emergency Department (ED) in the early hours of the morning looking very confused. The on-call doctor tries to take a history from the man however he has trouble speaking. He is unable to walk in a straight line and keeps bumping into other people in the ED. His girlfriend who has accompanied him informs the doctor that he recently contracted malaria for which he was taking quinine sulfate. Which of the following is the most appropriate first-line investigation for this man?
Thyroid Function Test FBC Troponin Blood glucose Liver Function tests
Blood glucose
Hypoglycaemia is commonly mistaken for being ‘drunk’ and so blood glucose measurement should always be part of initial assessment.
While working on a paediatrics ward as a junior doctor you are looking after 2-year-old boy with X-linked nephrogenic diabetes insipidus. He was recently diagnosed after his parents noticed that he was experiencing excessive polydipsia and polyuria. What is the pharmacological treatment of choice in this condition from the list below?
Desmopressin Vasopressin Terlipressin Chlorothiazide Furosemide
Chlorothiazide
Nephrogenic diabetes insipidus on the other hand is caused by the kidneys inability to respond to vasopressin. This means giving a patient synthetic vasopressin will be ineffective. It may seem paradoxical that a thiazide diuretic would be a treatment for this condition as polyuria is a symptom of the disorder.
DI leads to the production of vast amounts of dilute urine which is dehydrating and raises the plasma osmolarity, stimulating thirst. The effect of the thiazide causes more sodium to be released into the urine. This lowers the serum osmolarity which helps to break the polyuria-polydipsia cycle.
You are reviewing a 57-year-old man who was diagnosed with type 2 diabetes mellitus around four months ago. At the time of diagnosis his HbA1c was 54 mmol/mol (7.1%). He was started on metformin and the dose was titrated up. At what threshold should you consider adding a second agent?
58 mmol/L (7.5%)
Your next patient is a 74-year-old woman who is known to have type 2 diabetes mellitus. Her blood pressure has been borderline for a number of weeks now but you have decided she would would benefit from treatment. Her latest blood pressure is 146/88 mmHg, HbA1c is 7.5% and her BMI is 25 kg/m^2. What is the most appropriate drug to prescribe?
Bisoprolol
Amlodipine
Ramipril
Orlistat
Ramipril
A 30 year old type 2 diabetic presents to the diabetics clinic advising that she wishes to become pregnant. The patient normally has good glycaemic control and is currently being treated with metformin and gliclazide.
What advice should you give her about potential changes to her medication during pregnancy?
Metformin can be continued but gliclazide must be stopped
In the management of type 2 diabetes in pregnancy ‘women with pre-existing diabetes can be treated with metformin, either alone or in combination with insulin’
A 46-year-old man comes to see you complaining of feeling more tired than usual. He is worried that he may have developed diabetes like his father. You order a set of blood which show a HbA1c of 45 mmol/mol.
Which one of the following is the best course of action?
Discuss diet and exercise
Start metformin 1g BD
Reassure and advise repeat in 6 weeks
Refer to endocrinologist
Discuss diet and exercise
therapy to treat proliferative retinopathy. What should his target blood pressure be?
<140/85
<130/80
<130/85
<140/90
<130/80
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
A 62-year-old gentleman with a background of myocardial infarction, congestive heart failure and chronic obstructive pulmonary disease attends for a diabetes review at his GP. He has recently been diagnosed with type 2 diabetes mellitus and despite a trial of lifestyle modifications his HbA1c is 56 mmol/mol. His GP decides to commence drug treatment.
Which of the following drugs would be contraindicated for this patient?
Metformin Sitagliptin Pioglitazone Insulin Gliclizide
Pioglitazone
A 19-year-old female arrives at your clinic with flu-like symptoms, she has recently been diagnosed with type 1 diabetes and has come for advice regarding her diabetes management whilst she is ill. Which of the following options is one of the ‘sick-day rules’ insulin-dependent diabetics should adhere to during illness?
reduce insulin doses
monitor glucose as normal
aim to drink at least 3L of fluid
check urinary ketones at start of illness
aim to drink at least 3L of fluid
Which of the following results establishes a diagnosis of diabetes mellitus?
- Asymptomatic pt w/ fasting glucose 7.9 on 1 occasion
- Symptomatic pt w/ fasting glucose 6.8 on 2 occasions
- Asymptomatic pt w/ random glucose 22 on 1 occasion
- Symptomatic pt w/ random glucose 12 on 1 occasion
Symptomatic pt w/ random glucose 12
Diabetes diagnosis: fasting > 7.0, random > 11.1 - if asymptomatic need two readings
A 23-year-old man is diagnosed as having type 1 diabetes mellitus after presenting with diabetic ketoacidosis. His blood sugars are now stable and he is well. What is the first-line insulin regime he should be offered?
- Twice daily insulin
- once daily insulin
- basal bolus insulin regimen with twice daily insulin detemir
- basal bolus insulin regimen with once daily insulin glargine
- rapid acting insulin analogue
- basal bolus insulin regimen with twice daily insulin detemir
In newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be a basal–bolus using twice‑daily insulin detemir
A 39-year-old woman who has a history of type 1 diabetes mellitus phones for advice as she is worried about her blood sugar level. What is the target blood sugar level before meals at other times of the day (excluding first thing in the morning)?
5-9 4-7 4-6 6-8 5-7
4-7
In type 1 diabetics, blood glucose targets:
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
An overweight 12-year-old boy presents to clinic for review of treatment for diabetes mellitus. He originally presented with polyuria and polydipsia. It is written in the previous notes that there is no clear consensus as to whether the diagnosis is type 1 or type 2 diabetes mellitus. Maturity onset diabetes of the young (MODY) is considered unlikely as there is no parental history of diabetes. Which of the following investigations is most useful at this stage to help differentiate between these diagnoses?
C-peptide Random glucose GFR FBC Genetic testing
C-peptide
C-peptide will be low in individuals with type 1 diabetes mellitus (as the pancreas is not making enough insulin precursor, which breaks down to form C-peptide and insulin) , and normal or high in individuals with type 2 mellitus.
A 35-year-old man, diagnosed as having type 2 diabetes mellitus 10 years ago, has had poor control despite taking metformin. Several family members also have diabetes mellitus and a recent genotyping revealed a mutation in the HNF -1 alpha.
What is the most appropriate treatment?
Insulin
Gliclazide
Sitagliptin
Pioglitazone
Gliclazide
The patient has been diagnosed with maturity onset diabetes of the young (MODY) - type Hepatic Nuclear Factor 1 Alpha (HNF1A). HNF1A accounts for 70% of MODY cases. Sulfonylureas (e.g. gliclazide) are the optimal treatment in HNF1A-MODY.
A 19-year-old with type 1 diabetes presents to the Emergency Department feeling unwell. She states she has had vomiting and diarrhoea for 2 days and has not been taking her full insulin doses as she has been off her food. Her capillary glucose is 37 mmol/l and there are 4+ ketones on urinalysis.
An arterial blood gas is performed and the results are as follows:
pH 7.12 pO2 13 kPa pCO2 3.5 kPa HCO3 13 Na 129 mmol/l K 6.1 mmol/l
Which of the following is the most appropriate initial management?
IV 0.9% NaCl bolus
IV Abx
Insulin sliding scale
IV NaCl 0.9%
