diabetes real

Question 1

symptoms of diabetes

Answer 1

•	Polyuria 
•	Polydipsia 
•	Blurred vision 
•	Loss of sensation 
•	Poor wound healing 
•	More specific to T1 
o	Ketosis/ketonuria 
o	Polyuria, polydipsia, weight loss, younger age 
o	Rapid onset 
o	Family history of autoimmune disease

Question 2

diagnosis of diabetes

Answer 2

HbA1c
• Glycosylated hemoglobin is formed by the binding of glucose to hemoglobin
• Occurs gradually over the life span of RBC
• Reflects the average BSL over the 3 months

Oralglucose tolerance test
• Test them when they come
• Give them a sugary drink and then test them at 1 hour and 2 hour test

Question 3

chronic complications of diabetes •

Answer 3

Microvascular 
Eye disease 
Retinopathy 
Macular edema
o	Neuropathy 
•	Gastrointestinal
•	 sexual dysfunction 
•	Infectious 
•	Cataracts 
•	Glaucoma 
•	Periodontal disease

Question 4

type 1

Answer 4

• Absolute defiency of insulin caused by pancreatic b cell destruction

Question 5

Type 2

Answer 5

• Caused by a combination of
• Peripheral resistance to insulin action and inadequate secretory response by pancreatic b cells
• Relative insulin defiency

Question 6

short vs long acting insulin

Answer 6

o Better control
o More flexible
o More injection
o More risk of hypos

o Fewer injections
o Less risk of hypos
o Less flexible
o Looser control

Question 7

split mixed regimen

Answer 7

most common
Simple and coinvent 
Lower risk of hypos 
Decreased flexibility
Cannot skip meals

Question 8

basal bolus regimen

Answer 8

o Typically 4 injections a day
o Three daily injection of short acting
o One long acting at night
Flexibility

Better bsl control
Regular bsl monitoring required

Fails to cover snacks

Higher risk of hypos

Question 9

Medication therapy

Answer 9

o 1st line Metformin
o 2nd line agents SGLT2 inhibitor, GLP1 agonists or DPP4
o 3rd line is adding sulphonyurea or thiazolidinedione

Question 10

Metformin

Answer 10

o	Reduce hepatic glucose production 
o	Increases peripheral utilization of glucose 
o	Gi adverse effects common 
o	Nausea, vomiting, anorexia, diarrhea 
o	Start at low dose 
o	Lactic acidosis is rare 
o	Usually comes with weight loss 
o	It is renally cleared so cant use it with people with kidney disease 
o	Slow onset may take up to 2 weeks

Question 11

Incretin hormones

Answer 11

• Associated with weight loss
• DPP-4 inhibitors
• By inhibiting DPP-4 these agents increase concentration of GLP-1 and GIP (the ‘incretin’ hormones)–results in increased glucose-dependent insulin secretion, reduced glucagon
• Oral

Question 12

GLP -1 agonists

Answer 12

o Exenatide
o Injectable agents that mimic GLP-1
o Nausea and vomiting

Question 13

Sodium glucose co-transporter 2 SGLT2 inhibitors

Answer 13

o Dapagliflozin, Empagliflozin, Ertuglizin
o Reduces reabsorption of glucose in the kidney
o Eliminating more glucose
o Takes water and sodium with it thus reducing blood pressure and weight
o Shown to reduce CKD
o When used earlier on
o Good cardiovascular benefits for those with cardiovascular disease

Question 14

Sulfonylureas

Answer 14

o Glipizide
o Gliclazide
o Main effect to increase pancreatic insulin secretion
o Most common

Question 15

Thiazolidinediones

Answer 15

Pioglitazone

o Increase sensitivity of perioheral tissues to insulin, decrease hepatic glucose output

Question 16

Acarbose

Answer 16

o Last line option

o Not taken very well by patients

Question 17

Diabetic ketoacidosis complications and symptoms

Answer 17

Infection
Infarction

o	Nausea 
o	Thrist
o	Ab pain 
o	SOB
o	Physical findings
o	Tachycardia 
o	Dehydration 
o	Tachypnoea 
o	Lethargy

Question 18

management of diabetic ketoacidosis

Answer 18

o	Patient should be managed in endocrine unit 
o	Obs 
	Bp 
	Pulse 
	Urine output 
	Capillary blood glucose 
	Electrolytes especially potassium
o	Correct with fluid loss
o	Correct hyperglycemia and suppress ketones with insulin 
o	Correct electrolyte disturbances
o	Resolution of acid base balance 
o	Treatment of concurrent conditions

Question 19

Type 2 HHS hyperglycemic hyperosmolar state symptoms

Answer 19

o Hyperglycemia and osmotic diuresis occur but lipolysis and ketosis are limited
o Extreme hyperglycemia develops via
o Increased hepatic glucose production
o Decreased peripheral glucose utilization

Generalized weakness leg cramps
Focal neurological symptoms 
Seizures 
Dehydration 
Tachycardia 
Tachypnoea

Question 20

Management Type 2 HHS hyperglycemic hyperosmolar state

Answer 20

improvement of circulatory volume and tissue perfusion; gradual reduction of serum glucose and plasma osmolarity; correction of electrolyte imbalance; and identification and prompt treatment of precipitating causes

Correct potassium and electrolytes

Start prophylactic doses of low molecular heparin, and consider full anticoagulation if serum osmolarity exceeds 350 mmol/l

Give insulin infusion, and stop oral hypoglycaemic medications

Insulin plays a secondary role in the management of HHS, and fluid therapy should always precede insulin administration

Question 21

Those involved in diabetes management

Answer 21

• GP
• Pharmacist
• Specialist
• Diabetes educator
• Podiatrist
• Optometrist
• Dietician

Question 22

Why do oral hypoglycaemics eventually fail on these drugs and require insulin?

Answer 22

• Diabetes being a chronic condition
• Insulin resistance increasing
• Beta cell dysfunction
• Patients will need muitple meds

Question 23

What are the potential side effects of insulin

Answer 23

• Although weight gain and lipohypertrophy are potential problems with insulin, the most frequent/serious adverse effect is hypoglycaemia
• Rotate site of incision
• Give food before regular eating
• Exercise and diet
• Hypoglycaemic episodes (‘hypos’) may occur with excessive insulin dosage, delayed or insufficient food, or increased physical activity
• Warning symptoms include sweating, hunger, faintness, palpitations, tremor, headache, visual disturbance and altered mood, and usually occur <2.2mmol/L (although can occur at higher BSLs)
• If person is conscious, initial hypoglycaemia treatment should be with oral glucose (or sucrose)
• If the patient is unconscious give glucagon 1 mg subcutaneously, intramuscularly or intravenously
• Carers and colleagues of the at risk person with diabetes should be familiar with the identification of hypoglycaemia and treatment including SC glucagon administration